Showing papers in "Foot & Ankle International in 2015"
TL;DR: Osteoarthritis is 1 component of long-term outcome of malleolar fractures, and the results of this study demonstrate that there was more radiographic osteoarth arthritis in patients with medium and large posterior fragments than in those with small fragments.
Abstract: Background:One of the factors contributing to long-term outcome of posterior malleolar fractures is the development of osteoarthritis. Based on biomechanical, cadaveric, and small population studies, fixation of posterior malleolar fracture fragments (PMFFs) is usually performed when fragment size exceeds 25-33%. However, the influence of fragment size on long-term clinical and radiological outcome size remains unclear.Methods:A retrospective cohort study of 131 patients treated for an isolated ankle fracture with involvement of the posterior malleolus was performed. Mean follow-up was 6.9 (range, 2.5-15.9) years. Patients were divided into groups depending on size of the fragment, small ( 25%, n = 25), and presence of step-off after operative treatment. We have compared functional outcome measures (AOFAS, AAOS), pain (VAS), and dorsiflexion restriction compared to the contralateral ankle and the incidence of osteoarthritis on X-ray.Results:There were no non...
153 citations
TL;DR: Patients with HV deformities had a more pronated first metatarsal than the control group, with a greater α angle, and the use of the CT axial view in assessments of Hv deformity may benefit surgeons when they make operative choices to correct these deformities.
Abstract: Background:We aimed to find a new radiographic measurement for evaluating first metatarsal pronation and sesamoid position in hallux valgus (HV) deformity.Methods:Data from a clinical study of 19 control patients (19 feet) with no HV deformity were compared with preoperative data of 138 patients (166 feet) with HV deformities. Using a weightbearing plain radiograph in anteroposterior (AP) view, the intermetatarsal angles (IMAs) and the hallux valgus angles (HVAs) of the control and study groups were measured. Using a semi-weightbearing coronal computed tomography (CT) axial view, the α angle was measured in the control and study groups. In addition, the tibial sesamoid grades in plain radiograph tangential view and the CT axial view were measured. The tibial sesamoid position in an AP view was checked preoperatively. Based on these measurements, 4 types of HV deformities were defined.Results:The mean values of the α angle in the control and HV deformity groups (control group µ = 13.8 degrees, study group ...
142 citations
TL;DR: The present study reports the largest single-center series of acute Achilles tendon ruptures in the literature with lower complication rates for operatively treated Achilles ruptures compared with previous reports.
Abstract: Background:Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures.Methods:Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision with Fib...
142 citations
TL;DR: Both PRP and HA injections improved the clinical outcomes of patients who underwent operation for talar OCLs in the midterm period and can be used as adjunct therapies for these patients.
Abstract: Background:Osteochondral ankle injuries commonly affect the dome of the talus, and these injuries are a common cause of athletic disability. Various treatment options are available for these injuries including intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) injections. The purpose of this study was to compare the effects of HA and PRP as adjunct therapies after arthroscopic microfracture in osteochondral lesions (OCLs) of the talus.Methods:In this prospective, randomized blinded study, 40 patients with talar OCLs in their ankle joints were treated with arthroscopic debridement and a microfracture technique. Thirteen randomly selected patients received PRP, 14 patients received HA, and the remaining 13 patients received saline as a control group. The participants were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog pain scale (VAS) scores after a 15.3-month (range, 11-25 months) follow-up.Results:Postoperatively, all the groups exhibited significan...
98 citations
TL;DR: For most foot and ankle injuries, the new code structure includes location, laterality, degree of healing, and encounter type, which will initially be a complex task.
Abstract: The use of the 10th Revision of the International Classification of Diseases (ICD-10) will likely be required as of October 2015. ICD-10 was developed to increase the specificity and accuracy of disease and injury reporting. The number of diagnostic codes in this system has increased substantially, and approximately half of all ICD-10 codes are related to the musculoskeletal system, whereas 25% of all codes are related to fractures. For most foot and ankle injuries, the new code structure includes location, laterality, degree of healing, and encounter type. At the provider level, navigating this system will initially be a complex task. Understanding the ICD-10 code structure, properly training appropriate staff, and financially preparing for implementation will minimize potential practice disruption.
97 citations
TL;DR: The authors’ results reveal that the arthroscopic Brostrom is a safe and effective procedure with outcomes at least equal to published results for traditional open techniques.
Abstract: Surgical strategy regarding chronic lateral ankle instability is undergoing an evolution from traditional open procedures to minimally invasive and arthroscopic techniques. The development of arthroscopic techniques for the ankle mirrors the processes witnessed for the shoulder and knee over the last 30 years. The arthroscopic Brostrom is a novel technique that allows the surgeon to use an arthroscope to perform a lateral ankle ligament reconstruction that was previously thought possible only through open surgical technique. Indications and contraindications for the arthroscopic technique are essentially the same as those for an open Brostrom type of procedure. The arthroscopic Brostrom procedure is easy to remember and relatively simple to perform for the surgeon who has mastered basic ankle arthroscopy. The authors’ results discussed in this article reveal that the arthroscopic Brostrom is a safe and effective procedure with outcomes at least equal to published results for traditional open techniques.Le...
88 citations
TL;DR: Compared with the HAV, the medial distal tibial angle on the AP view was less sensitive to changes in foot-ankle position, however, increasing the tilt of the x-ray beam from the horizon altered the MDTA on theAP view substantially.
Abstract: Background:Using digitally reconstructed radiographs (DRRs), we determined how changes in the x-ray beam projection angle from the horizon, tibiotalar joint angle, and axial rotation of the foot influenced measurements of the medial distal tibial angle (MDTA) on the anteroposterior (AP) and hindfoot alignment views (HAV).Methods:Seven cadaver foot-ankle specimens were scanned by computed tomography (CT) at fixed tibiotalar joint positions, ranging from 15 degrees of dorsiflexion to 25 degrees of plantarflexion. DRRs were created from each CT scan to simulate alterations in the horizontal projection angle (0 to 25 degrees) and foot axial rotation (–30 to 30 degrees). The MDTA was measured on each DRR and compared with that quantified on the baseline HAV and AP view.Results:Altering the horizontal projection angle by ≥5 degrees and >10 degrees significantly altered the MDTA for the AP view and the HAV, respectively. Shifting dorsiflexion and plantarflexion caused minor changes in the MDTA that were only sta...
88 citations
TL;DR: Inftal-hor and inFTal-suptal angles provided a reliable means of evaluating the orientation of the subtalar joint axis in AAFD via MP-WB, and showed that the subt alar joint had increased valgus orientation in A AFD compared to controls.
Abstract: Background:Patients with adult-acquired flatfoot deformity (AAFD) develop peritalar subluxation, which may stem from valgus inclination of the inferior surface of the talus. We hypothesized that patients with AAFD would have an increased valgus tilt of the subtalar joint in the coronal plane compared to controls when assessed with a novel multiplanar weight-bearing imaging (MP-WB).Methods:Eighteen normal and 36 stage II AAFD patients scheduled to undergo operative reconstruction were evaluated by MP-WB through measuring 3 novel angles of the subtalar joint in the coronal view: (1) angle between inferior facet of the talus and the horizontal/floor (inftal-hor), (2) angle between inferior and superior facets of the talus (inftal-suptal), and (3) angle between inferior facet of the talus and superior facet of the calcaneus (inftal-supcal). Intra- and interobserver reliability were evaluated via intraclass correlation coefficients (ICCs). Differences in angles between AAFD patients and controls were evaluated...
83 citations
TL;DR: Given the morbidity of infected ankle arthroplasty, careful consideration should be made about performing arthroPlasty in patients with multiple prior surgeries and comorbidities that predispose to wound-healing difficulties.
Abstract: Background:Infections in total ankle arthroplasty are a serious complication, about which there is little information in the current literature.Methods:This is a retrospective review of infected total ankle arthroplasty at one institution from 1995 to 2012. Risk factors were compared between patients with infected total ankle arthroplasty and age- and sex-matched patients who did not have infection (control patients) within the same time period.Results:966 patients with total ankle arthroplasty were reviewed, and 29 cases of infected total ankle arthroplasty (3.2%) were identified. The incidence of infection in primary ankle arthroplasty was 2.4% and in revision arthroplasty was 4%. Risk factors for infection in our cohort included diabetes, prior ankle surgery, and wound healing problems more than 14 days postoperatively. No significant difference was found between groups with respect to risk factors including smoking, body mass index, and operative time. At latest follow-up, none of the patients had sig...
81 citations
TL;DR: Considerable changes in ankle joint kinematics and contact mechanics may explain why moderate syndesmosis injuries take longer to heal and are more likely to develop long-term dysfunction and, potentially, ankle arthritis.
Abstract: Background:Ligamentous injuries to the distal tibiofibular syndesmosis are predictive of long-term ankle dysfunction. Mild and moderate syndesmotic injuries are difficult to stratify, and the impact of syndesmosis injury on the magnitude and distribution of forces within the ankle joint during athletic activities is unknown.Methods:Eight below-knee cadaveric specimens were tested in the intact state and after sequential sectioning of the following ligaments: anterior-inferior tibiofibular, anterior deltoid (1 cm), interosseous/transverse (IOL/TL), posterior-inferior tibiofibular, and whole deltoid. In each condition, specimens were loaded in axial compression to 700 N and then externally rotated to 20 N·m torque.Results:During axial loading and external rotation, both the fibula and the talus rotated significantly after each ligament sectioning as compared to the intact condition. After IOL/TL release, a significant increase in posterior translation of the fibula was observed, although no syndesmotic wide...
79 citations
TL;DR: Open ankle fusion failed in 9% of uncomplicated ankles with arthritis, and patients who had an open ankle fusion done after previous subtalar joint fusion, as well as those who had preoperative varus ankle alignment, had a significantly higher rate of nonunion.
Abstract: Background:The objective of this study was to identify factors influencing operative outcomes in straightforward, uncomplicated open ankle fusions.Methods:We reviewed all primary open ankle fusions conducted at 1 institution over an 11-year period to identify straightforward, uncomplicated open ankle fusions. Inclusion required a minimum of 6 months follow-up. Patients were excluded for neuropathic arthropathy, insensate limb, failed total ankle replacement, simultaneous arthrodesis of the subtalar joint, or fusions performed within 1 year of injury to salvage failed fixation and painful function due to (1) open fractures, (2) segmental bone loss greater than 1 cm, (3) infection, or (4) talar body fractures. The primary outcome variable was radiographic union at 6 months. Other operative complications were analyzed as secondary outcomes. Five hundred twenty-eight ankle fusion surgeries were performed on 440 patients at 1 institution during the study period. Two hundred fifteen surgeries met inclusion/excl...
TL;DR: Outcomes of TAA in younger patients were similar to outcomes in older patients at early follow-up, and the incidence of wound complications, need for reoperation, and revision were not different between groups.
Abstract: Background:Little is known about the efficacy and durability of total ankle arthroplasty (TAA) in younger patients. The purpose of this study was to determine the effect of age on the clinical, radiographic, and patient-reported outcomes of patients with end-stage ankle arthritis treated with TAA using modern prostheses.Methods:Patients who underwent primary TAA from June 2007 to July 2011 were prospectively enrolled in the study. Three hundred and ninety-five consecutive patients were reviewed with a mean follow-up of 3.5 years (range, 2-5.4 years). Patients were divided into 3 groups based on age at the time of surgery ( 70 years). Patient-reported outcome scores, physical performance scores, and weight-bearing radiographs were used to assess patients preoperatively and at yearly postoperative office visits. Revision was defined as failure of either the tibial or talar components requiring removal of the metallic implants. A repeated-measures analysis of variance with post hoc testing an...
TL;DR: Cryopreserved hAM injection may be safe and comparable to corticosteroid injection for treatment of plantar fasciitis in regard to patient outcomes, and this is a pilot study and requires further investigation.
Abstract: Background:Treatment options for plantar fasciitis have resulted in varied patient outcomes. The aim of this study was to compare a novel treatment, cryopreserved human amniotic membrane (c-hAM), t...
TL;DR: In the current cohort of STAR ankle patients, implant survival, patient satisfaction, pain relief, and function were high, however, the rate of additional procedures was also high, which highlights the need for patient follow-up and additional long-term outcome studies on total ankle arthroplasty.
Abstract: Background:The published long-term follow-up of modern total ankle arthroplasty is limited. We report results after a minimum of 10-year follow-up in a cohort of patients who underwent the Scandinavian Total Ankle Replacement (STAR™) in the United States.Methods:Between 1998 and 2003, 18 patients underwent total ankle arthroplasty for end-stage ankle degeneration and were available for follow-up at a minimum of 10 years postoperatively out of a consecutive series of 41 patients. All surgeries were performed by a single surgeon at a single institution. Clinical, radiographic, and functional examinations were performed. Revision was defined as failure of either the tibial or the talar metallic component. The mean length of follow-up was 12.6 years (range, 10.2 to 14.6).Results:Overall implant survival was 94.4% (17/18). A total of 39% (7/18) required additional surgical procedures, most of which were performed greater than 9 years postoperatively, and 1 required a revision of the prosthesis. Preoperative VA...
TL;DR: Direct comparison of instruments revealed similarity between scales in construct validity and reliability, and postoperative patients’ preferences supported the use of these scales.
Abstract: Background:Patient-reported outcome measures are increasingly used evaluating clinical care. Many measures used to assess operative hindfoot interventions vary in content, and some have not been psychometrically validated in this population. The purpose of this study was to compare measurement properties of 6 lower-extremity patient-reported outcome measures, and to evaluate their reliability and validity in light of patients’ preferences.Methods:Cross-sectional survey of 42 preoperative and 100 postoperative patients completed 6 lower-extremity outcome measures on 2 occasions: Foot Function Index (FFI), Ankle Osteoarthritis Scale (AOS), patient-reported items of the American Orthopaedic Foot & Ankle Society Questionnaire (AOFAS), Lower Extremity Functional Scale (LEFS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Musculoskeletal Function Assessment (SMFA), as well as measures of preference, and symptoms.Results:Internal consistency was good to excellent for all s...
TL;DR: The data indicate that after intra-articular ankle fracture the SF exhibits a largely pro-inflammatory and extra-cellular matrix degrading environment similar to that described in idiopathic osteoarthritis.
Abstract: Background:Posttraumatic osteoarthritis (PTOA) can occur after intra-articular fracture despite anatomic fracture reduction. It has been hypothesized that an early inflammatory response after intra-articular injury could lead to irreversible cartilage damage that progresses to PTOA. Therefore, in addition to meticulous fracture reduction, it would be ideal to prevent this initial inflammatory response but little is known about the composition of the synovial environment after intra-articular fracture. The purpose of this work was to characterize the inflammatory cytokine and matrix metalloproteinase (MMP) composition in the synovial fluid (SF) of patients with acute intra-articular ankle fractures.Methods:Twenty-one patients with an intra-articular ankle fracture were included in this study. All patients had a contralateral ankle joint that was pain free, had no radiographic evidence of arthritis, and no history of trauma. The uninjured ankle served as a matched control. SF was obtained from bilateral ank...
TL;DR: Although FHL transfer was a safe adjunct to tendon debridement and partial ostectomy for insertional Achilles tendinopathy in older patients with little compromise in function, it may not be necessary for primary cases.
Abstract: Background:Chronic insertional Achilles tendinopathy is a common pathology that can be difficult to manage. Some experts have advocated augmentation with the flexor hallucis longus (FHL) tendon in ...
TL;DR: Minimally invasive suture tape augmentation seems to be an effective alternative for young women with chronic ankle instability and the longevity of mechanical ankle stability and the proper indication for using the internal brace technique should be addressed in future studies.
Abstract: Background:Although the modified Brostrom procedure has had excellent clinical results, postoperative complications such as skin irritation by suture material and problematic scar formation occur. This prospective study was performed to evaluate the clinical outcomes of mini-open ligament augmentation (internal brace technique) using suture tape for chronic ankle instability in a select cohort of patients.Methods:Thirty-four young female patients with less than 70 kg of body weight were followed for more than 2 years after suture tape augmentation for lateral ankle instability. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) score, Sefton grading system, and the period to return to various activities. Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate the longevity of mechanical ankle stability.Results:FAOS and FAAM scores had significantly improved to 92.5 points at final follo...
TL;DR: Osteochondral lesions in an unstable ankle had an increased proportion of larger lesions and additional chondral lesions at the tip of the medial malleolus and the tibia plafond and inferior performance in sport and recreational activities may be more likely in patients with both OLT and CLAI.
Abstract: Background:Previous reports suggest that prolonged instability of the ankle may contribute to development of osteochondral lesions and eventually lead to osteoarthritis. However, no studies have directly compared osteochondral lesions in ankles with chronic lateral ankle instability (CLAI) to those without instability. This study was performed to determine characteristics and resulting clinical outcomes associated with osteochondral lesions of the talus (OLT) in patients with and without instability.Methods:Of 420 patients who underwent primary arthroscopic marrow stimulation for OLT, 74 patients were identified as having concomitant CLAI. After considering age, sex, body mass index, and initial trauma history for the propensity score (1:2 ratio), a total of 148 patients without CLAI were matched from the remainder of the cohort. Demographics and lesion characteristics were compared using preoperative magnetic resonance imaging (MRI) and arthroscopy. Clinical outcomes were compared using a visual analog s...
TL;DR: Patients who underwent TAR with a first- or second-generation fixed-bearing prosthesis with an intramedullary tibial component demonstrated significant improvements in all measures of pain and function with sustained improvements in coronal plane alignment.
Abstract: Background:This series reviews the clinical and radiographic outcomes of patients who underwent total ankle replacement (TAR) using first- and second-generations of a modern fixed-bearing prosthesis utilizing a modular intramedullary stem.Methods:A consecutive series of first- and second-generation primary TARs with modular intramedullary stems were identified. Clinical outcome data were collected prospectively—including visual analog scale for pain, American Orthopaedic Foot & Ankle Society hindfoot-ankle, Short Musculoskeletal Function Assessment, and Short Form–36 scores. Preoperative coronal plane deformity and correction of deformity after TAR were assessed. Complications, subsequent procedures, and failure rates were compared. A total of 193 first- and 56 second-generation patients were identified with a mean follow-up of 3.7 and 2.1 years, respectively.Results:Clinical outcome data reflected significant improvements at 1 year postoperatively, and improvements were maintained at 2-year follow-up for...
TL;DR: It is hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time when treated nonoperatively.
Abstract: Background:We hypothesized that patients undergoing nonoperative treatment for asymptomatic or minimally symptomatic osteochondral lesions of the talus (OLTs) would not deteriorate clinically or radiologically over time.Methods:Forty-eight patients (mean age = 48 years; range, 13-78 years) with an OLT confirmed by magnetic resonance imaging (MRI) who had not undergone ankle joint surgery were retrospectively reviewed. All patients were evaluated after a minimum follow-up of 2 years (mean = 52 months; range, 27-124 months). All patients filled out an individual questionnaire and underwent a physical and radiographic assessment (radiograph and hindfoot MRI).Results:At final follow-up, 43 ankles (86%) in 41 patients were pain-free (visual analogue scale [VAS] 0, n = 12) or less painful (VAS 1-3, n = 31). Radiographically, osteoarthritis was absent in 47%, and grade 1 and 2 osteoarthritis each were found in 27% (van Dijk classification). Magnetic resonance imaging revealed no substantial progression in stagin...
TL;DR: Until long-term comparative studies are performed, the optimal treatment for end-stage ankle arthritis remains controversial, but this study provides greater clarity with regard to hospitalization outcomes after the 2 procedures and shows no significant difference in risk for the majority of medical perioperative complications.
Abstract: Background:The aim of this study was to analyze a validated, nationally representative admissions database in order to compare perioperative complications and hospitalization outcomes associated wi...
TL;DR: Patients undergoing TAR had higher expectation scores prior to surgery than those undergoing ankle fusion, and satisfaction scores were strongly associated with AOS scores at follow-up, indicating that expectation is independent of pain and function.
Abstract: Background:Current operative outcome scales are based on pain and function, such as the Ankle Osteoarthritis Scale (AOS). Outcomes based on patient expectation and satisfaction may be more useful. ...
TL;DR: It is found that there is often complete avulsion of the superficial deltoid complex off the proximal aspect of the medial malleolus during high-energy ankle fractures in athletes.
Abstract: Background Infolding and retraction of an avulsed deltoid complex after ankle fracture can be a source of persistent increased medial clear space, malreduction, and postoperative pain and medial instability. The purpose of this descriptive case series was to analyze the preliminary outcomes of acute superficial deltoid complex avulsion repair during ankle fracture fixation in a cohort of National Football League (NFL) players. We found that there is often complete avulsion of the superficial deltoid complex off the proximal aspect of the medial malleolus during high-energy ankle fractures in athletes. Methods Between 2004 and 2014, the cases of 14 NFL players who underwent ankle fracture fixation with open deltoid complex repair were reviewed. Patients with chronic deltoid ligament injuries or ankle fractures more than 2 months old were excluded. Average age for all patients was 25 years and body mass index 34.4. Player positions included 1 wide receiver, 1 tight end, 1 safety, 1 running back, 1 linebacker, and 9 offensive linemen. Average time from injury to surgery was 7.5 days. Surgical treatment for all patients consisted of ankle arthroscopy and debridement, followed by fibula fixation with plate and screws, syndesmotic fixation with suture-button devices, and open deltoid complex repair with suture anchors. Patient demographics were recorded with position played, time from injury to surgery, games played before and after surgery, ability to return to play, and postoperative complications. Return to play was defined as the ability to successfully participate in at least 1 full regular-season NFL game after surgery. Results All NFL players were able to return to running and cutting maneuvers by 6 months after surgery. There were no significant differences in playing experience before surgery versus after surgery. Average playing experience before surgery was 3.3 seasons, 39 games played, and 22 games started. Average playing experience after surgery was 1.6 seasons, 16 games played, and 15 games started. Return to play was 86% for all players. There were no intraoperative or postoperative complications noted, and no players had clinical evidence of medial pain or instability at final follow-up with radiographic maintenance of anatomic mortise alignment. Conclusion Superficial deltoid complex avulsion during high-energy ankle fractures in athletes is a distinct injury pattern that should be recognized and may benefit from primary open repair. The majority of NFL players treated surgically for this injury pattern are able to return to play after surgery with no reported complications or persistent medial ankle pain or instability. Level of evidence Level IV, retrospective case series.
TL;DR: It is believed that the lateral incongruency angle can serve as a valuable preoperative measurement to help surgeons titrate the proper amount of correction performed intraoperatively.
Abstract: Background:Correction of forefoot abduction in stage IIb adult acquired flatfoot likely depends on the amount of lateral column lengthening (LCL) performed, although this represents only one aspect...
TL;DR: A high incidence of anterior/anterolateral synovitis in patients with chronic lateral ankle instability is found and there was a relatively low incidence of posterior bony impingement lesions or OCLs in the retrospective case series.
Abstract: Background:Anterolateral impingement associated with intra-articular synovitis, scarring, and fibrosis is a less recognized feature in patients with chronic lateral ankle instability. The aim of ou...
TL;DR: Early clinical evidence is provided that preoperative CT scan–derived patient-specific surgical plans and guides can help provide accurate and reproducible TAA radiographic alignments.
Abstract: Background:Preoperative computer navigation and patient-specific instrumentation have had promising results in total knee arthroplasty and in a previous cadaveric total ankle arthroplasty (TAA) study. Potential benefits of patient-specific guides include improved implant alignment and decreased surgical time. The purpose of this retrospective case series was to evaluate the accuracy, reproducibility, and limitations of TAA tibia and talar implant placement and radiographic alignment using preoperative computed tomography (CT) scan–derived instrumentation in a clinical setting.Methods:Between 2012 and 2014, 42 consecutive TAA cases in 42 patients using preoperative CT scan–derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis TN) were reviewed from a single center of foot and ankle fellowship–trained orthopaedic surgeons. TAA implants used included 29 intramedullary referencing implants (INBONE II, Wright Medical Technology) and 13 low-profile tibia and talar resurfacing i...
TL;DR: K-wire fixation for the treatment of hammertoe deformities led to good maintenance of correction with a relatively low complication rate, and it is believed that it remains an effective, low-cost method of fixation for hammertoe correction.
Abstract: Background:Kirschner wire (K-wire) fixation for correction of hammertoe deformity is a common, low-cost method for fixation of hammertoes after proximal interphalangeal (PIP) arthroplasty or fusion. Complications of this procedure include pin-tract infection, pin migration, pin bending or breakage, and recurrence of deformity. The investigators reviewed a large experience using K-wire stabilization for hammertoe correction.Methods:All hammertoe corrections performed by a single surgeon from 1999 to 2013 were retrospectively reviewed. A resection arthroplasty of the PIP joint or PIP fusion was performed and fixed with a K-wire. Follow-up duration, preoperative diagnosis, pin duration, concomitant procedures, recurrence rates, and complications were reviewed and analyzed. A total of 1,115 operations were performed on 876 patients, with correction of 2,698 hammertoes. There were 709 female and 167 male patients, with an average age of 57.5 years (range, 14-88 years), followed for an average of 20.8 months (r...
TL;DR: Despite a relatively low overall reported complication rate with treatment of these injuries, they are associated with substantially increased 1-year mortality in both patient groups, and the nonoperative cohort demonstrated a 2-fold elevated mortality rate.
Abstract: Background:The incidence of ankle fractures is increasing in the geriatric population, and several studies suggest them to be the third most common extremity fracture in this age group Previous work has reflected relatively low complication rates during operative treatment Little is known, however, about the association between these injuries and overall mortality, nor whether operative intervention has any effect on mortality We hypothesized that geriatric ankle fractures would be correlated with an elevated mortality rate and that operative intervention would be associated with a reduced mortality when compared to nonoperative managementMethods:Following Institutional Review Board approval we retrospectively assessed all relevant 2008 part A inpatient claims from the Medicare database We queried diagnosis codes for ankle fractures, and then excluded any patients whose age was less then 65 or had an admission related to an ankle fracture during the previous year Operative patients were then identif
TL;DR: It is concluded that a proximal supination osteotomy of the first metatarsal was an effective procedure for correction of hallux valgus and can achieve a low rate ofHallux Valgus recurrence.
Abstract: BACKGROUND Risk factors for hallux valgus recurrence include postoperative round-shaped lateral edge of the first metatarsal head and postoperative incomplete reduction of the sesamoids. To prevent the occurrence of such conditions, we developed a proximal supination osteotomy of the first metatarsal. Our aim was to describe this novel technique and report the outcomes in this report. METHODS Sixty-six patients (83 feet) underwent a distal soft tissue procedure combined with a proximal supination osteotomy. After the proximal crescentic osteotomy, the proximal fragment was pushed medially, and the distal fragment was abducted, and then the distal fragment of the first metatarsal was manually supinated. Outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and radiographic examinations. The average follow-up duration was 34 (range, 25 to 52) months. RESULTS The mean AOFAS score improved significantly from 58.0 points preoperatively to 93.8 points postoperatively (P < .0001). The mean hallux valgus and intermetatarsal angle decreased significantly from 38.6 and 18.0 degrees preoperatively to 11.0 and 7.9 degrees postoperatively, respectively (both, P < .0001). Sixty-nine feet (69/83, 83%) had a positive round sign preoperatively, and 66 feet (66/83, 80%) had a negative round sign postoperatively. According to the Hardy's classification of position of the sesamoids, all feet were classified as grade V or greater preoperatively, and 49 feet (49/83, 59%) were classified as grade IV or less postoperatively. Three feet (3/83, 4%) had recurrence of hallux valgus, defined as a hallux valgus angle ≥ 25 degrees. CONCLUSION The rates of occurrence of a positive round sign and incomplete reduction of the sesamoids significantly decreased postoperatively, which may have contributed to the low hallux valgus recurrence rates. We conclude that a proximal supination osteotomy was an effective procedure for correction of hallux valgus and can achieve a low rate of hallux valgus recurrence. LEVEL OF EVIDENCE Level IV, retrospective case series.