American Orthopaedic Foot And Ankle Surgery Research Articles

The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy for hallux valgus with severe metatarsal adduction

To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction. From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up. Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference(t=65.781, P<0.05);while no difference in IMA before and after operation(P>0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation(t=3.279, P<0.05), and had difference compared with the latest follow-up(1.16±1.12)(t=4.859, P<0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair. The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.

External fixator combined with three different fixation methods of fibula for treatment of extra-articular open fractures of distal tibia and fibula: a retrospective study

BackgroundTo compare the efficacy of three different fixation methods of fibula combined with external fixation of tibia for the treatment of extra-articular open fractures of distal tibia and fibula.MethodsFrom January 2017 to July 2019, 91 cases of open fractures of distal tibia and fibula were treated with external fixator, and the fibula was fixed with non-fixation (group A, n = 35), plate-screw (group B, n = 30) and Kirschner wire (group C, n = 26). The operation time, intraoperative blood loss, surgical and implants costs, fracture healing time, postoperative complications, and American Orthopaedic Foot and Ankle surgery (AOFAS) scores were compared among the groups.ResultsFour patients were lost to follow-up, and 87 patients were followed up for 5–35 months (average, 14.2 months). The operation time of group C (114.92 ± 36.09 min) was shorter than that of group A (142.27 ± 47.05 min) and group B (184.00 ± 48.56 min) (P < 0.05). There was no difference in intraoperative blood loss among the three groups (P > 0.05). The surgical and implants costs in group C (5.24 ± 1.21, thousand dollars) is lower than that in group A (6.48 ± 1.11, thousand dollars) and group B (9.37 ± 2.16, thousand dollars) (P < 0.05). The fracture healing time of group C (5.67 ± 1.42 months) was significantly less than that of group A (6.90 ± 1.33 months) and group B (6.70 ± 1.12 months) (P < 0.05). The postoperative complications such as fractures delayed union and nonunion in group C (2 cases, 8.00%) is less than that in group A (13 cases, 39.39%) and group B (11cases, 37.93%) (P < 0.05). The wound infection and needle-tract infection did not differ among the three groups (P > 0.05). The excellent or good rate of ankle function was 69.70% in group A, 72.41% in group B and 84.00% in group C, with no statistical difference among the three groups (P > 0.05).ConclusionCompared with simple external fixator fixation and external fixator combined with plate-screw osteosynthesis, external fixator combined with K-wire intramedullary fixation shortens the operative time and fracture healing time, reduced costs and complications of fracture healing, while the blood loss, infection complications and ankle function recovery showed no difference with the other two groups. External fixator combined with plate-screw osteosynthesis had no advantage in treating extra-articular open fractures of distal tibia and fibula when compared with simple external fixation.

Percutaneous hallux valgus surgery: Comparison between mini-invasive Chevron and Bosch osteotomies

Background and objectiveThrough percutaneous approaches, hallux valgus corrections can be performed with minimal soft tissue injury, postoperative pain, and good cosmetic results. Bosch osteotomy and MICA (Minimally Invasive Chevron Akin) have been shown to be effective techniques for the correction of hallux valgus, although there are currently no publications comparing percutaneous techniques with each other. The aim of this work is to compare the radiological and functional results of both techniques. Materials and methodsA retrospective, comparative study was carried out on patients with moderate hallux valgus. They were divided into 2 groups according to the percutaneous technique used: chevron osteotomy and Bosch osteotomy with screw fixation. The metatarsophalangeal, intermetatarsal, and distal articular veneer declination angles of the first metatarsal and the bone consolidation time were evaluated radiologically. The American Orthopaedic Foot and Ankle Surgery (AOFAS) scale was used for functional assessment. Complications were collected during the first year. ResultsThirty-eight patients in each group were included for the study. In each of the groups, the radiological angles were compared preoperatively and at the end of the follow-up, showing statistically significant changes in the 3 variables considered; but no differences were obtained by comparing them with each other. The time of consolidation was also similar in both groups. As for the AOFAS scale, an improvement was obtained with both techniques, but the difference was not significant when comparing them. ConclusionsBoth Bosch and MICA techniques showed comparable results at the end of the monitoring. Further work is needed to determine the advantages of each in the immediate postoperative period.

Cirugía percutánea para hallux valgus: comparación entre osteotomía en chevron y de Bosch

Background and objectiveThrough percutaneous approaches, hallux valgus corrections can be performed with minimal soft tissue injury, less postoperative pain and good cosmetic results. Bosch osteotomy and MICA (Minimally Invasive Chevron Akin) have shown to be effective techniques for the correction of hallux valgus, although there are currently no publications comparing each other. The aim of this study is to compare the radiological and functional results of both techniques. Materials and methodsA retrospective, comparative study was carried out on patients with moderate hallux valgus. They were divided into two groups according to the percutaneous technique performed: Chevron osteotomy and Bosch osteotomy with screw fixation. The metatarsophalangeal, intermetatarsal, and distal articular veneer declination angles of the first metatarsal and the bone consolidation time were evaluated radiologically. The American Orthopaedic Foot and Ankle Surgery (AOFAS) score was used for functional assessment. Complications were registered during the first year. ResultsThirty-eight patients in each group were included for the study. In each of the groups, the radiological angles were compared preoperatively and at final follow-up, showing statistically significant changes in the three variables considered; but no differences were obtained by comparing them with each other. The time of consolidation was also similar in both groups. As for the AOFAS scale, an improvement was obtained with both techniques, but the difference was not significant when comparing them. ConclusionsBoth Bosch and MICA techniques showed comparable results at the end of the follow-up. Further work is needed to determine the advantages of each in the immediate postoperative time.

A Clinicoradiological and Functional Evaluation of Lapidus Surgery for Moderate to Severe Bunion Deformity Shows Excellent Stable Correction and High Long-Term Patient Satisfaction.

Background. Lapidus surgery involving arthrodesis of the first metatarsocuneiform (MTC) joint is an effective procedure for the correction of moderate to severe hallux valgus. The aim of this study was to collect and analyze radiographic data from our institution and determine the extent of first metatarsal shortening associated with the Lapidus procedure. Materials and Methods. A total of 53 patients (54 feet) who underwent arthrodesis of the first MTC joint combined with modified McBride bunionectomy for correction of moderate to severe hallux valgus deformity, between 2010 and 2015 were included in this study. Complete radiographic evaluation and AOFAS (American Orthopaedic Foot and Ankle Surgery) scoring was available for 54 feet. The average preoperative hallux valgus angulation (HVA) was 32° and the average intermetatarsal angle (IMA) was 16°. Results. Excluding 2 patients with postoperative hallux varus the average postoperative HVA correction at last follow-up was 14°. Average postoperative IMA was 9°. Although there was minimal bone resection during preparation of the MTC joint, no significant shortening of the first metatarsal was observed with this procedure. The relative length of the first metatarsal to the second metatarsal changed only 1.3%. Nonunion of the first MTC joint occurred in 10.3%, but only 1 foot was symptomatic requiring revision. The average postoperative hallux AOFAS score was 80.8. In sum, 63% of patients were very satisfied, 27% satisfied with reservations, and 10% were dissatisfied. Conclusion. The Lapidus bunion procedure offers excellent stable correction of moderate to severe hallux valgus deformity with minimal shortening of the first metatarsal and thereby higher patient satisfaction.Levels of Evidence: Level IV: Retrospective case series.

Functional Outcome of Intramedullary Interlocking Nail and Plate Fixation in The Surgical Management in Distal Tibia Fracture: A Comparative Study

Background : On the basis of the fracture location in the bone distal tibia fractures have the second highest incidence of all tibia fractures after the mid-shaft fracture of tibia[1]. we conducted this study comparing functional outcome of intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. The Patients with Distal tibia fracture were grouped in two. Group I patients were treated with Intramedullary interlocking nail; Group II patients were treated with open reduction and internal fixation with Plating. We Assessed patients with Functional recovery between two treatment modality intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. Material and method: A prospective study was conducted in department of orthopaedic. All patients attending the orthopaedic department with extra-articular fracture of distal tibia who met the inclusion criteria were counselled regarding the disease and the study and those willingly consenting to participate in the study were selected. A total of 42 subjects were consecutively recruited for the study. The Patients with Distal tibia fracture who came to our hospital Grouped into Group I and Group II. For each Group, patients were selected consecutively. Group I (n=21) patients were treated with Intramedullary interlocking nail; Group II (n=21) patients were treated with open reduction and internal fixation with Plating. Clinical follow-up examination was performed at 4 weeks, 6 weeks, 10 weeks, 3 months, 6 months and 1 year. All patients were assessed clinically and radiographically with following terms such as tenderness at fracture site, abnormal mobility, infection, pain on movement of knee and ankle joints and antero-posterior and lateral radiographs of the leg for union of fracture. Assessment of the patient with Functional recovery was done with American orthopaedic foot and ankle surgery (AOFAS) minimum 6 months after injury. Result: Our study showed that the mean operating time in nail i.e. Group I was 102.14 minutes, where in Group II 96.67 minutes. Mean union time in Group I was 18.43 weeks and 21.43 weeks in Group II. 2 patients had wound problem in group II. 3 patients complained knee pain from Group I. 3 patients had delayed union, 2 patients had malalignment, and one patient had non-union in Group I. 2 cases had superficial infections and delayed wound healing in Group II. Mean operating time and mean time of healing between Group I and Group II were statistically significant (p<0.05). 6(28.57%) patients had secondary procedure in nailing group. 3 patients had bone marrow aspiration, 2 had nail exchange and one case undergone dynamisation. The functional outcome was assessed by American ankle and foot score (AOFAS). In our study, 12 (57.14%) patients had excellent, 6 (28.58%) patients had good, 2 (9.52%) had fair and 1(4.76%) patients had poor functional outcome from Group I. In group II, 11(52.38%) patients had excellent, 8(38.1%) patients had good and 2(9.52%) patients had fair outcome. The comparison of the various parameters of this study with other published data shows that the results were comparable. Conclusion: Based upon the findings of the present study, both the methods studied are suitable treatments in the surgical management of extra-articular distal tibia fracture. IM nailing shows lower rate of delayed wound healing and superficial infection but more likely to require additional surgeries to achieve union, and probably will have more complaints of pain in their limbs or knee. While plating avoids malunion and knee pain but the functional and efficacy outcomes appear to be similar between the two treatment groups. Therefore, the choice of surgical procedure should be based on the surgeon’s expertise, the clinical circumstances, and especially the patient’s injury pattern.

Functional Outcome of Intramedullary Interlocking Nail and Plate Fixation in the Surgical Management in Distal Tibia Fracture: A Comparative Study

Background : On the basis of the fracture location in the bone distal tibia fractures have the second highest incidence of all tibia fractures after the mid-shaft fracture of tibia[1]. we conducted this study comparing functional outcome of intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. The Patients with Distal tibia fracture were grouped in two. Group I patients were treated with Intramedullary interlocking nail; Group II patients were treated with open reduction and internal fixation with Plating. We Assessed patients with Functional recovery between two treatment modality intramedullary interlocking nail and locking plate fixation in the surgical management of extra-articular distal tibia fracture. Material and method: A prospective study was conducted in department of orthopaedic. All patients attending the orthopaedic department with extra-articular fracture of distal tibia who met the inclusion criteria were counselled regarding the disease and the study and those willingly consenting to participate in the study were selected. A total of 42 subjects were consecutively recruited for the study. The Patients with Distal tibia fracture who came to our hospital Grouped into Group I and Group II. For each Group, patients were selected consecutively. Group I (n=21) patients were treated with Intramedullary interlocking nail; Group II (n=21) patients were treated with open reduction and internal fixation with Plating. Clinical follow-up examination was performed at 4 weeks, 6 weeks, 10 weeks, 3 months, 6 months and 1 year. All patients were assessed clinically and radiographically with following terms such as tenderness at fracture site, abnormal mobility, infection, pain on movement of knee and ankle joints and antero-posterior and lateral radiographs of the leg for union of fracture. Assessment of the patient with Functional recovery was done with American orthopaedic foot and ankle surgery (AOFAS) minimum 6 months after injury. Result: Our study showed that the mean operating time in nail i.e. Group I was 102.14 minutes, where in Group II 96.67 minutes. Mean union time in Group I was 18.43 weeks and 21.43 weeks in Group II. 2 patients had wound problem in group II. 3 patients complained knee pain from Group I. 3 patients had delayed union, 2 patients had malalignment, and one patient had non-union in Group I. 2 cases had superficial infections and delayed wound healing in Group II. Mean operating time and mean time of healing between Group I and Group II were statistically significant (p&lt;0.05). 6(28.57%) patients had secondary procedure in nailing group. 3 patients had bone marrow aspiration, 2 had nail exchange and one case undergone dynamisation. The functional outcome was assessed by American ankle and foot score (AOFAS). In our study, 12 (57.14%) patients had excellent, 6 (28.58%) patients had good, 2 (9.52%) had fair and 1(4.76%) patients had poor functional outcome from Group I. In group II, 11(52.38%) patients had excellent, 8(38.1%) patients had good and 2(9.52%) patients had fair outcome. The comparison of the various parameters of this study with other published data shows that the results were comparable. Conclusion: Based upon the findings of the present study, both the methods studied are suitable treatments in the surgical management of extra-articular distal tibia fracture. IM nailing shows lower rate of delayed wound healing and superficial infection but more likely to require additional surgeries to achieve union, and probably will have more complaints of pain in their limbs or knee. While plating avoids malunion and knee pain but the functional and efficacy outcomes appear to be similar between the two treatment groups. Therefore, the choice of surgical procedure should be based on the surgeon’s expertise, the clinical circumstances, and especially the patient’s injury pattern.

Retrospective analysis of AO 42A-B type tibia fractures treated with percutaneus locked plating and intramedullary nailing

In this study, the results of AO 42A and 42B type tibia fractures treated with intramedullary nail (IMN) and percutaneus locking plate (PLP) were evaluated. The complications were examined, and it was questioned whether the type of fixation had an effect on union time and functional results. Forty-two patients with extraarticular distal tibial fractures were enrolled in this retrospective study. Eighteen patients were treated with closed IMN (Group I) and 24 patients were treated with PLP fixation (Group II). Mean age was 41 (range: 16-70) years; thirty-two of the patients were men. Fractures were classified according to the AO classification system. Union time, functional results and complications (malunion, malalignment, infection) were compared. The American Orthopaedic Foot and Ankle Surgery (AOFAS) scoring was used to compare functional results. The average follow-up period was 20 (12-32) months for Group I and 23 (13-36) months for Group II. The average union time was 16 (12-24) weeks in Group I and 19 (range: 16-24) weeks in Group II (p=0.002). The AOFAS scoring was 85 (range: 69-100) points in Group I and 81 (range: 60-95) points in Group II. The difference in AOFAS scoring was not significant (p=0.06). Two patients had nonunion in Group II. Two patients in Group I and three patients in Group II had malalignment. We suggest that IMN can provide early healing time. Although it is not statistically significant, complication rate was lower and functional results were better in patients treated with IMN.

RETRACTED: A randomised prospective study of two different combined internal and external fixation techniques for distal tibia shaft fractures

External fixation combined with limited open reduction and internal fixation (EF + LORIF) is a well-accepted and effective method for distal tibia shaft fractures, but it was also related to complications. The objective of this study was to compare external fixation combined with closed reduction and internal fixation (EF + CRIF) with EF + LORIF in the treatment of distal tibia shaft fractures, and explore the benefits and defects of these two techniques. Fifty-six patients were randomised to operative stabilisation either by an external fixator combined with two closed titanium elastic nails or by external fixation combined with limited open reduction and internal fixation. Pre-operative variables included the patients’ age, sex, the affected side, cause of injury, Tscherne classification of soft tissue injury, fracture pattern, and time from injury to surgery. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems and other complications, union time, time of recovery to work, the functional American Orthopaedic Foot and Ankle surgery (AOFAS) score. There was no significant difference in the mean operating time (72.6 ± 11.5 vs. 78.5 ± 16.4 min, P = 0.125), the time to union (21.2 ± 11.0 vs. 22.5 ± 12.3 weeks, P = 0.678), the time of recovery to work (25.0 ± 14.5 vs. 26.4 ± 13.6 weeks, P = 0.711), pin track infection (3/28 vs. 4/28, P = 1.000), delayed union (2/28 vs. 3/28, P = 1.000), pain (38.3 ± 1.6 vs. 38.7 ± 1.5, P = 0.339), function (44.4 ± 6.0 vs. 45.0 ± 5.5, P = 0.698), and total AOFAS scores (91.5 ± 7.4 vs. 93.4 ± 6.8, P = 0.322) between the two groups. However, the mean radiation time was longer in the EF + CRIF group than in the EF + LORIF group (2.0 ± 1.2 vs. 0.3 ± 0.1 min, P < 0.01). The EF + CRIF group had no wound complications while the EF + LORIF group had five wound complications, though the difference was not statistically significant (P = 0.052). Acceptable alignment was obtained in 50 patients (22 in EF + CRIF vs. 28 in EF + LORIF, P = 0.023). Two cases with EF + CRIF had a 6 degrees of recurvatum deformity and four had 6–9 degrees of valgus deformity. Our results indicated that both EF + CRIF and EF + LORIF were reliable methods in treatment of distal tibia shaft fractures. EF + CRIF had fewer wound complications and broader indications while EF + LORIF had lower radiation exposure and better alignment.