American Orthopedic Foot And Ankle Society Scale Research Articles

Toenail Composite Tissue Flap as a Novel Reconstructive Approach in the Treatment of Macrodactyly of Foot.

The microsurgical technique has been used to dissect macrodactyly into a composite tissue flap with arteries, veins, and toenail phalanxes to reconstruct the deformed toe into a near-normal one. This study retrospectively collected relevant data from ten patients undergoing toenail composite tissue flaps to reconstruct their macrodactyly. This case series included two female and eight male pediatric patients with a mean age of 27.2 months (8-64 months), who had been followed for average 24.3 months after the reconstruction surgery (3-57 months). The American Orthopedic Foot and Ankle Society Scale (AOFAS) score was obtained by the operating surgeons before and after the reconstruction operation while all the patients completed the postoperative questionnaires. The reconstruction surgery took an average of three hours with minimal intraoperative blood loss. The postoperative score of the AOFAS scale was significantly improved from the one before the surgery (33.3+/-12.4 vs. 76.3+/-10, p≤0.001). The average score obtained from the postoperative questionnaires for foot macrodactyly was 9.4 in the range between 0 and 10 for the functional and aesthetic restorations. All reconstructed toes were viable without signs of infection or necrosis and possessed satisfactory function and appearance during the follow-up period after the reconstruction surgeries. It is feasible and effective to dissect a macrodactyly into a composite tissue flap for being reconstructed into a nearly normal toe.

AOFAS and Karlsson-Peterson scales in evaluating patients treated with modified Broström-Gould and suture tape augmentation for ankle instability: a performance analysis

Objective: The objective of this study was to evaluate the performance of the American Orthopedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson scales in patients with lateral ankle instability treated with modified Bröstrom-Gould (MBG) plasty and suture tape augmentation. Methods: This retrospective, bicentric, cohort study involved consecutive patients with lateral ankle instability treated with MBG plasty and suture tape augmentation. The Visual Analog Scale (VAS), AOFAS scale, and Karlsson-Peterson scale were used in pre-/postoperative assessments. Results: Fifty-five patients who underwent MBG plasty and suture tape augmentation were included. Mean preoperative and postoperative VAS scores were 7.1 ± 1.4 and 1.3 ± 1.6 (p<0.001), respectively. Mean AOFAS scores were 61.3 ± 21.1 and 95.4 ± 8.4, respectively (p<0.001). Mean Karlsson-Peterson scale scores were 46.8 ± v14.3 and 95.2 ± v7.9 (p<0.001), respectively. Conclusions: The Karlsson-Peterson scale showed a better performance than the AOFAS scale in the clinical and functional evaluation of patients with ankle instability treated with MBG plasty and suture tape augmentation. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

Does the posterior approach offer advantages in short-term in trimalleolar ankle fractures?

Objective: The aim of this study was to compare the early (nine months after surgery) synthesis of the posterior malleolus by direct posterior (P) approach versus the percutaneous anteroposterior (AP) screw in trimalleolar ankle fractures to analyze the early clinical status of the patient (eight months) by studying the American Orthopedic Foot And Ankle Society (AOFAS) scale to compare postsurgical clinical recovery between both approaches, the rate of hospital days in both groups, the quality of joint reduction by computed tomography (CT) study and the rate of most frequent complications (fibular tendinopathy and surgical wound). Methods: A retrospective comparative study was performed between 2016-2020, including 94 patients with trimalleolar ankle fracture type 44-A/B/C (27 percutaneous AP surgical treatment and 67 P approach). Both groups were compared by analyzing demographic variables, clinical-functional status, radiological variables, and complications. Statistical analysis was performed using SPSS-20, with a p-value of 0.05 as significance. Results: Demographically, both groups were comparable, not finding significant differences between them. An increase in the days of admission before surgery was observed in the P approach with a mean of 4 (p=0.001). No significant clinical differences were found in the AOFAS scale, with a mean of 85 in both groups. Regarding the radiological result, a better reduction was observed with P approach (good=57, fair=9, poor=0) compared to the AP approach (good=10, fair=7, poor=9) (p=0.001). As for the complications, no significant differences were observed for the surgical wound. However, a higher need for fibular plate removal could be observed with P approach (n=17) (p=0.046). Conclusions: Clinically, both groups observed no significant differences through the AOFAS scale. The posterolateral approach has a higher rate of hospital days before surgery. Radiologically, a better joint reduction is achieved by a direct approach to the posterior fragment. Level of Evidence III; Retrospective Comparative Study.

The results and safety of endoscopic plantar fascia release for treatment of chronic plantar fasciitis

BackgroundA prospective study was conducted to evaluate the results of endoscopic plantar fascia release (EPFR) and its safety in treating patients with chronic plantar fasciitis. Patients and methodsThirty patients who had chronic plantar fasciitis for more than 6 months participated in this study from March 2015 to June 2018. Seventeen patients were females, and thirteen were males with an average age of 46 years (ranged between 35 and 52 years). All patients had a failed history of conservative treatment. They were treated with endoscopic plantar fascia release. If a heel spur existed, it was resected by an arthroscopic burr. Pain and functional limitations were evaluated with the American Orthopedic Foot and Ankle Society Scale (AOFAS) and Roles and Maudsley score. ResultsAt the end of follow-up, the mean AOFAS scoring changed significantly from 67 points before surgery to 93 points (P < .0001) which was clinically significant. Sixteen (53.3%) patients had excellent results, 8 (26.6%) patients had good results, 4 (13.33%) patients had acceptable results, and 2 (6.66%) patients had poor results. Three cases complained of postoperative superficial infection at the medial portal. Two cases developed numbness and paraesthesia at the sole of the foot. Three patients had ongoing start-up pain that resolved within two months. The mean duration to full weight bearing after surgery was 40 days. All patients returned to full activities by a mean of 10 weeks. ConclusionEndoscopy offers the optimum solution for the resistant cases, but is not without complications. EPFR should be reserved only for severe cases after a trial period of conservative methods of treatment.

The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis.

To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index. Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I2 = 78.5%) for percutaneous surgery. Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.

Conservative treatment of intra-articular calcaneal fracture

Objective: To evaluate patients who received conservative treatment for a displaced intra-articular calcaneal fracture and to correlate the clinical-functional outcomes with the calcaneus shape measured using radiographs at the last outpatient visit. Methods: A retrospective study was performed with patients who suffered calcaneal bone fractures and were treated nonsurgically between 2006 and 2016. Radiographic (Böhler’s and Gissane’s angles, calcaneal width, talar declination angle, and calcaneal pitch) and clinical-functional parameters (American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) pain scores and personal satisfaction) were evaluated. Results: We found no relationship between the measured angles and the clinical-functional outcomes. Conclusion: Despite the small number of cases evaluated in this study, the clinical-functional ankle and hindfoot AOFAS scale score was considered satisfactory in most cases. We found no relationship between the calcaneus shape measured using radiographic parameters and the clinical-functional outcome. Level of Evidence IV; Therapeutic Studies; Case Series

Prevalence and associated factors of intra-articular lesions in acute ankle fractures evaluated by arthroscopy and clinical outcomes with minimum 24-month follow-up.

Background:Acute ankle fractures can lead to high rate of concomitant intra-articular lesions which may compromise clinical results. The purpose of this study was to evaluate the incidence of concomitant intra-articular lesions in acute ankle fractures with arthroscopy. We also sought to analyze the relationship between intra-articular lesions and the fracture type, as well as the severity of the fracture.Methods:It was a retrospective cohort study. From April 2014 to December 2015, we have chosen arthroscopy-assisted open reduction and internal fixation (AORIF) for the treatment of unstable acute ankle fractures. All concomitant intra-articular lesions were assessed and documented carefully and prospectively, such as ligament injuries, osteochondral lesions, and tibiofibular syndesmosis injuries. All fractures were classified according to the Lauge-Hansen classification system. The American Orthopedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale was used to assess post-operative function. Statistical comparisons between the intra-articular lesions, the fracture type, and the severity of the presenting fracture were performed using a Chi-squared analysis.Results:Data of 36 patients were analyzed in the study, including 23 supination-type fractures and 13 pronation-type fractures. The incidence of tibiofibular syndesmosis injuries, chondral lesions, and loose bodies were 92%, 72%, and 39%, respectively. Avulsion fractures of the anterior tibiofibular syndesmosis were more commonly found in supination-type fractures than pronation-type fracture (45% vs. 15%, χ2 = 5.78, P = 0.02), which would cause mechanical blocking in the anterior portion of the ankle. On the contrary, chondral lesions were more commonly found in the more severe fractures than mild fractures (86% vs. 53%, χ2 = 4.57, P = 0.03). A mean 41.7 months (range, 33.0–51.0 months) of follow-up was achieved. A mean AOFAS's ankle-hindfoot scale was 96.9, and 97.2% of the patients were satisfied with the procedure.Conclusions:Acute ankle fractures have a high incidence of concomitant intra-articular lesions. Avulsion fractures of the anterior tibiofibular syndesmosis are more commonly found in supination-type fractures. Chondral lesions are related to the severity of the fractures, but not with the classification of the fractures. AORIF can be one reliable solution in dealing with the associated injuries seen with acute ankle fractures.

Terapia de ondas de choque frente a infiltración corticosteroidea en el tratamiento de la fascitis plantar crónica

BackgroundChronic plantar fasciitis (CPF) is a painful condition where the primary goal of treatment is relieve the pain and restore function. Extracorporeal shockwaves therapy (ESWT) has shown efficacy in the treatment of plantar fasciitis with reported few side effects compared to other conservative methods. The purpose of the study is to compare the response to treatment of ESWT against corticosteroid infiltration for PF using VAS (Visual Analogue Scale) and AOFAS (American Orthopedic Foot and Ankle Society's) hind foot scales. Materials & methodsSixty patients with PF were randomized to receive ESWT (group A, n=36) or corticosteroid infiltration (group B, n=24) through a program of random number generation. They were evaluated with VAS and AOFAS hind foot scales before treatment, immediately after treatment and at 3, 6 and 12 months post treatment. ResultsThe two groups were similar in demographic characteristics. Both groups improved during treatment and follow-up period. The mean VAS decreased from 8 to 1.68 (p <0.001) in group A and 6.75 to 1.31 (p <0.001) in group B and presented a mean increase in AOFAS scale from 50.3 to 67.8 (p <0.001) in group A and 51.3 to 66 (p <0.001) in group B at 12 months follow up. At 3 months, the B group presented a lower average score in VAS when compared with patients in group A (1.12 vs 1.96; p=0.035). Finally, follow-up improvement was seen in both groups with no significant differences. DiscussionESWT and corticosteroid injections are both effective in reducing symptoms and increased functionality when applied to patients diagnosed with CPF. Evidence levelII.

Application of pedicled perforator propeller flaps for incision poor healing after lower extremity fracture surgery

Objective To investigate the clinical efficacy of pedicled perforator propeller flaps for incision poor healing after the surgery of lower extremity fractures. Methods A retrospective case series analysis was made on 40 patients managed with pedicled perforator propeller flaps for incision poor healing caused by skin necrosis after surgery of lower extremity fractures from February 2013 to February 2016. There were 28 males and 12 females, with a mean age of 42.7 years (range, 19-65 years). In all, 17 patients were noted with skin necrosis or poor healing of the lateral incision complicated by internal fixation exposure after calcaneal fracture surgery, 11 poor anterior incision healing complicated by poor tendon and internal fixation exposure after pilon fracture surgery, 8 poor medial incision healing complicated by poor internal fixation exposure after distal tibial fracture surgery, and 4 poor lateral incision healing complicated by internal fixation exposure after lateral malleolus fracture surgery. Surgical efficacy was evaluated in terms of the flap survival rate, infection control, elasticity, color and appearance of skin, donor site scar, skin sensation, and patient acceptance. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale was recorded after operation. Results Duration of follow-up was 5-21 months (mean, 12.3 months). One patient suffered from vascular crisis after operation and was cured after symptomatic treatment. All flaps survived with the appearance, color and elasticity close to the surrounding normal skin. Donor sites exhibit no infection and were healed with small scarring. Acceptance was satisfactory in 32 patients and ordinary in 8 patients. According to the AOFAS scale, the results were excellent in 18 patients, good in 21 and fair in 1. Conclusion Perforator pedicled propeller flaps are effective in treatment of incision poor healing after surgery of lower extremity fractures and deserve to be popularized in clinics. Key words: Surgical flaps; Postoperative complications; Propeller flaps

Buttress plate fixation alone or combined with hollow screws for treatment of posterior tibial pilon fractures

Objective To study the effect of buttress plate fixation alone or combined with hollow screw fixation of posterior tibial pilon fractures. Methods A retrospective case series analysis was made on 28 cases of posterior tibial pilon fractures admitted from February 2010 to February 2015. There were 18 males and 10 females, aged from 20 to 65 years (mean, 40.5 years). Klammer classification was type 1 in 10 cases, type 2 in 12 and type 3 in 6. Denis-Weber classification was type B in 26 cases and type C in 2 cases. Fourteen cases had buttress plate fixation, 4 hollow screw fixation through posterior-anterior approach, and 10 buttress plate fixation combined with hollow screws. Fracture reduction, function recovery, incidence of complications, and range of motion of ankle joint were detected after operation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale, Kellgren-Lawrence grading for osteoarthritis and visual analogue scale (VAS) were applied to evaluate clinical efficacy at the final follow-up. Results Operation incision healed by first intention. Anatomic reduction and rigid stabilization were noted in all, except that two cases presented one millimeter gap in the posterior articular surface. Duration of follow-up was 13 to 36 months (mean, 20.6 months). Time to fracture healing was 6 to 10 weeks after operation (mean, 7.5 weeks). No deep incision infection or lower extremity deep venous thrombosis occurred after operation. One case developed epidermal necrosis, and resulted in scar healing by strengthening the dressing. One case developed fibula tendon irritation symptom, and disappeared after the removal of internal fixation. One case developed skin irritation symptom because of the overlong screw, and disappeared after the removal of the screw. One case developed osteoarthritis because of the mild displacement of fracture bone in the process of fixation. One case developed toe flexion deformity two months after operation. AOFAS scale was (88.6±6.4)points at the final follow-up, and differed significantly from that before operation [(32.2±1.3)points] (P<0.05). Kellgren-Lawrence grading zero was noted in 24 cases, grading Ⅰ in 2, grading Ⅱ in 1, and grading in 1. VAS was (0.8±0.3)points at the final follow-up, and differed significantly from that before and after operation [(8.5±1.5)points and (6.3±1.0)points, respectively] (P<0.05). Conclusion Anatomical reduction of posterior tibial pilon fractures can be received by buttress plate fixation alone or combined with hollow screws, which can reduce the complications and attain excellent clinical outcomes. Key words: Tibial fractures; Ankle; Fracture fixation, internal

Evaluación de los resultados de la artrodesis tibiotalocalcánea con enclavado retrógrado como técnica de rescate en 15 casos

Objective To evaluate the usefulness of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in patients with deformity and pain in the tibia-astragalus and sub-astragalus joints. Material and method A retrospective study of 15 consecutive cases (9 men, 5 women), with a mean age of 46 years, in whom a tibiotalocalcaneal arthrodesis using a retrograde nail was performed. Other measures had failed in all the patients. An anamnesis, physical and radiographic examination, details of previous treatments were carried out, as well as functional assessment using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the degree of fusion after surgery with x-rays and CT. Results The most common indication was post-traumatic arthrosis 8 of the 15 cases, followed in frequency by primary arthrosis in 4 cases. Consolidation was achieved in 93% of cases (14 of the 15 patients) in a mean time of approximately 20 weeks and a mean follow up of 20 months. Complications were observed in 73% of patients, with delayed consolidation and pseudoarthrosis being the most important. The mean improvement on the AOFAS scale was 43.8 points, mainly due to the improvement in pain. Conclusion We agree with that published in the literature in considering this a useful rescue technique in patients where previous surgery has failed, and as a procedure of choice in patients with inflammatory arthritic disease. However, it is a demanding technique, with a high percentage of complications, and requires careful selection of the cases and a detailed dialogue on the expectations of the patients.

Evaluation of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in 15 cases

Objective To evaluate the usefulness of tibiotalocalcaneal arthrodesis using a retrograde nail as a rescue technique in patients with deformity and pain in the tibia-astragalus and sub-astragalus joints. Material and method A retrospective study of 15 consecutive cases (9 men, 5 women), with a mean age of 46 years, in whom a tibiotalocalcaneal arthrodesis using a retrograde nail was performed. Other measures had failed in all the patients. An anamnesis, physical and radiographic examination, details of previous treatments were carried out, as well as functional assessment using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the degree of fusion after surgery with x-rays and CT. Results The most common indication was post-traumatic arthrosis 8 of the 15 cases, followed in frequency by primary arthrosis in 4 cases. Consolidation was achieved in 93% of cases (14 of the 15 patients) in a mean time of approximately 20 weeks and a mean follow up of 20 months. Complications were observed in 73% of patients, with delayed consolidation and pseudoarthrosis being the most important. The mean improvement on the AOFAS scale was 43.8 points, mainly due to the improvement in pain. Conclusion We agree with that published in the literature in considering this a useful rescue technique in patients where previous surgery has failed, and as a procedure of choice in patients with inflammatory arthritic disease. However, it is a demanding technique, with a high percentage of complications, and requires careful selection of the cases and a detailed dialogue on the expectations of the patients.