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Foot and ankle orthopaedics

Wahid Abdul, Ben Hickey, Anthony Perera
BACKGROUND: Conservative treatment or debridement is generally sufficient for Freiberg disease grades I and II but operative intervention for the late stages of the disease process (III-V) is more challenging. Debridement alone is not sufficient and various forms of arthroplasty have been put forward. We have evaluated the outcomes of patients treated with an interpositional arthroplasty technique using a pedicle graft of periosteum and fat made into a "Rollmop" spacer for severe Freiberg disease...
August 17, 2018: Foot & Ankle International
Muhammad Ali Fazal, Jason Hol-Ming Wong, Luthfur Rahman
OBJECTIVE: First MTP joint fusion is a reliable procedure for advanced arthritis for the first MTP joint. There are many techniques described. The purpose of our study is to report clinical, radiological, functional outcomes and complications of first metatarsophalangeal joint fusion with hand preparation of the joint and fixation with two orthogonal locking plates without a compression screw. METHODS: 32 feet in 26 consecutive patients under went first metatarsophalangeal joint fusion with above technique...
August 11, 2018: Acta Orthopaedica et Traumatologica Turcica
Antonia F Chen, Andrew Fleischman, Matthew S Austin
Intrawound antibiotics have been used in orthopaedic surgery procedures to prevent the development of surgical site infections. Local delivery of antibiotic powder has demonstrated a notable reduction in surgical site infection in rabbit and rodent in vivo models, as well as in other surgical fields, including vascular, colorectal, cardiothoracic, and dermatologic surgery. Intrawound antibiotic powder has been used in many orthopaedic applications, including spine surgery, total joint arthroplasty, trauma, foot and ankle reconstruction, and elbow surgery...
August 8, 2018: Journal of the American Academy of Orthopaedic Surgeons
Chen Wang, Xiang Geng, Xu Wang, Xin Ma, Chao Zhang, Jiazhang Huang
Synovial cysts are benign tissue masses that develop near joints and tendons as a result of fluid leakage. They can be difficult to eradicate, and adjacent tendon and joint surfaces can complicate their treatment. We retrospectively analyzed the data from 4 consecutive patients who had undergone hallux interphalangeal fusion from January 2009 to December 2010. Of the 4 patients, 3 were male and 1 was female, with a mean age of 55 ± 22 (range 26 to 79) years. These 4 patients had developed painful interphalangeal arthritis with radiographic cystic changes of 1 to 4 years' duration...
August 6, 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Cory Messerschmidt, Anuj Netto, William R Barfield, Christopher Gross, William McKibbin
The effects of gastrocnemius recession on strength and function are underreported. This prospective study reports strength and functional effects after isolated gastrocnemius recession. Patients (n D 20) underwent an isolated gastrocnemius recession for foot and ankle conditions with associated gastrocnemius or gastrocnemius-soleus contracture. Eight patients prospectively underwent range of motion (ROM) and Biodex testing preoperatively and at 3 and 6 months postoperatively. Foot Function Index (FFI) assessed functional outcomes...
2018: Journal of Surgical Orthopaedic Advances
Piotr Morasiewicz, Maciej Dejnek, Mirosław Kulej, Szymon Ł Dragan, Grzegorz Konieczny, Artur Krawczyk, Wiktor Urbański, Wiktor Orzechowski, Szymon F Dragan, Łukasz Pawik
BACKGROUND: Severe osteoarthritis (OA) of the ankle joint constitutes an important social problem. OBJECTIVES: We used (1) the GRIMBY scale, (2) the LOWER LIMB Activity scale, (3) the UCLA (University of California Los Angeles) activity scale, (4) the VAS (visual analogue scale) ACTIVITY scale, and (5) the FAAM (foot and ankle ability measure) SPORT scale to verify whether the type of ankle joint arthrodesis stabilization affected sports and physical activity levels...
August 6, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Jianping Hu, Chunlin Zhang, Kunpeng Zhu, Lei Zhang, Weiping Wu, Tao Cai, Xiaolong Ma
BACKGROUND: We initiated a retrospective study on ankle fractures to assess (1) the time needed for fracture union; (2) the incidence of adverse radiographic outcomes (AROs); (3) factors that might lead to AROs; and (4) whether AROs were associated with worse function and higher incidence of post-trauma osteoarthritis (PTOA). METHODS: From 2007 to 2016, a total of 296 patients (169 women, 127 men; average age, 48.6 years; range, 20-84) were diagnosed with a medial malleolar fracture, whether isolated or in the setting of bi- or trimalleolar fractures, and underwent open reduction and internal fixation (ORIF) or percutaneous screw fixation (PSF)...
July 25, 2018: Foot & Ankle International
Qining Yang, Yongwei Zhou, Youjia Xu
BACKGROUND: The aim of this study was to determine the functional and radiological outcomes of arthroscopic treatment of anterior ankle impingement (AAI) in patients with chronic lateral ankle instability (CAI). METHODS: All patients with CAI between June 2012 and May 2015 were invited to participate in this investigation. All of them accepted open modified Broström repair of lateral ankle ligaments and were divided into two groups: AAI group (with anterior ankle impingement) and pure CAI group (without anterior ankle impingement)...
July 19, 2018: BMC Musculoskeletal Disorders
Danica D Vance, Hasani W Swindell, Justin K Greisberg, James T Vosseller
Ankle fractures are common orthopaedic injuries often requiring open reduction and internal fixation. A variety of positions for plate placement exist for surgical fixation of distal fibula fractures, including direct lateral, posterior, or posterolateral. Direct lateral is more common, despite evidence that posterior and posterolateral placement is mechanically superior. However, concern for peroneal tendon injury from posterior plating remains. Our study investigates clinical and functional outcomes of patients who underwent operative fixation of distal fibula fractures with posterior or posterolateral plating over a 3-year period...
July 1, 2018: Foot & Ankle Specialist
Henryk Liszka, Artur Gądek
BACKGROUND: The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). METHODS: We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients)...
July 1, 2018: Foot & Ankle International
Christopher M McAndrew, William M Ricci, Anna N Miller, Matthew C Avery
A 2-stage approach to treatment of tibia pilon fractures was reported in the 1990s and popularized over the ensuing decade to help avoid catastrophic soft-tissue complications experienced with one-stage open reduction and internal fixation. This approach can be expanded to the treatment of other high-energy injuries of the hind foot, with variation in external fixator application as needed. Key factors to maximize the utility and decrease complications of the external fixation stage include the following: (1) anatomic reduction of the talus under the long axis of the tibia in the coronal and sagittal planes, (2) strategic application of Schantz pins to resist deforming forces resulting from the injury, and (3) external fixation outside the zone of injury and definitive surgical treatment...
August 2018: Journal of Orthopaedic Trauma
Constantine A Demetracopoulos, Elizabeth A Cody, Samuel B Adams, James K DeOrio, James A Nunley, Mark E Easley
INTRODUCTION: Failure to correct coronal deformity at the time of total ankle arthroplasty (TAA) can lead to early implant failure. We aimed to determine clinical, radiographic, and patient-reported outcomes of patients with moderate to severe valgus deformity who underwent TAA for end-stage ankle arthritis. METHODS: Patients with a valgus deformity of at least 10° who underwent TAA were retrospectively reviewed. The coronal tibiotalar angle was assessed on radiographs preoperatively, at 1 year, and at final follow-up...
July 1, 2018: Foot & Ankle Specialist
Kathleen D Rickert, Pooya Hosseinzadeh, Eric W Edmonds
BACKGROUND: Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity. METHODS: An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures...
July 2, 2018: Journal of Pediatric Orthopedics
James R Lachman, Jania A Ramos, James K DeOrio, Mark E Easley, James A Nunley, Samuel B Adams
BACKGROUND: Acute hematogenous periprosthetic joint infection (PJI) is defined in the literature as infection diagnosed and treated within 2 to 4 weeks from the onset of symptoms. In total hip and knee arthroplasty, irrigation and debridement (I&D) and polyethylene exchange with component retention has been studied extensively. However, there is minimal literature evaluating this treatment method for PJI in total ankle arthroplasty (TAA). The purpose of this study was to evaluate both the clinical and patient-reported outcomes and survivorship of TAA acute hematogenous PJIs treated with I&D and polyethylene exchange...
July 1, 2018: Foot & Ankle International
Kevin Mertz, Sara Eppler, Jeffrey Yao, Derek F Amanatullah, Loretta Chou, Kirkham B Wood, Marc Safran, Robert Steffner, Michael Gardner, Robin Kamal
BACKGROUND: Shared decision-making between patients and physicians involves educating the patient, providing options, eliciting patient preferences, and reaching agreement on a decision. There are different ways to measure shared decision-making, including patient involvement, but there is no consensus on the best approach. In other fields, there have been varying relationships between patient-perceived involvement and observed patient involvement in shared decision-making. The relationship between observed and patient-perceived patient involvement in decision-making has not been studied in orthopaedic surgery...
September 2018: Clinical Orthopaedics and related Research
Christopher P Chiodo, Catherine Logan, Cheri A Blauwet
Orthopaedic surgeons frequently use aspirations and injections to both diagnose and treat disorders of the lower extremity. Comprehensive knowledge of regional anatomy, procedural indications, and appropriate techniques are essential. Clinicians must be well versed in a range of musculoskeletal aspiration and injection techniques, including patient positioning, equipment needs, injectable solutions, aspirate analysis, and potential complications. Safe and effective aspiration and injection techniques for the lower extremity, including the hip, knee, foot, and ankle, are reviewed...
August 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
L R Perotti, O Abousamra, M Del Pilar Duque Orozco, K J Rogers, J P Sees, F Miller
Purpose: Foot and ankle deformities are common orthopaedic disorders in children with Down syndrome. However, radiographic measurements of the foot and ankle have not been previously reported. The aim of this study is to describe the foot and ankle deformity in children with Down syndrome. Methods: Children who had foot and ankle radiographs in the standing weight-bearing position were selected. Three groups of patients were identified. The relationship of radiographic measurements with age, body mass index and pain is discussed...
June 1, 2018: Journal of Children's Orthopaedics
Zaher Jandali, Martin C Lam, Benedikt Merwart, Bernd Möhring, Stephanie Geil, Klaus Müller, Mihai Ionac, Lucian P Jiga
BACKGROUND:  The composite anterolateral thigh flap with vascularized fascia lata (ALT-FL flap) for covering complex soft tissue defects involving the Achilles tendon has shown promising results. The age and body mass index (BMI) are important predictors of clinical outcome after surgical treatment of Achilles tendon ruptures. In this study, we investigate whether these also influence the outcome of patients after Achilles tendon reconstruction using the ALT-FL flap. METHODS:  Twenty patients (mean age: 55...
June 26, 2018: Journal of Reconstructive Microsurgery
M G Walcher, L Fraissler, C Konrads, P Plumhoff, M Hoberg, M Rudert
OBJECTIVE: Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. INDICATIONS: Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. CONTRAINDICATIONS: Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade 3-4 in the Outerbridge classification in the complete joint...
June 22, 2018: Operative Orthopädie und Traumatologie
Martinus Richter, Per-Henrik Agren, Jean-Luc Besse, Maria Cöster, Hakon Kofoed, Nicola Maffulli, Dieter Rosenbaum, Martijn Steultjens, Fernando Alvarez, Andrzej Boszczyk, Kris Buedts, Marco Guelfi, Henryk Liszka, Jan-Willem Louwerens, Jussi P Repo, Elena Samaila, Michael Stephens, Angelique G H Witteveen
BACKGROUND: A scientifically sound validated foot and ankle specific score validated ab initio for different languages is missing. The aim of a project of the European Foot and Ankle Society (EFAS) was to develop, validate, and publish a new score(the EFAS-Score) for different European languages. METHODS: The EFAS Score was developed and validated in three stages: (1) item (question) identification, (2) item reduction and scale exploration, (3) confirmatory analyses and responsiveness...
June 2018: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
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