Complex Foot Research Articles

Management and Outcome of Hindfoot Trauma With Concomitant Talar Head Injury.

Background:Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures.Methods:This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years.Results:All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74.Conclusion:Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended.Level of Evidence:Level IV, retrospective case series.

Triple Arthrodesis for Equinovarus Foot using Ilizarov Technique: A Retrospective Study

Introduction: Equinovarus foot deformity is a significant problem in adolescents and its treatment remains challenging. Triple arthrodesis, even though an effective palliative tool in management of complex foot deformity, has its own limitations if it is done for acute deformity correction. Ilizarov technique offers gradual deformity correction, fusion and takes care of many known complications of acute correction. However, there are very few studies about effectiveness and functional outcome of triple arthrodesis for equinovarus deformity when done gradually with an Ilizarov fixator. Aim: To study the effectiveness of triple arthrodesis, performed with Ilizarov technique for equinovarus foot deformity in adolescents and adults and to evaluate the early functional outcome and patient satisfaction rate for this procedure. Materials and Methods: A retrospective analysis of 22 feet in 20 patients with equinovarus foot deformity between January 2015 and December 2018 was done. Patients underwent gradual deformity correction and triple fusion with Ilizarov fixator. Foot was assessed for any residual deformity and shortening. Functional outcome and patient satisfaction were assessed by Ankle Hind Foot Scale (AHFS) and Likert scale, respectively using paired t-test. Final analysis was done with Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Twelve males and eight females with mean age of 15.9±3.4 years fulfilled the inclusion criteria and were included for final analysis of results. Fusion rate was 86.1% with mean union time of 12.5 weeks. Mean AHFS improved from 61.27 before surgery to 76.9 which was statistically significant (p<0.0001). One or more complications were seen in 15 (68.1%) feet but were managed satisfactorily without any significant impact on final outcome. Patient satisfaction rate for the procedure was 80%. After a mean follow-up of 18.1 months, plantigrade foot with equal foot length was obtained in all patients. Conclusion: Triple arthrodesis with gradual deformity correction by Ilizarov technique effectively corrects equinovarus foot deformity and foot length discrepancy. Known complications of acute deformity correction can be avoided with equally good results. It corrects deformity and restores alignment of foot more accurately leading to a high patient satisfaction rate.

Retrospective review of complications following long tourniquet time in foot and ankle surgery

BackgroundTourniquet use is ubiquitous in orthopaedic surgery to create a bloodless field and to facilitate safe surgery, however, we know of the potential complications that can occur as a result of prolonged tourniquet time. Experimental and clinical research has helped define the safe time limits but there is not much literature specific to foot and ankle surgery. MethodsA retrospective review of the postoperative course of patients with prolonged tourniquet time (longer than 180 min) for foot and ankle procedures was done. Data related to the patient factors and the surgical procedure was collected. The length of stay, re-admissions and complications were the important indicators of the individual patient’s recovery. ResultsTwenty patients were identified with longer than 180-min tourniquet times for complex foot and ankle procedures. The average uninterrupted tourniquet time was 191 min. Eight of the twenty procedures were revision surgeries. The average length of stay was 3 days and there were no re-admissions within 30 days. Eight patients (40%) had at least one recorded complication. The complications seen in this group were transient sensory loss, wound issues, superficial infection, ongoing pain and non-union. ConclusionsThis case series has not revealed any major systemic complications resulting from the prolonged tourniquet such as pulmonary embolism or renal dysfunction. Unlike past literature on knee procedures with extended tourniquet times, no major nerve palsies were seen in our patient group. Our understanding of the local and systemic effects of tourniquet is not complete and this study demonstrates that the complications do not necessarily increase in a linear fashion in relation to the tourniquet time.

From Patient to Procedure: The Process of Creating a Custom 3D-Printed Medical Device for Foot and Ankle Pathology.

Three-dimensional (3D) printing technology has advanced greatly over the past decade and is being used extensively throughout the field of medicine. Several orthopaedic surgery specialties have demonstrated that 3D printing technology can improve patient care and physician education. Foot and ankle pathology can be complex as the 3D anatomy can be challenging to appreciate. Deformity can occur in several planes simultaneously and bone defects either from previous surgery or trauma can further complicate surgical correction. Three-dimensional printing technology provides an avenue to tackle the challenges associated with complex foot and ankle pathology. A basic understanding of how these implants are designed and made is important for surgeons as this technology is becoming more widespread and the clinical applications continue to grow within foot and ankle surgery.Levels of Evidence: Level V.

The effects of driving time scales on heating in a coronal arcade

Context. The relative importance of alternating current (AC) and direct current (DC) heating mechanisms in maintaining the temperature of the solar corona is not well constrained. Aims. We aim to investigate the effects of the characteristic time scales of photospheric driving on the injection and dissipation of magnetic and kinetic energy within a coronal arcade. Methods. We conducted three-dimensional magnetohydrodynamic simulations of complex foot point driving imposed on a potential coronal arcade. We modified the typical time scales associated with the velocity driver to understand the efficiency of heating obtained using AC and DC drivers. We considered the implications for the injected Poynting flux and the spatial and temporal nature of the energy release in dissipative regimes. Results. For the same driver amplitude and complexity, long time scale velocity motions are able to inject a much greater Poynting flux of energy into the corona. Consequently, in non-ideal regimes, slow stressing motions result in a greater increase in plasma temperature than for wave-like driving. In dissipative simulations, Ohmic heating is found to be much more significant than viscous heating. For all drivers in our parameter space, energy dissipation is greatest close to the base of the arcade, where the magnetic field strength is strongest, and at separatrix surfaces, where the field connectivity changes. Across all simulations, the background field is stressed with random foot point motions (in a manner more typical of DC heating studies), and, even for short time scale driving, the injected Poynting flux is large given the small amplitude flows considered. For long time scale driving, the rate of energy injection was comparable to the expected requirements in active regions. The heating rates were found to scale with the perturbed magnetic field strength and not the total field strength. Conclusions. Alongside recent studies that show that power within the corona is dominated by low frequency motions, our results suggest that, in the closed corona, DC heating is more significant than AC heating.

Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release

AimThe aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results.MethodsA retrospective review of CFD associated with LLD simultaneous correction utilizing the Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted.ResultsThirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, the ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study.ConclusionThe therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD.Level of evidenceLevel IV, retrospective case series

Foot Care Self-Management in Non-Diabetic Older Adults: A Pilot Controlled Trial.

Self-management can mitigate common foot problems; however, community-dwelling older adults without diabetes rarely receive foot care self-management training. This two-group pilot study examined feasibility and preliminary efficacy of the novel, nurse-led 2 Feet 4 Life intervention. Twenty-nine adults (M age 76 years ± 6.6 years) from two senior centers completed the study (90.6% retention rate). Intervention dosage was one hour/week for four consecutive weeks. Study procedures were safe and feasible. Intervention group participants found the intervention acceptable and valuable. Observed between-group effect sizes were the following: knowledge (4.339), self-efficacy (3.652), behaviors (3.403), pain (0.375) and foot health (0.376). Large effect sizes were observed within-groups and within their interaction for knowledge (1.316), behaviors (8.430), pain (9.796), and foot health (3.778). Effect sizes suggest the intervention impacted foot care outcomes between groups and within individuals over seven months' time. Fully powered studies are indicated to test the intervention in diverse samples with more complex foot problems.

Bone scan with SPECT/CT in children with complex foot and ankle pain: Initial experience of a paediatric tertiary referral centre.

PurposeThis study was designed to review the diagnostic yield of single photon emission computed tomography-computed tomography (SPECT/CT) in children with complex foot/ankle pain.MethodsWe reviewed the records of 33 patients with complex foot and ankle pain referred for SPECT/CT (36 scans) performed between 1st September 2009 to 30th September 2019. All patients had foot and ankle radiographs and 18 out of 33 patients had undergone magnetic resonance imaging (MRI) prior to SPECT/CT. The diagnostic contribution of SPECT/CT was established at the time of the scan during a multi-disciplinary team meeting.ResultsThe patients’ mean age was 13.4 years (range six to 16.5 years) and 58% were female. In total, 18 patients had undergone previous surgical treatment. SPECT/CT was found to have decisive clinical value compared with radiographs and CT/MRI in 28 out of 36 cases. In ten patients it prompted surgical management (coalition excision, arthrodesis), in seven patients it redirected conservative management, in six patients it excluded other pathology and in five patients it showed additional/unexpected focal areas of mechanical stress, thus avoiding surgery. When compared with MRI, SPECT/CT added further clinical information in 13 out of 18 cases. SPECT/CT added decisive clinical value in five out of five patients with accessory ossicles, eight out of nine patients with tarsal coalition, five out of seven patients with surgically treated Congenital Talipes Equinovarus (CTEV) and four out of five patients with neuromuscular feet. In eight out of 36 cases SPECT/CT confirmed the diagnosis without adding significant information.ConclusionsSPECT/CT can identify foci of active mechanical stress at cortical bone level in children with unexplained complex foot and ankle pain, particularly in the multiply operated foot, accessory ossicles and tarsal coalitions.Level of EvidenceIV

Geographic Distribution of Foot and Ankle Orthopaedic Surgeons Throughout the United States

Category:OtherIntroduction/Purpose:Orthopaedic Surgery has become increasingly subspecialized since fellowships were established in the 1970s. Previous investigations within hand and urologic surgery have demonstrated an uneven geographic distribution within these subspecialties. Economic factors can influence surgeon distribution within a particular geographic region. At present, the geographic distribution of orthopaedic foot and ankle (OFA) surgeons in the US is poorly defined. The purpose of this investigation is to determine the geographic distribution of OFA surgeons in the US. We hypothesize that there will be substantial differences in OFA surgeon density throughout the US and that economic factors may play a role in access to subspecialty OFA care.Methods:A current membership list was obtained from the American Orthopaedic Foot & Ankle Society (AOFAS). Active AOFAS members were categorized relative to states and US House of Representatives Congressional Districts. Using publicly available census data, we recorded the population within each state and district as well as the percentage of families and people with income below the federally defined poverty level. Descriptive statistics were utilized for demographic information. The relationship between income level and the number of surgeons was determined using a Pearson correlation. These data were used to generate OFA surgeons per capita at a state and congressional district level. This information was also used to generate choropleth maps comparing surgeon density and poverty.Results:We identified a list of 1,103 active AOFAS members with 1,311 practice addresses. There was an average of 21.2 OFA surgeons per state. There was an average of 0.38 and 0.40 OFA surgeons per 100,000 people in each state and congressional district respectively. The District of Columbia, VT, WY, and NE had the highest OFA surgeon density. WV, KY, NM, RI had the lowest density. 75 congressional districts had no OFA surgeons. There was a statistically significant negative relationship demonstrating that regions with higher levels of poverty had fewer OFA surgeons, with a Pearson correlation coefficient of -0.14, (P-value = 0.008). This relationship is further illustrated in Figure 1.Conclusion:There is wide geographic variation of OFA surgeon density throughout the US. Regions with higher levels of poverty have less access to OFA surgeons compared to regions with lower poverty levels. Understanding these trends may aid in developing both recruitment and referal strategies for complex foot and ankle care in underserved regions.

Combined Internal and External Fixation for Charcot Neuroarthropathy: A Learning Curve

Category:Diabetes; TraumaIntroduction/Purpose:Management of complex foot and ankle deformities secondary to charcot neuroathropathy represents a significant challenge. This is a consequence of medical co-morbidities, vascular disease, peripheral neuropathy, and immune compromise with the surgical challenges of progressive bony defomity and bone resorption. To combat these challenges ‘superconstructs’ have been developed to improve fixation. These aim for fusion beyond the zone of injury with adequate deformity correction all whilst maintaining viability of the soft tissue envelope and mechanical function. This can be achieved with internal fixation using indication specific plates and beaming techniques, external fixation with a circular frame or a combination of the two. The aim of this study was to evaluate of a tertiary referral hospital in the operative management of charcot neuroarthopathy.Methods:This is a retrospective two surgeon case series with all cases jointly operated upon. Cases were identified from a locally held diabetic patient registry as those undergoing charcot foot and ankle reconstruction from 2017 to 2019. No exclusion criteria were outlined. Patient demographics and co-morbidities were collected, pre-op radiological markers (meary’s angle) measured and repeated at 6 weeks and one year. Pre-op radiographs were classifed accroding to brodsky classification. Patient outcomes were recorded of amputation, mortality, ulcer recurrence, reported pain, stable heel, ability to ambulate, need for revision surgery, need for prolonged antibiotics, fusion and surgical complications. PROMS were requested and still awaited at time of submission.Results:Eleven Cases were identified from ten patients, all were included for analysis. Three patients had internal fixation, two had external fixation and six had combined internal with external fixation. Eight patients were Brodsky 1, two patients were Brodsky 3 and one patient was Brodsky 2. Limb salvage was 100% with nil amputations, mortality 0%, ulcer recurrence 0%, 100% improved pain score, and 100% with a stable heel. Meary’s angle improved by a mean of 14o from -16o to -2o at 1 year. Fusion rate determined clinically and radiologically with X-ray was 100% with mean of 129 days and range of (360 - 52). Mean follow-up 454 days and range (547-417). Complications of 2 tibial fractures and 1 deep infection with delayed wound healing.Conclusion:The outcomes of using all three methods is positive with 100% limb salvage, 100% fusion rate, 100% ulcer free and maintenace of Meary’s angle at 1 year post op. We believe that combined internal and external fixation, not widely reported in the literature, is a good option in these cases. The complications reported here were in the first three patients undergoing said technique and represent a learning curve.

Integrated Reconstruction for Chronic Foot Dislocations

Category:Hindfoot; Diabetes; Midfoot/ForefootIntroduction/Purpose:Chronic dislocations of the hindfoot and midfoot are a treatment challenge due to difficulties in achieving re-alignment without bone or soft tissue compromise. Neuropathy and diabetes are often associated with the chronic foot dislocation, and further complicate treatment. Our prior studies with integrated fixation methods (ring external fixation and internal fixation) for severe tibia pilon fractures and deformed, infected neuroarthopathic ankles has shown that internal fixation around the ankle can be safely combined with external fixation in single stage procedures.In this study, a staged approach is utilized to limit bone resection and minimize risks of soft tissue compromise and neurovascualar injury with severe and rigid defomity corrections. The purpose is to assess the results and complications of this surgical treatment approach.Methods:Medical records, clincal evaluation, and radiographs for 9 patients treated with gradual hexapod realignment and staged arthrodesis of chronic foot dislocations were retrospectively reviewed. There were six female and three male patients with a mean age of 59 (range, 43-71) years. Follow-up ranged from 12 months to 12 years. All had neuropathy; seven were diabetic, one CMT, one idiopathic, and one rheumatoid. Dislocation was present for a minimum of 16 weeks (range, 4 to 36 months). Seven patients had preoperative ulcerations. Seven had peritalar dislocations (subtalar and talonavicular), and two had midfoot dislocations (naviculocuneiform-1, talonavicular-1).Treatment protocol included: Surgical stage 1- soft tissue releases and Taylor spatial frame application; gradual correction of dislocation; Surgical stage 2-open arthrodeses with internal fixation and frame modification or removal.Results:All nine patients achieved a stable plantigrade and functional foot position. All fusions healed except for one talonavicular nonunion. All preoperative ulcerations healed. Six patients with peritalar dislocations had frame modification at the time of arthrodesis (mean frame time was 5.9 months). Three patients had frame removal at time of arthrodesis (mean frame time was 3 months). Average time from hexapod realignment to arthrodesis surgery was 8 (range, 3-16) weeks.Outcome with the Reinker/Carpenter scale was 5 excellent, 2 good, and 2 fair. Two peritalar dislocations developed complications; one talonavicular nonunion, and one deep infection. Other complications included further surgery in two midfoot dislocations, two forefoot wire complications, and one ankle deformity during peritalar correction.Conclusion:Staged integrated realignment/arthrodesis for chronic neuropathic foot dislocations resulted in good clinical outcomes with manageable complications. The Taylor spatial frame miter and butt constructs were successful in reducing hindfoot and midfoot dislocations, respectively. There was reliable fusion and ulcer healing with our staged protocol. This case series furthers our successful clinical results with the combined use of ring external fixation and internal fixation methods for complex foot and ankle pathology.

Preoperative Planning for the Foot and Ankle: A Technique Tip

Category:Other; Ankle; Midfoot/ForefootIntroduction/Purpose:Computed tomography (CT) advanced imaging techniques are a valuable tool for orthopedic surgeons when evaluating complex foot and ankle pathology. With advances in CT data processing, surgeons can create custom reformation of the imaging data in real time using postprocessing imaging tools. This article presents a technique describing how to manipulate CT data using two of these tools, multiplanar reformation (MPR) and maximal intensity projection (MIP), to better visualize pathology and allow a more definitive diagnosis preoperatively. Despite their availability on most modern picture archiving and communication systems, most surgeons across orthopaedics disciplines fail to utilize these powerful tools.Methods:Patients with complex midfoot deformities underwent CT scans for diagnosis and preoperative planning. Case 1 underwent percutaneous pinning of multiple metatarsal fractures. Post-operatively she had severe pain localized to the second and third metatarsals. A CT scan obtained in standard axes failed to interpret the multiplanar deformities when viewed initially on PACS. Using MPR/MIP, the axes were rotated to generate a detailed view of the deformities and subsequently template osteotomies. Case two underwent arthrodesis of the second and third tarsometatarsal (TMT) joints for an unstable Lisfranc injury. Post-operatively she presented with severe midfoot pain prohibiting her return to athletics. Radiographs demonstrated normal alignment with hardware obscuring the joints. Standard CT axes were difficult to interpret due to metal artifact and oblique planes of the TMT joints. MPR/MIP reformatting allowed metal artifact reduction through axes adjustment, improving visualization and facilitating diagnosis of nonunion of the second and third TMT fusions.Results:Case One:MIP/MPR allowed manipulation of the CT scan in the axial and coronal planes provided a sagittal reformat of the entire second and third metatarsals. The second metatarsal had a gradual plantarflexion malunion of the diaphysis. The third metatarsal had an acute plantarflexed deformity of the metatarsal neck. Reformatting provided an accurate preoperative template for planned dorsiflexion osteotomies. Case Two: Metal artifact and the oblique orientation of the TMT joints prevented evaluation of previous fusions. MIP/MPR reformatting provided axes which were perpendicular to the TMT joints decreased metal artifact and demonstrated nonunion of the previous fusions. Use of MIP/MPR in this case provided valuable diagnostic information regarding the source of pain and a plan for removal of hardware and revision TMT fusions.Conclusion:The MPR/MIP function is available in most PACS systems and allows customizable CT reformats. The technique is easy to learn and can be done quickly in the office or pre-operative setting. The technology has facilitated streamlined pre- operative planning and improvements in injury visualization numerous times, particularly in complex deformities and trauma. Using MIP/MPR reformats, the authors have been able to identify critical fracture lines and relationships between anatomic structures which may otherwise have been missed or less precisely understood. The authors hope that this article will enhance awareness and encourage others to utilize this powerful technology.

Surgical treatment of severe posttraumatic foot deformity

The surgical treatment of a 17-year-old patient with posttraumatic complex and rigid foot deformity by the transosseous osteosynthesis method by Ilizarov (original frame) is presented in the article. Previously, the patient incurred a fracture of the left tibia. He was treated by open reduction and internal fixation with a plate in the private clinic. Within four years, an equinovarus adductus foot deformity had developed. During our treatment, the deformity of the foot was eliminated without resection of the bones of this segment. After one year of treatment, the patient was satisfied with the functional condition of the foot, its cosmetic appearance, and the absence of pain in the foot. The American Orthopedic Foot and Ankle Society scale score increased significantly from 30 points preoperatively to 82 postoperatively, whereas the visual analog scale (VAS)-pain scale score decreased from 7 to 1. His ankle motion increased from 10 preoperatively to 29 postoperatively. This case demonstrates the possibilities of the Ilizarov method and our approach in the treatment of severe rigid foot deformities by the Ilizarov technique.

Complex foot deformity and Illizarov technique: a record-based study

<p class="abstract"><strong>Background:</strong> Complex foot deformities may occur as a result of trauma, poliomyelitis, osteomyelitis, burn contractures, neuromuscular diseases or may present as a resistant congenital contracture such as clubfoot. The Ilizarov fixator is new and more efficient method in the treatment of orthopedic foot problems. The aim of the study was to assess the outcome of Illizarov technique.</p><p class="abstract"><strong>Methods:</strong> This is a hospital record-based study conducted in 32 patients of foot deformity at orthopedic ward of Navodaya Medical college and Hospital, Raichur. The record- based data was collected in January to July 2019. Data analysis done with SPSS 24.0 version IBM USA.<strong></strong></p><p class="abstract"><strong>Results:</strong> Majority of the subjects were from 0 to 5 years age group i.e. 14 (43.8%). Mean age was 26.2±4.9 years. Majority in our study were males i.e. 71.9%. In majority of the cases, the cause of foot deformity was neglected and relapsed club foot i.e. 12 (37.5%). Treatment period was 22±7 weeks. </p><p class="abstract"><strong>Conclusions:</strong> The Ilizarov method can successfully correct complex foot deformities. Success rate was 90.6%.</p>

Tibial pylon fracture associated with talus fracture and infrasindesmal spiral fibula. Case report and literature review

Combined fractures of the tibial pilon and the adjacent bones are infrequent. We present a case of a 59-year-old female with a complex foot and ankle trauma resulting in an unusual combined ipsilateral fracture of the tibial pilon, talus neck, fibula spiral and dislocation. The fractures were treated by open reduction with anatomic reconstruction. To the best of our knowledge, this combination of fractures has not yet been reported in the literature.

Configuration design and correction ability evaluation of a novel external fixator for foot and ankle deformity treated by U osteotomy.

As a basic osteotomy technique, U osteotomy can be applied for certain complex foot and ankle deformities. Gradual correction cases using Ilizarov apparatus and Taylor Spatial Frame have been reported. This paper proposes a novel parallel distraction apparatus for U osteotomy (PDA-Uos) to supplement the correction equipment for surgeon. Designed with an adjustable structure, the PDA-Uos can adopt different assembly shapes (joint connection points). However, the influence of the change in assembly shape on interference-free workspace and self-structural performance of the external fixator have received little attention. To address this issue and enhance the selection of the most suitable assembly shape for patient, an algorithm to obtain the interference-free workspace of different assembly shapes is proposed based on the inverse position solution of the PDA-Uos. Additionally, correction ability indices are defined according to the requirements of accurately controlled motion and high structural stiffness of the external fixator along the correction path. The results of simulation cases indicate that the interference-free workspace and the correction ability vary according to the assembly shape and thus the proposed method can be used to select an assembly shape with sufficient workspace and the best correction ability before performing correction for a given patient. Graphical abstract.

Оперативное лечение сложных деформаций стоп при ревматоидном артрит

Оперативное лечение сложных деформаций стоп при ревматоидном артрит

Foot salvage using microsurgical free muscle flaps in severely crushed foot with soft tissue defects

ObjectiveManagement of complex foot injuries including skin, tendons, vessels, bone, with soft tissue defects is considered as an orthopedic challenge. Microsurgical free muscle flaps provide the best solution in such cases. Patients and methodsThirty two consecutive cases of complex ankle and foot injuries were treated by skin grafted muscle free flap in one stage procedure after radical debridement. Twenty four were males and 8 were females. Right foot was affected in 26 and left was involved in 6 patients. The average age was 22 years (range 6–33 years). The most common cause of injury was motor car accident. All cases had complex soft tissue defect with bone exposure. All cases were candidate for amputation. Gracilis muscle transfer was done in 26 cases and latissimus dorsi free flap in 6 cases. The average follow up was 38 months. ResultsAll the free muscle flaps survived. The involved bone fracture was united at an average 3 months. No evidence of osteomyelitis was noted. Full weight bearing was restored 3 months post-operatively. All patients were satisfied with the cosmetic appearance and functional capacity of their operated limbs. ConclusionSkin-grafted free muscle flap as one-stage procedure is a good solution for reconstruction of complex ankle and foot injuries.

Effects of teriparatide on fusion rates in patients undergoing complex foot and ankle arthrodesis

BackgroundHere, we determined whether teriparatide treatment would increase fusion rates after foot and ankle arthrodesis by comparing treatment results between patients with high-risk factors for nonunion who received teriparatide against those who did not. MethodsWe retrospectively reviewed 66 consecutive patients who underwent foot and ankle arthrodesis. The inclusion criterion was the presence of at least one of the following risk factors for nonunion after previous foot and ankle arthrodesis: deformity, bone defects, avascular necrosis, and nonunion. Sixteen patients were finally enrolled and divided into 2 groups: 8 patients received teriparatide treatment after fusion surgery (PTH group), and 8 patients did not (control group). ResultsThe fusion rate was significantly greater in the PTH group than in the control group (100% vs 50%). Four patients in the control group developed nonunion, 3 of whom underwent revision fusion; however, all patients received the teriparatide treatment after revision surgery and subsequently achieved union. No significant differences in demographics, fusion sites, and complication rates were found. ConclusionThough the sample size was small, the current study suggests that teriparatide administration may improve fusion rates in patients with high-risk factors for nonunion after foot and ankle arthrodesis.

High Patient Catastrophizing Score Predicts Poor Outcome in the Complex Foot and Ankle Patient

Category:AnkleIntroduction/Purpose:Patients perspective and experience is heavily modulated by their understanding of their pre-operative disability along with their overall coping strategy and life philosophy. It is well appreciated that patient’s catastrophization and emphasis on outcomes can affect their outcome. Given that we are relying on patient-reported outcomes more and more, the orthopedic community must be diligent in differencing patients that may have the same objective outcome vary widely on a patient-centered subjective basis. Catastrophization has been reported to affect outcomes in the arthroplasty litterature and this was the first study to look at its effect in the foot and ankle world.Methods:This current study set out to look at a cohort of complex consecutive foot and ankle cases and describe the relationship between Patient Catastrophizing Score (PCS) and multiple functional outcomes that are used routinely. The PCS has three subcategory rumination, helplessness and magnification. In the end, 46 patients were found to be eligible in the study with an average age of 54.72 ± 14.41 years-old, a majority female 30 / 46 (65.22%), a minority employed at the pre-operative visit 19/46 (41%) and with an average BMI of 26.2 ± 5.56. We used univariate and multivariate regression analysis for further statistical analysis.Results:We found that the mental component of the SF12 had a statistically significant negative effect with the rumination score (-1.03) and the helplessness score (-1.05). There was no statistically significant effect for the physical component of the SF-12. Looking at the FAOS Pain component, it correlated with the PCS rumination and helplessness. Otherwise the FAOS ADL component showed correlation as well with the PCS rumination (M -4.67 (p=0.02) U: -1.85 (0.01)), helplessness (M -5.89 (p = 0.01) U -1.81 (p = 0.001)) and total score (M: 3.74 (p=0.02) U -0.75 (p=0.01)). The FAOS Quality of life component was statistically significant for the rumination score (-11.59) (p > 0.05) and the helplessness score (-9.65) (p = 0.002) also the PCS total (8.54).Conclusion:This study confirms that post-operative patient reported outcome (SF- 12MCS, FAOS) are affected by pre-operative catastrophization scores. This has extensive implications in the patient selection, counselling and tailoring of surgeries offered to patients. This is also a symbolic finding highlighting that certain outcomes measure need to be adjusted or updated. This was a pilot study to capture the initial trend and within the limits of our methodology we would recommend future larger study trials and careful pre-operative selection based on PCS scores.