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Journal Cover Foot & Ankle International
   [11 followers]  Follow    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1071-1007
     Published by Sage Publications Homepage  [737 journals]   [SJR: 1.021]   [H-I: 62]
  • Osteochondral Lesions in Surgically Treated Hallux Valgus
    • Authors: Jastifer, J. R; Coughlin, M. J, Doty, J. F, Stevens, F. R, Hirose, C, Kemp, T. J.
      Pages: 643 - 649
      Abstract: Background: Patient dissatisfaction following surgical correction of hallux valgus remains a clinical problem. The aim of this study was to investigate articular erosion patterns of the first metatarsal head in patients with hallux valgus, to evaluate if the cartilage damage was associated with the degree of hallux valgus deformity, and to prospectively evaluate the effect on patient outcomes. Methods: Fifty-six consecutive feet undergoing surgical correction for hallux valgus were prospectively enrolled and followed for 24 months postoperatively. In addition to clinical and radiographic examinations, intraoperative measurements were obtained to quantify osteochondral lesion location, size, and grade of the first metatarsal head cartilage. Results: Fifty-one of 56 feet (91%) had osteochondral lesions. The mean number of zones affected was 2.9, and the mean maximum International Cartilage Repair Society (ICRS) scale lesion grade was 2.9 out of 4. A total of 44/56 (79%) completed a minimum of 24 months of follow-up. The grade of the lesion and the extent of the lesion did not have a strong correlation with the radiographic measures or clinical outcome scores. Conclusions: This study showed a high prevalence of osteochondral lesions in patients undergoing operative correction of hallux valgus. Since the grade and the extent of the lesions did not have a strong correlation with the severity of the deformity or the clinical outcome, the significance of these lesions remains unknown. Level of Evidence: Level III, comparative series.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531234|hwp:master-id:spfai;1071100714531234
      Issue No: Vol. 35, No. 7 (2014)
  • Low Wound Complication Rates for the Lateral Extensile Approach for
           Calcaneal ORIF When the Lateral Calcaneal Artery Is Patent
    • Authors: Bibbo, C; Ehrlich, D. A, Nguyen, H. M. L, Levin, L. S, Kovach, S. J.
      Pages: 650 - 656
      Abstract: Background: Historically, the lateral extensile approach for calcaneal fracture osteosynthesis has had relatively high rates of wound healing problems. The vascular territory (angiosome) of the lateral foot is now known to be dependent upon the lateral calcaneal branch of the peroneal artery (LCBP artery). We postulated that patency of the LCBP artery may have a profound positive impact on incisional wound healing for calcaneal open reduction and internal fixation (ORIF). Methods: Ninety consecutive calcaneal fractures that met operative criteria were preoperatively evaluated for the presence of a Doppler signal in the LCBP artery and were followed for the development of wound healing problems. Results: Among these 90 fractures, 85 had a positive preoperative Doppler signal along the course of the LCBP artery (94%) and 5 had no Doppler signal (6%). All patients underwent ORIF via a lateral extensile approach. Overall, incisional wound healing problems occurred in 6 of 90 calcaneal incisions (6.5%). All 5 feet that exhibited an absent Doppler signal in the LCPB artery developed an incisional wound healing complication (5/6, approximately 83%): 2 large apical wounds and 3 major dehiscence/slough. However, among the 84 feet that possessed a positive preoperative Doppler signal in the LCBP artery, there was only 1 (1/84, approximately 1%) incisional wound healing problem (P < .0001, Fischer’s exact test). Smokers with a positive Doppler signal in the LCBP artery did not develop a wound healing complication. Conclusions: This study suggests a strong link to low incisional wound healing complications for the lateral extensile approach to the calcaneus when a preoperative Doppler signal is present in the LCBP artery. We believe this simple examination should be routinely performed prior to calcaneal ORIF. Level of Evidence: Level III, comparative case series.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714534654|hwp:resource-id:spfai;35/7/650
      Issue No: Vol. 35, No. 7 (2014)
  • Comparison of Early and Delayed Open Reduction and Internal Fixation for
           Treating Closed Tibial Pilon Fractures
    • Authors: Tang, X; Liu, L, Tu, C.-q, Li, J, Li, Q, Pei, F.-x.
      Pages: 657 - 664
      Abstract: Background: The timing of surgery for osteosynthesis of type C pilon (AO/OTA) fractures remains controversial. The aim of this study was to determine the outcome of early and delayed open reduction and internal fixation (ORIF) for treating closed type C pilon fractures. Methods: Forty-six patients with closed type C pilon fractures matched according to age, gender, soft tissue conditions, and fracture pattern were divided into group A (early group: underwent surgery within 36 hours of the injury) or group B (delayed group: underwent surgery 10 days to 3 weeks postinjury after the soft tissue swelling subsided). In the delayed group, 9 patients were treated first by temporary external fixation. All the closed fractures were managed by ORIF with locking plates. At follow-up, the clinical and radiographic results were retrospectively analyzed. The mean follow-up time was 25.8 months (range, 14 to 48 months) in group A and 26.0 months (range, 15 to 44 months) in group B. Results: There was no significant difference (P > .05) between the 2 groups regarding the rate of soft tissue complication, the rate of fracture union, and the final functional score. The patients in group A had a significantly shorter mean time to fracture union (21.5 ± 4.0 weeks vs 23.3 ± 3.7 weeks, P < .05), operating time (84.3 ± 12.1 months vs 100.6 ± 13.7 months, P < .01), and hospital stay (7.6 ± 2.6 days vs 15.2 ± 4.2 days, P < .01). Conclusion: If soft tissue conditions are acceptable, early ORIF for treating closed type C pilon fractures can be safe and effective, with similar rates of wound complication, fracture union, and final good functional recovery but shorter operative time, union time, and hospital stay. These results favorably compare with delayed ORIF treatment. Level of Evidence: Level III, retrospective comparative study.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714534214|hwp:master-id:spfai;1071100714534214
      Issue No: Vol. 35, No. 7 (2014)
  • Total Ankle Arthroplasty Accuracy and Reproducibility Using Preoperative
           CT Scan-Derived, Patient-Specific Guides
    • Authors: Berlet, G. C; Penner, M. J, Lancianese, S, Stemniski, P. M, Obert, R. M.
      Pages: 665 - 676
      Abstract: Background: Preoperative navigation has provided many potential benefits for total knee arthroplasty, including patient-specific alignment, repeatable implant placement, and decreased operative time. For the first time, this technology was applied to total ankle arthroplasty (TAA). This study evaluated repeatability of tibia and talus patient-specific guide placement and deviation between the preoperative plan and actual implant placement. Methods: Routine ankle CT scans were acquired of 15 cadaveric lower extremity limbs, converted into 3D solid models, and imported into a computer-assisted design assembly. Anatomic landmarks defining tibia/talus alignment were established and used to perform a virtual TAA. Commercially available implant components were placed to mimic traditional cases. An operative guide referencing the cadaver-specific anatomy was engineered to define the resection planes necessary to re-create virtual placement of traditional tibia and talus implants in the postoperative position. Board-certified TAA orthopaedic surgeons with no prior preoperative navigation experience placed the operative guides onto the bones based on tactile and visual feedback. Guide placement was repeated 4 times to determine variability. Final implant position was recorded with an infrared probe, confirmed with CT scans, and compared to the preoperative plan. Average deviations between planned and actual guide placement were determined for all rotational and translational degrees of freedom (DOF). In addition, implant component location was measured radiographically. Results: Intraobserver tibia and talus guide variation between all trials was 0.26 ± 0.18 degrees and 0.36 ± 0.25 degrees in flexion/extension, 0.61 ± 0.58 and 0.53 ± 0.53 in varus/valgus, and 0.79 ± 0.38 degrees and 1.15 ± 0.77 degrees in internal/external rotation, respectively. Average variation between preoperative and postoperative implant placement was less than 2 degrees and 1.4 mm in all specimens tested. Conclusion: Preliminary data suggest that preoperative navigation and custom operative guides result in reliable and reproducible placement of TAA implants and patient-specific ankle alignment. Deviation of final implant placement from the preoperative plan was less than 2 degrees in all angular DOF, providing greater accuracy than the ±3 degrees determined in other implant system studies using traditional instrumentation and computer navigation. Clinical Relevance: We have further demonstrated that final implant position is successfully guided by these patient-specific guides, with reproducibility of tibial component placement falling within 2 degrees of the intended target. This level of reproducibility suggests a promise for this technology, and it is hoped this level of accuracy will become the benchmark for the next generation of total ankle arthroplasty.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531232|hwp:master-id:spfai;1071100714531232
      Issue No: Vol. 35, No. 7 (2014)
  • Calcaneocuboid Joint Subluxation After the Calcaneal Lengthening Procedure
           in Children
    • Authors: Ahn, J.-Y; Lee, H.-S, Kim, C.-H, Yang, J.-P, Park, S.-S.
      Pages: 677 - 682
      Abstract: Background: We investigated radiographic changes of calcaneocuboid (CC) joint subluxation following calcaneal lengthening procedure for the treatment of pediatric planovalgus foot deformities. Methods: This study included 44 cases of planovalgus foot deformities in 24 patients with mean age of 9.7 (range, 8 to 13) years who underwent calcaneal lengthening between 1999 and 2011. The mean follow-up period was 25 (range, 12 to 159) months. Anteroposterior (AP) and lateral radiographs of the weight-bearing view of the foot from immediate postoperative, 3-month postoperative, and last follow-up evaluations were reviewed and also used for trend analysis. Percentage of CC joint subluxations was measured on both AP and lateral view of the foot. Correlations between the percentage of CC joint subluxation and follow-up periods were assessed. Results: All of the feet showed dorsal subluxation of their CC joint on the immediate postoperative lateral plain radiographs. The median percentage of dorsal subluxation of the CC joint improved from 26.0% (range, 10.0 to 67.0) at the immediate postoperative evaluation to 16.5% (range, 7.0 to 47.0, P = .0001) at the 3-month postoperative evaluation and to 11% (range, 2.0 to 30.0, P = .0003) at last follow-up. The trend analysis over time indicated that the CC joint subluxation percentage with calcaneal lengthening generally decreased over time (r s = –.67, P = .001). No patients showed osteoarthritic changes in the CC joint or nonunion at the calcaneal osteotomy site at last follow-up. Conclusion: At midterm follow-up, the CC joint subluxation was gradually resolving over time, with no evidence of osteoarthritic change in the CC joint. Level of Evidence: Level IV, case series.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714528494|hwp:master-id:spfai;1071100714528494
      Issue No: Vol. 35, No. 7 (2014)
  • Comparison of Outcome After Retinaculum Repair With and Without Fibular
           Groove Deepening for Recurrent Dislocation of the Peroneal Tendons
    • Authors: Cho, J; Kim, J.-Y, Song, D.-G, Lee, W.-C.
      Pages: 683 - 689
      Abstract: Background: This study compared the operative outcome between retinaculum repair with and without fibular groove deepening for the treatment of recurrent traumatic peroneal tendon dislocation in young, active patients. Methods: A consecutive series of 29 patients who underwent operative treatment of recurrent peroneal tendon dislocation were evaluated. Thirteen patients were treated by the superior peroneal retinaculum repair with fibular groove deepening (group A) and 16 patients by superior peroneal retinaculum repair alone (group B). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score for pain, and overall patient satisfaction were used to evaluate the clinical outcome after a minimum follow-up period of 12 months postoperatively. In addition, mean time to return to sports activity and tourniquet time were compared between groups. Results: Mean AOFAS score improved significantly from 59.3 points preoperatively to 92.2 points at the final follow-up in group A and from 58.5 points preoperatively to 91.3 points at the final follow-up in group B. Mean VAS score also improved significantly from 5.0 points preoperatively to 1.0 points at the final follow-up in group A and from 4.9 points preoperatively to 1.2 points at the final follow-up in group B. Improvements in AOFAS and VAS scores at the final follow-up were not significantly different between the 2 groups. Mean time to return to sports activity was approximately 3 months in both groups. Mean tourniquet time in group B was significantly shorter than that in group A (42.2 vs 29.5 min). Conclusions: Isolated retinaculum repair compared to retinaculum repair with fibular groove deepening was a faster and simpler technique, but both techniques had good outcomes for the treatment of recurrent traumatic peroneal tendon dislocation. Level of Evidence: Level II, prospective, nonrandomized, comparative study.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531233|hwp:master-id:spfai;1071100714531233
      Issue No: Vol. 35, No. 7 (2014)
  • Second-Generation Ceramic First Metatarsophalangeal Joint Replacement for
           Hallux Rigidus
    • Authors: Nagy, M. T; Walker, C. R, Sirikonda, S. P.
      Pages: 690 - 698
      Abstract: Background: Ceramic first metatarsophalangeal (MP) joint replacement has been reported for treatment of hallux rigidus, but there are no published mid- or long-term studies available. We present our midterm results using a second-generation ceramic first MP joint implant. Methods: A retrospective review of clinical data and radiographs was performed for 31 feet (24 women; mean age at surgery, 55 ± 6 years) who had first MP joint replacement with a second-generation ceramic prosthesis (primary, 29 feet; revision, 2 feet). Mean follow-up was 81 ± 27 months after surgery Results: Mean first MP passive range of motion was 32 ± 17 degrees (dorsi- and plantarflexion). Mean AOFAS score was 72 ± 19 points and Foot Function Index was 27 ± 26 points (all 31 feet). Clinical rating for 29 feet that had surgery as a primary procedure was excellent in 5 feet (17%), good in 8 feet (28%), fair in 3 feet (10%), and poor in 13 feet (45%). Patients were satisfied with the outcome in 24 feet (77%). Follow-up radiographs showed that radiolucency, change in angulation, sinkage, and malalignment of the metatarsal or proximal phalanx components were common. Complications included 1 superficial wound infection, and revision was performed in 5 feet (16%) because of loosening, sinkage, subluxation, pain, or fractured prosthesis. Implant survival was 92% at 5 years, 85% at 7 years, and 68% at 9 years. Conclusion: The results of second-generation ceramic first MP joint replacement in our series demonstrated poor clinical and radiological results with a high revision rate. Level of Evidence: Level IV, case series.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714536539|hwp:resource-id:spfai;35/7/690
      Issue No: Vol. 35, No. 7 (2014)
  • Semitendinosus Tendon Autograft for Reconstruction of Large Defects in
           Chronic Achilles Tendon Ruptures
    • Authors: Dumbre Patil, S. S; Dumbre Patil, V. S, Basa, V. R, Dombale, A. B.
      Pages: 699 - 705
      Abstract: Background: Chronic Achilles tendon ruptures are associated with considerable functional morbidity. When treated operatively, debridement of degenerated tendon ends may create large defects. Various procedures to reconstruct large defects have been described. We present a simple technique in which an autologous semitendinosus tendon graft is used to reconstruct defects larger than 5 cm in chronic Achilles tendon ruptures. The purpose of this study was to describe our operative technique and its functional outcome. Methods: Achilles ruptures of more than 6 weeks duration were considered for the study. We treated 35 patients (20 males, 15 females) with symptomatic chronic Achilles tendon ruptures. The mean age was 47.4 years (range, 30 to 59). The smallest defect that we had reconstructed was 5 cm, and the largest was 9 cm in length. The average follow-up duration was 30.7 months (range, 20 to 42). Postoperatively, the strength of gastrocsoleus was measured by manual muscle testing (MMT) in non-weight-bearing and weight-bearing positions. Results: All operated patients showed satisfactory functional outcome, good soft tissue healing, and no reruptures. The preoperative weight-bearing MMT of 2/5 improved to 4/5 or 5/5 postoperatively. In all patients, postoperative non-weight-bearing MMT was 5/5. All patients returned to their prerupture daily activity. Conclusion: We present a technique that is simple, with low morbidity. We believe it is a valuable option especially when allografts are not available. It is inexpensive as suture anchors or tenodesis screws are not used. This can be a useful option if other tendons (flexor hallucis longus, peroneus brevis, etc) are not available for transfer. Level of Evidence: Level IV, retrospective case series.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531228|hwp:master-id:spfai;1071100714531228
      Issue No: Vol. 35, No. 7 (2014)
  • Retrograde Intramedullary Nail With Femoral Head Allograft for Large
           Deficit Tibiotalocalcaneal Arthrodesis
    • Authors: Bussewitz, B; DeVries, J. G, Dujela, M, McAlister, J. E, Hyer, C. F, Berlet, G. C.
      Pages: 706 - 711
      Abstract: Background: Large bone defects present a difficult task for surgeons when performing single-stage, complex combined hindfoot and ankle reconstruction. There exist little data in a case series format to evaluate the use of frozen femoral head allograft during tibiotalocalcaneal arthrodesis in various populations in the literature. Methods: The authors evaluated 25 patients from 2003 to 2011 who required a femoral head allograft and an intramedullary nail. The average time of final follow-up visit was 83 ± 63.6 weeks (range, 10-265). Results: Twelve patients healed the fusion (48%). Twenty-one patients resulted in a braceable limb (84%). Four patients resulted in major amputation (16%). Conclusion: This series may allow surgeons to more accurately predict the success and clinical outcome of these challenging cases. Level of Evidence: Level IV, case series.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531231|hwp:master-id:spfai;1071100714531231
      Issue No: Vol. 35, No. 7 (2014)
  • Plantar Pressure Anomalies After Open Reduction With Internal Fixation of
           High-Grade Calcaneal Fractures
    • Authors: Hetsroni, I; Ben-Sira, D, Nyska, M, Ayalon, M.
      Pages: 712 - 718
      Abstract: Background: Plantar pressure abnormalities after open reduction with internal fixation (ORIF) of intra-articular calcaneal fractures have been observed previously, but high-grade fractures were not selectively investigated and follow-up times were shorter than 2 years. The purpose of this study was to characterize plantar pressure anomalies in patients with exclusively high-grade calcaneal fractures after ORIF with a minimum 2 years of follow-up, and to test the association between plantar pressure distribution and the clinical outcome. Methods: The orthopaedic registry was reviewed to identify patients with isolated high-grade calcaneal fractures (Sanders types III-IV) who were operated on and had a minimum 2 years of follow-up. Sixteen patients were evaluated. Mean age was 47 years and follow-up was between 2 and 6 years. The Pedar-Mobile system was used to measure 3 loading and 3 temporal variables and compare these between the operated and the uninjured limbs. Results: Mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 76 ± 7 at latest follow-up. Bohler’s angle was 5 ± 8 degrees before surgery and 25 ± 7 degrees at latest follow-up. Stance was shorter in operated limbs (P = .001). Timing of the peak of pressure was delayed in operated limbs under the hallux and the second toe (P ≤ .03). Peak pressure, force time integral, and pressure time integral were increased under the lateral midfoot (P ≤ .03) and decreased under the second metatarsal (P ≤ .03). Force time integral was decreased under the first metatarsal (P = .02) and under the hallux and the lateral toes (P ≤ .05). Increased loading under the lateral midfoot and decreased loading under the lateral toes were correlated with poorer clinical outcome (r = –.53, P < .05, and r = .63, P < .01, respectively). Conclusions: Side-to-side plantar pressure mismatch persisted at more than 2 years after ORIF of high-grade calcaneal fractures performed via lateral approach, despite improvement of Bohler’s angle. This was characterized by shortened stance phase, delayed timing of peak of pressure under the hallux and second toe, lateral load shift at the midfoot, and decreased toe pressures in operated limbs. Since loading abnormalities were correlated with the clinical outcome, modifications in treatment strategy that can improve foot loading may be desirable in these cases. Level of Evidence: Level III, case control.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531226|hwp:master-id:spfai;1071100714531226
      Issue No: Vol. 35, No. 7 (2014)
  • A Novel Method of Postoperative Wound Care Following Total Ankle
    • Authors: Hsu, A. R; Franceschina, D, Haddad, S. L.
      Pages: 719 - 724
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714534217|hwp:master-id:spfai;1071100714534217
      Issue No: Vol. 35, No. 7 (2014)
  • Ankle Deformity After High Tibial Osteotomy for Correction of Varus Knee:
           A Case Report
    • Authors: Jeong, B. O; SooHoo, N. F.
      Pages: 725 - 729
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714531230|hwp:master-id:spfai;1071100714531230
      Issue No: Vol. 35, No. 7 (2014)
  • Dorsal Approach for Plantar Plate Repair With Weil Osteotomy: Operative
    • Authors: Watson, T. S; Reid, D. Y, Frerichs, T. L.
      Pages: 730 - 739
      Abstract: In recent years, the role of the plantar plate in lesser metatarsophalangeal joint stability has increasingly been recognized. Tearing or attenuation of the plantar plate often will result in crossover or hammertoe deformity with hyperextension of the MTP joint. Some patients are able to have resolution of painful symptoms with conservative treatment but for those that fail these measures, surgical fixation of the plantar plate is indicated. While, there have been some described techniques for direct repair of the plantar plate, we present a surgical technique through a dorsal approach with a Weil osteotomy which accomplishes great clinical correction of the plantar plate tear and associated toe deformity as well as relief of patient’s pain. Additionally, we believe this technique is safe, efficient and reproducible. Level of Evidence: Level V, expert opinion.
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714536540|hwp:master-id:spfai;1071100714536540
      Issue No: Vol. 35, No. 7 (2014)
  • Appropriate Use Criteria
    • Authors: Pinzur M. S.
      Pages: 740 - 740
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714525568|hwp:resource-id:spfai;35/7/740
      Issue No: Vol. 35, No. 7 (2014)
  • Re: Tibial Stress Fracture Secondary to Half-pins in Circular Ring
           External Fixation for Charcot Foot
    • Authors: Liu, Y; Li, H.
      Pages: 741 - 741
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714534420|hwp:resource-id:spfai;35/7/741
      Issue No: Vol. 35, No. 7 (2014)
  • Author Response
    • Authors: Pinzur M. S.
      Pages: 742 - 742
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714540602|hwp:resource-id:spfai;35/7/742
      Issue No: Vol. 35, No. 7 (2014)
  • Clarification
    • Pages: 743 - 743
      Abstract: Nodzo SR, Miladore MP, Kaplan NB, Ritter CA. Short to Midterm Clinical and Radiographic Outcomes of the Salto Total Ankle Prosthesis. Foot Ankle Int. 2014;35(1): 22-29. (Original
      DOI : 10.1177/1071100713510497)
      PubDate: 2014-07-01T12:37:52-07:00
      Issue No: Vol. 35, No. 7 (2014)
  • Education Calendar
    • Pages: 744 - 744
      PubDate: 2014-07-01T12:37:52-07:00
      DOI: 10.1177/1071100714542594|hwp:resource-id:spfai;35/7/744
      Issue No: Vol. 35, No. 7 (2014)
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