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Journal Cover   Foot & Ankle International
  [SJR: 1.202]   [H-I: 68]   [10 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1071-1007
   Published by Sage Publications Homepage  [814 journals]
  • Risk Factors for Wound Complications in Patients After Elective Orthopedic
           Foot and Ankle Surgery
    • Authors: Wiewiorski, M; Barg, A, Hoerterer, H, Voellmy, T, Henninger, H. B, Valderrabano, V.
      Pages: 479 - 487
      Abstract: Background: The aim of this study was to quantify the incidence of postoperative wound complications in elective foot and ankle surgery as well as the risk factors for postoperative wound complications. Methods: Two hundred ninety-five elective orthopaedic foot and ankle operative procedures were performed in 290 patients between January 2006 and June 2010. A logistic multiple regression model was used to identify independent risk factors for postoperative wound healing complications/infection. Results: The overall prevalence of postoperative wound complications within our cohort was 16.9%. In 4 patients (1.4%) deep infection was diagnosed requiring operative irrigation and debridement. Using a logistic multiple regression model we identified the following statistically independent risk factors: age ≥ 60 years (OR = 8.98, 95% CI = 3.55 to 25.02), tobacco use (OR = 48.77, 95% CI = 15.55 to 139.71), and tourniquet time ≥ 90 minutes (OR = 7.02, 95% CI = 2.77 to 19.32). Conclusion: Patients at risk for postoperative wound healing complications following elective orthopaedic foot and ankle surgery include those with higher age, tobacco use, and prolonged use of tourniquet. Level of Evidence: Prognostic Level III, comparative study.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565792
      Issue No: Vol. 36, No. 5 (2015)
       
  • Cigarette Smoking Increases Complication Rate in Forefoot Surgery
    • Authors: Bettin, C. C; Gower, K, McCormick, K, Wan, J. Y, Ishikawa, S. N, Richardson, D. R, Murphy, G. A.
      Pages: 488 - 493
      Abstract: Background: Cigarette smoking is known to increase perioperative complication rates, but no study to date has examined its effect specifically in forefoot surgery. The purpose of this study was to determine whether cigarette smoking increased complications after forefoot surgery. Methods: The records of 602 patients who had forefoot surgery between 2008 and 2010, and for whom smoking status was known, were reviewed. Patients were categorized into 3 groups based on smoking status: active smoker, smoker in the past, or nonsmoker. Medical records were reviewed for occurrence of complications, including nonunion, delayed union, delayed wound healing, infection, and persistent pain. Results: Active smokers were found to have a notably higher complication rate (36.4%) after forefoot surgery than patients who previously (16.5%) or never (8.5%) smoked. Patients who continued to smoke in the perioperative period had the highest percentage of delayed union (3.0%), infection (9.1%), delayed wound healing (10.6%), and persistent pain (15.2%). Active cigarette smokers were 4.3 times more likely to have a complication than nonsmokers. Patients who smoked at any point in the past but quit prior to surgery were 1.9 times more likely than nonsmokers to incur a complication. The average time of smoking cessation for patients who had smoked at any point in the past but had quit prior to surgery was 17 years. For active smokers, those with a complication smoked an average of 18 cigarettes daily, while those without a complication smoked 14 cigarettes daily. Conclusions: Before forefoot surgery, surgeons should educate patients who smoke about their increased risk of complications and encourage smoking cessation. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565785
      Issue No: Vol. 36, No. 5 (2015)
       
  • Hammertoe Correction With K-Wire Fixation
    • Authors: Kramer, W. C; Parman, M, Marks, R. M.
      Pages: 494 - 502
      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 (range, 27 days to 12.7 years). Results: Complications included 94 pin migrations (3.5%), 9 pin-tract infections (0.3%), and 2 pin breakages (0.1%). There were 150 recurrent deformities (5.6%) and 94 toes (3.5%) required revision hammertoe surgery. Malalignment was noted in 55 toes (2.1%). Vascular compromise occurred in 16 toes (0.6%), with 10 (0.4%) requiring amputation. Ninety-four toes (3.5%) required revision surgery because of symptomatic recurrence of deformity. The expected rates and rate ratios (RRs) of patients requiring revision hammertoe correction, compared with the study population as a whole, were statistically significantly higher in patients who underwent an metatarsophalangeal joint capsulotomy (3.10 vs 0.97; RR, 3.20) and those who experienced K-wire-related complications (5.10 vs 1.80, RR, 2.84). Conclusions: K-wire fixation for the treatment of hammertoe deformities led to good maintenance of correction with a relatively low complication rate, and we believe that it remains an effective, low-cost method of fixation for hammertoe correction. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714568013
      Issue No: Vol. 36, No. 5 (2015)
       
  • Liposomal Bupivacaine in Forefoot Surgery
    • Authors: Robbins, J; Green, C. L, Parekh, S. G.
      Pages: 503 - 507
      Abstract: Background: Liposomal bupivacaine is increasingly being utilized in attempts to provide prolonged local analgesia in the immediate postoperative period. The purpose of this study was to quantify the reduction in opioid consumption as well as postoperative pain scores in the postoperative period when liposomal bupivacaine is used at the conclusion of forefoot surgery. Methods: This was a prospective therapeutic cohort study with 20 patients receiving liposomal bupivacaine at the conclusion of their forefoot procedure in addition to our routine multimodal analgesic protocol and 20 patients as the control without the addition of liposomal bupivacaine. Pain scores, number of narcotic pills consumed on postoperative days 1 through 4, need for refill, time to first refill and wound complications were evaluated. Results: Mean number of narcotic pills consumed on postoperative day 1 (1.4 vs 3.6, P = .002) and day 2 (1.8 vs 3.6, P = .021) was significantly lower for the liposomal bupivacaine group than the control group. Daily pain scores were lower for those patients who received liposomal bupivacaine on postoperative days 1 through 4, although this was not statistically significant. Fewer patients required medication refills in the liposomal bupivacaine group compared to the control group, however this was not statistically significant (3 vs 7, P = .273). There was no increase in wound complications in the liposomal bupivacaine group when compared to the control (1 vs 4). Conclusion: Liposomal bupivacaine appears to be a useful adjunct in the treatment of postoperative pain when used as a part of a multimodal analgesic regimen in patients undergoing forefoot surgery. Level of Evidence: Level II, prospective comparative study.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714568664
      Issue No: Vol. 36, No. 5 (2015)
       
  • Effect of Delay to Definitive Surgical Fixation on Wound Complications in
           the Treatment of Closed, Intra-articular Calcaneus Fractures
    • Authors: Kwon, J. Y; Guss, D, Lin, D. E, Abousayed, M, Jeng, C, Kang, S, Ellington, J. K.
      Pages: 508 - 517
      Abstract: Background: There are conflicting data regarding the benefits of delaying operative fixation of calcaneus fractures to decrease wound complication rates. The purpose of this study was to examine the effect of delaying fixation on wound complication rates as well as to identify other risk factors. Methods: A retrospective review at 4 institutions, including 24 surgeons, identified 405 closed, operatively treated, intra-articular calcaneus fractures. We compared fractures with and without wound complications with regards to patient demographics, medical risk factors, fracture severity, time to fixation, operative approach, primary subtalar arthrodesis, and surgeon experience. Results: Wound complications were observed in 21% (87/405) of fractures, of which 33% (29/87) required operative intervention. Male sex (P = .032), smoking (P = .028), and the extensile lateral approach (P < .001) were associated with higher complication rates. Fractures treated with an extensile lateral approach had an overall wound complication rate of 32.1%, while those treated with a sinus tarsi or percutaneous approach had an overall wound complication rate of 8.3% (odds ratio [OR], 5.3; 95% confidence interval [CI], 2.9-9.5; P < .001). Among patients treated with an extensile lateral approach, delayed operative fixation did not decrease wound complication rates despite comparable fracture severity across time points. In contrast, among fractures treated with less invasive approaches, delayed fixation beyond 2 weeks resulted in a significantly increased wound complication rate of 15.2% as compared to a wound complication rate of only 2.1% among fractures treated within a week of injury (OR, 3.2; 95% CI, 1.3-9.5; P = .01). This was observed despite similar fracture severity across time points. Primary subtalar arthrodesis did not impact complication rates. A higher wound complication rate among senior surgeons was likely secondary to their predilection for the extensile lateral approach. Conclusion: Delaying definitive fixation of closed, intra-articular calcaneus fractures did not decrease wound complication rates when using the extensile lateral approach, and we found an increased wound complication rate when using less invasive approaches. Level of Evidence: Level III, observational study.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565178
      Issue No: Vol. 36, No. 5 (2015)
       
  • Intermediate-term Results of Mobile-bearing Total Ankle Replacement
    • Authors: Deleu, P.-A; Devos Bevernage, B, Gombault, V, Maldague, P, Leemrijse, T.
      Pages: 518 - 530
      Abstract: Background: The literature analyzing total ankle replacement (TAR) results should be critically interpreted because studies made by the design surgeons are potentially subject to bias. European nondesigner surgeon studies reviewing the HINTEGRA TAR system are scarce in the literature. The present study is a European nondesigner surgeon study reviewing a consecutive series of 50 HINTEGRA TAR systems with a minimum follow-up of 2 years, focusing on clinical and radiographic outcomes. Methods: Fifty primary TAR procedures were performed between February 2008 and January 2012 by a single surgeon. Every patient underwent a standardized clinical and radiographic follow-up at 6 weeks, 3 and 6 months, and 1 year postoperatively and annually thereafter. The mean time to final follow-up was 45 months. Results: The mean American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score significantly increased from 43.5 preoperatively to 83.8 postoperatively. Clinical range of motion of the ankle also improved from 23.3 degrees preoperatively to 28.3 degrees postoperatively. In 70% of the TAR procedures, the talar component was positioned anteriorly with respect to the tibial axis. Radiological evidence of osteolysis was identified in 24 ankles. The failure rate in the present series was 10%, which was defined as having major revision surgery within 4 years. Conclusion: The survival of the first 50 HINTEGRA TAR systems in this series was satisfactory from clinical and radiological points of view. However, the incidence of asymptomatic periprosthetic osteolytic lesions was quite high (24 ankles). Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714561058
      Issue No: Vol. 36, No. 5 (2015)
       
  • Anterolateral Tibial Osteotomy for Accessing Osteochondral Lesions of the
           Talus in Autologous Osteochondral Transplantation: Functional and T2 MRI
           Analysis
    • Authors: Gianakos, A. L; Hannon, C. P, Ross, K. A, Newman, H, Egan, C. J, Deyer, T. W, Kennedy, J. G.
      Pages: 531 - 538
      Abstract: Background: Autologous osteochondral transplantation (AOT) is a primary treatment strategy for large or cystic osteochondral lesions of the talus (OLT) or a secondary replacement strategy after failed bone marrow stimulation. The technique requires perpendicular access to the talar dome, which is often difficult to obtain for posterior or lateral lesions. Traditional methods to access these areas have required disruption of the syndesmotic complex with concern over osteotomy reduction, malalignment, and ligament disruption. An alternate to these traditional methods of access is an anterolateral tibial osteotomy. The purpose of this study was to report functional and magnetic resonance imaging (MRI) outcomes in a series of patients that underwent AOT for treatment of an OLT via an anterolateral tibial osteotomy. Methods: Records of patients that underwent an anterolateral tibial osteotomy for AOT were retrospectively reviewed. Pre- and postoperative Foot and Ankle Outcome Scores (FAOS) and demographic data were recorded. Magnetic resonance observation of cartilage repair tissue (MOCART) was used to assess morphologic state of tibial cartilage at the repair site of the osteotomy. Quantitative T2 mapping MRI was analyzed in the superficial and deep cartilage layers of the repair site of the osteotomy and in adjacent normal cartilage to serve as control tissue. Seventeen patients with a mean age of 36.9 (range, 17-76) years underwent anterolateral tibial osteotomy with a mean follow-up of 64 (range, 29 to 108) months. MOCART data were available in 9 of 17 patients, and quantitative T2 mapping was available in 6 patients. Results: FAOS significantly improved from an average 39.2 (range, 14 to 66) out of 100 points preoperatively to 81.2 (range, 19 to 98) postoperatively (P < .01). The average MOCART score was 73.9 out of 100 points (range, 40 to 100). Quantitative T2 analysis demonstrated relaxation times that were not significantly different from the normal native cartilage in both the deep half and superficial half of interface repair tissue (P > .05). Conclusion: This study demonstrated that the anterolateral tibial osteotomy was a reasonable alternative for accessing centrolateral or posterolateral OLT for AOT with limited morbidity associated with the osteotomy. The evidence demonstrated adequate osteotomy and cartilaginous healing with improvement in functional outcome scores at medium-term follow-up. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714563308
      Issue No: Vol. 36, No. 5 (2015)
       
  • Tibiotalocalcaneal Arthrodesis Using a Straight Intramedullary Nail
    • Authors: Lucas y Hernandez, J; Abad, J, Remy, S, Darcel, V, Chauveaux, D, Laffenetre, O.
      Pages: 539 - 546
      Abstract: Background: Tibiotalocalcaneal (TTC) arthrodesis is a proven solution for severe hindfoot arthropathy that reestablishes stability for plantigrade gait and alleviates pain, while correcting deformity. Intramedullary nailing is an effective option for fixation. The aim of this study was to determine clinical outcome, analyze the fusion rate, and determine final hindfoot alignment in a consecutive series of patients using a single-design straight intramedullary nail. Methods: This study evaluated 63 patients treated between 2006 and 2010 with at least 36 months of follow-up. Ten patients were excluded because of study inclusion criteria, and 4 were lost to follow-up, leaving 49 patients available for review. The average follow-up was 70.7 ± 15.1 months. Results: The American Orthopaedic Foot and Ankle Society score improved from 29.7 ± 15.1 before arthrodesis to 65.8 ± 14.6 after (P
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565900
      Issue No: Vol. 36, No. 5 (2015)
       
  • An Analysis of 2 Fusion Methods for the Treatment of Osteomyelitis
           Following Fractures About the Ankle
    • Authors: Moore, J; Berberian, W. S, Lee, M.
      Pages: 547 - 555
      Abstract: Background: In the setting of chronic osteomyelitis following fractures about the ankle, reconstruction through bony arthrodesis may be used as a reconstructive alternative to amputation. During these cases, surgeons often avoid using internal fixation in an attempt to avoid reinfection or premature hardware failure. In this retrospective review, we analyzed the outcomes of chronic osteomyelitic patients who had an arthrodesis of the ankle using either internal or external fixation, focusing on salvage rates, infection clearance, union rates, and functional outcomes. No device was implanted into a known active infection. Methods: We performed a retrospective chart review of adult patients undergoing arthrodesis in the setting of a previously septic ankle following a traumatic injury. In each case, multiple irrigation and debridement procedures and local and systemic antibiotics were used. Infection status was determined by clinical exam, MRI, nuclear medicine studies, and ultimately bone biopsies. No fixation device was implanted in ankles with known active infections. Patients were divided into 2 cohorts: those fused with internal devices and those fused with external fixators. Thirty patients underwent a total of 32 arthrodesis procedures. Mean follow up time was 27 months (range, 6 to 144). Results: Nineteen fusions were performed using internal fixation; only 2 required amputations, therefore limb salvage was 90%. Fifteen were able to ambulate with or without the assistance of an orthosis (79%). Four patients experienced recurrent infection (21%) and 5 developed nonunion (26%). Of the 13 fusions performed with external fixators, only 1 required an amputation, putting limb salvage at 92%. Ten patients were able to walk with or without the assistance of an orthosis as their final functional status (77%). Two patients experienced recurrent infection (15%), and 4 went on to nonunion (31%). Conclusion: When analyzing these 2 fusion methods in posttraumatic patients with previously septic ankles, with the numbers available both methods achieved similar rates of limb salvage and final functional status in these patients, as well as similar rates of infection clearance and bony union. As internal fixation is often less labor-intensive for the surgeon and more palatable for the patient postoperatively, we encourage surgeons to consider arthrodesis with internal fixation once the infection is successfully eradicated, especially in a noncompliant patient population. Level of Evidence: Level III, retrospective comparative series.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714563309
      Issue No: Vol. 36, No. 5 (2015)
       
  • Interposition Bone Block Arthrodesis for Revision Hallux
           Metatarsophalangeal Joint Surgery: A Case Series
    • Authors: Malhotra, K; Nunn, T, Qamar, F, Rao, V, Shanker, J.
      Pages: 556 - 564
      Abstract: Background: The operative management of failed hallux metatarsophalangeal joint surgery can be difficult. There is often substantial shortening of the first ray. Arthrodesis of the first metatarsophalangeal joint is one treatment option, but results in further shortening of the first ray. Methods: We present a large retrospective series of patients who had an interposition bone block arthrodesis procedure performed using a nonvascularized tricortical autologous iliac crest bone graft in an attempt to maintain first ray length. Twenty-four patients (25 feet) underwent this salvage procedure over a 10-year period. The mean follow-up period was 62 (range, 11-117) months. Results: Indications included failed hallux valgus surgery, Keller’s procedures, various other first metatarsal osteotomies, and failed arthrodesis procedures with shortening of the first ray. All patients had tricortical iliac crest grafts inserted into bony defects of mean length 10.7 (range, 8-15) mm. Fixation was achieved using either multiple wires or a low-profile plate. Mean lengthening was 4.4 (range, 0-8) mm. Three feet went on to nonunion requiring further revision surgery and at latest follow-up 2 had united. All patients underwent removal of a stabilizing Kirschner wire. Median patient-reported outcome score using the Foot and Ankle Disability Index was 84.6 (range, 37.5-97.1). Conclusion: These results suggest this procedure was successful in salvaging failed first ray surgery and prevented further shortening. We believe good results can be achieved, but care must be taken to ensure wound closure without excessive tension to permit wound healing. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714563536
      Issue No: Vol. 36, No. 5 (2015)
       
  • Ankle Ligament Laxity and Stiffness in Chronic Ankle Instability
    • Authors: Brown, C. N; Rosen, A. B, Ko, J.
      Pages: 565 - 572
      Abstract: Background: The contribution of mechanical laxity and ligament stiffness to chronic ankle instability is unclear, particularly when using the inversion laxity test, and may have implications for diagnosis, prognosis, and treatment. Our purpose was to determine if individuals with chronic ankle instability demonstrate greater mechanical ligament laxity and altered stiffness compared to controls and copers (those with a healed sprain) during an instrumented arthrometer inversion stress test. Methods: Recreationally active individuals were classified as those with chronic ankle instability (n = 16), copers (n = 16), or controls (n = 16) based on injury history and self-reported score on the Cumberland Ankle Instability Tool (CAIT). Three trials of an inversion stress test were applied with an instrumented arthrometer utilizing a reliable tester. Talocrural inversion (degrees) and stiffness values were extracted. One-way ANOVAs were calculated, and Tukey post hoc testing was applied (α ≤ .05). Results: Groups were not different in age, height, or weight. The chronic ankle instability group (19 ± 6) had significantly lower CAIT scores than the control (30 ± 1) and coper (29 ± 1) groups (P < .001). The chronic ankle instability group (23 ± 12 degrees) demonstrated significantly greater inversion than the controls (13 ± 9 degrees) (P = .04) but was not significantly different than the copers (17 ± 10 degrees). No significant differences were detected in stiffness between the groups. Conclusion: The chronic ankle instability group demonstrated decreased self-reported ankle function and increased mechanical laxity utilizing an instrumented arthrometer for inversion compared to the control group but not the coper group. Laxity, but not stiffness, may be a factor affecting chronic ankle instability and self-reported function. Level of Evidence: Level III, comparative study.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714561057
      Issue No: Vol. 36, No. 5 (2015)
       
  • Deep Transverse Metatarsal Ligament and Static Stability of Lesser
           Metatarsophalangeal Joints: A Cadaveric Study
    • Authors: Wang, B; Guss, A, Chalayon, O, Bachus, K. N, Barg, A, Saltzman, C. L.
      Pages: 573 - 578
      Abstract: Background: The static support that guides motion around the lesser metatarsophalangeal joints (MTPJs) is complex. Biomechanical studies revealed important roles of both the plantar plane and collateral ligaments. Since part of the plantar plate is attached to the deep transverse metatarsal ligament (DTML), we hypothesized that the transection of the DTML in the intermetatarsal space may substantially reduce the MTPJ stability. Methods: The second, third, and fourth MTPJ stabilities of 6 fresh-frozen human cadaveric foot specimens were measured under load control. Both dorsiflexion and dorsal subluxation conditions were tested. After the intact condition was assessed, the DTML was sequentially transected such that each MTPJ had a unilateral and then a bilateral DTML transection. Stiffness data were calculated using the loading range in each test condition. Paired Student t tests were performed to test for statistical significance (P value less than .05). Results: In intact specimens, the mean stiffness with dorsiflexion of the second, third, and fourth toes was 0.52 ± 0.15 N/deg. When the DTML was operatively transected on one side, the dorsiflexion stiffness significantly decreased 17.3% to an average of 0.43 ± 1.00 N/deg (P < .001). Subsequent transection of the DTML on the other side of each joint resulted in a further significant decrease of 5.8% to an average of 0.40 ± 0.08 N/deg (P < .001). The mean stiffness with dorsal subluxation of the intact second, third, and fourth toes was 3.55 ± 0.66 N/mm. When the DTML was operatively transected on one side, the dorsal subluxation stiffness significantly decreased 16.1% to an average of 2.98 ± 0.64 N/mm (P < .001). Subsequent transection of the DTML on the other side of each joint resulted in a further significance decrease of 7.6% to an average of 2.71 ± 0.48 N/mm (P = .016). Conclusion: The DTML has a significant role in maintaining lesser MTPJ ligament stability. Both unilateral and bilateral DTML transections caused substantial instability of the lesser MTPJ. Clinical Relevance: The DTML is part of the natural static restraint to dorsiflexion or dorsal subluxation of the lesser MTPJ. Operative transection, injury, or degeneration of this ligament may predispose the adjacent MTPJ to instability.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714563310
      Issue No: Vol. 36, No. 5 (2015)
       
  • The Effect of Peroneus Brevis Tendon Anatomy on the Stability of Fractures
           at the Fifth Metatarsal Base
    • Authors: Morris, P. M; Francois, A. G, Marcus, R. E, Farrow, L. D.
      Pages: 579 - 584
      Abstract: Background: Nonunion of classic Jones fractures has typically been attributed to the precarious vascular anatomy of the proximal fifth metatarsal. Despite this theory, the operative treatment of these fractures utilizes biomechanical solutions. The purpose of the present study was to evaluate the influence of the peroneus brevis (PB) tendon on the stability of fractures of the proximal fifth metatarsal. Methods: We utilized 5 matched pairs (10 specimens) of fresh-frozen cadaveric specimens. We used 2 loading conditions: (1) a simulated fracture distal to the PB insertion (Jones equivalent) and (2) a simulated fracture within the footprint of the PB insertion (avulsion equivalent). Following the creation of the fracture, each lower extremity was statically loaded through the Achilles and PB tendons. Our primary outcome measure was the degree of fracture diastasis with loading of the PB. Anteroposterior images with and without loading were obtained to evaluate fracture separation. We utilized a paired Student t test and the intraclass correlation coefficient (ICC) for all statistical analyses. Results: The average length of the PB footprint was 15.2 mm. The simulated Jones fractures demonstrated greater fracture widening following loading of the PB tendon compared to the simulated avulsion fractures. The simulated avulsion fractures widened 0.4 mm on loading compared to 1.1 mm of widening in the simulated Jones fractures (P = .02). Intraobserver reliability for all radiographic measurements showed substantial agreement (ICC = 0.91). Conclusion: The PB exerted a deforming force on the proximal fragment of simulated Jones fractures. This deforming force was less pronounced in the simulated avulsion fractures. The principal findings of this study were that proximal fifth metatarsal fractures distal to the PB insertion were significantly more unstable than more proximal fractures. Clinical Relevance: Our findings help support the notion that a mechanical component may contribute to the poor healing potential of Jones fractures secondary to deformation exerted by the PB tendon.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565177
      Issue No: Vol. 36, No. 5 (2015)
       
  • Proximal Phalanx and Flexor Digitorum Longus Tendon Biomechanics in Flexor
           to Extensor Tendon Transfer
    • Authors: DiPaolo, Z. J; Ross, M. S, Laughlin, R. T, Gould, G, Flower, K, Kiger, L, Markert, R. J.
      Pages: 585 - 590
      Abstract: Background: The flexor to extensor transfer of the flexor digitorum longus (FDL) tendon has been a relatively common operative procedure for the treatment of a flexible hammer toe deformity and chronic metatarsophalangeal (MTP) joint dislocation. A possible complication of using the tunnel technique rather than the tendon splitting technique is iatrogenic fracture through the drilled tunnel site. The purpose of this investigation was to study the FDL tendon and proximal phalanx dimensions in the area of the transfer procedure in order to improve preoperative planning and minimize postoperative complications. Additionally, this study investigated the force necessary to create a fracture in a predrilled proximal phalanx and attempted to elucidate a relationship between that force and the percentage of bone remaining after the drilling process. Methods: The proximal phalanx and FDL tendon of the second, third, and fourth toes from both the right and the left foot of 14 fresh frozen cadavers were dissected, and the digit was amputated at the MTP joint. A total of 84 toes (42 right, 42 left) were obtained from 14 cadavers. The diameter of the FDL tendon was measured, and the circumference and volume were calculated. Fourteen proximal phalanges of either the right or the left foot were then drilled with a 3.5-mm drill, as is often done in a tendon transfer procedure. The 14 nondrilled bones from the contralateral foot were used as matched controls. Radiographs were then taken of the proximal phalanges, and the dimensions of the drill tunnel and remaining bone were calculated. These measurements were used to calculate the volume of the bone, the volume of the drill tunnel, and the percentage of bone remaining after the drilling process. The bones were then tested for load-to-failure using a biomechanical loading apparatus. Results: The average bone and tendon diameter measurements showed a gradual decrease in size from the second to the fourth digits. The bone removed by drilling the tunnel accounted for approximately 20% to 30% of the total volume of bone. Half of the bones fractured with forces between 100 and 200 N, and the majority of bones with a diameter of less than 6 mm fractured with a force of less than 100 N. Conclusions: The average proximal phalanx and FDL tendon size both showed an overall decrease from the second to the fourth digit, albeit not symmetrically. The proximal phalanx diameter appeared to be the most important factor in determining the strength of the structure. Clinical Relevance: Iatrogenic fracture may occur in proximal phalanges with a diameter of bone less than 6 mm, as there may not be adequate bone strength remaining to withstand postoperative forces.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565927
      Issue No: Vol. 36, No. 5 (2015)
       
  • Arthroscopic Ankle Fusion for Avascular Necrosis of the Talus
    • Authors: Kendal, A. R; Cooke, P, Sharp, R.
      Pages: 591 - 597
      Abstract: Background: Avascular necrosis (AVN) of the talus is a painful condition leading to destruction of the ankle-hindfoot complex. Moderate outcomes and high complication rates are reported in small numbers of advanced disease treated with tibiotalocalcaneal fusion, which has the additional disadvantage of sacrificing both the ankle and subtalar joints. The blood supply of the talus is tenuous, and open procedures risk further talar collapse by disrupting extraosseous vessels. This article reports the outcome of arthroscopic ankle fusion for late-stage AVN of the talus. Our hypothesis was that arthroscopic ankle fusion would relieve symptoms of advanced talar AVN, prevent collapse of the talus, and preserve the subtalar joint. Methods: A cohort study was performed on 16 patients with talar AVN treated with arthroscopic ankle fusion. Our primary outcome was fusion rate. Secondary outcomes included perioperative complications, ongoing pain, and further operative intervention. All radiologic investigations were reported independently by a senior radiologist. The average age of the patients was 53.5 years. The presumed causes of talar AVN were steroids, trauma, hematologic disorders, and alcoholism. The etiology was unknown in 7 patients. One patient was lost to follow-up. Results: Clinical and radiologic fusion at the ankle joint was confirmed in 15 of 15 available patients. Thirteen patients reported resolution of pain at follow-up. Three patients had ongoing pain and underwent a subsequent successful subtalar fusion. Conclusions: Arthroscopic ankle fusion was a safe and reliable treatment of symptomatic advanced talar AVN. It was a minimally invasive procedure with minimal complication rate, preserving the talus and sparing the subtalar joint. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565901
      Issue No: Vol. 36, No. 5 (2015)
       
  • Operative Technique for Cuboid Instability in an Elite Gymnast: Case
           Report
    • Authors: Sullivan, M; de Silva, V, Panti, J. P. L, Linklater, J.
      Pages: 598 - 602
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714560585
      Issue No: Vol. 36, No. 5 (2015)
       
  • Fixation for Avulsion Fracture of the Calcaneal Tuberosity Using a
           Side-Locking Loop Suture Technique and Anti-Slip Knot
    • Authors: Miyamoto, W; Takao, M, Matsui, K, Matsushita, T.
      Pages: 603 - 607
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100714565179
      Issue No: Vol. 36, No. 5 (2015)
       
  • Individualized Care Plans
    • Authors: Pinzur; M. S.
      Pages: 608 - 608
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100715575012
      Issue No: Vol. 36, No. 5 (2015)
       
  • Education Calendar
    • Pages: 609 - 609
      PubDate: 2015-04-29T13:39:52-07:00
      DOI: 10.1177/1071100715585791
      Issue No: Vol. 36, No. 5 (2015)
       
 
 
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