Tarsometatarsal Joint Research Articles

First ray mobility in hallux rigidus, hallux valgus, and normal feet based on weightbearing computed tomography and three-dimensional analysis: A case-control study.

BackgroundHallux valgus and hallux rigidus are disorders affecting the first ray and are associated with hypermobility of this structure. This study aimed to investigate the three-dimensional mobility of each joint of the first ray between feet with hallux valgus or hallux rigidus and healthy feet using weightbearing and nonweightbearing computed tomography (CT). MethodsThis case-control study analyzed 17 feet of 11 healthy volunteers (control group), 16 feet of 16 patients with hallux valgus (HV group), and 16 feet of 11 patients with hallux rigidus (HR group). First, nonweightbearing foot CT imaging was performed in the supine position on a loading device with no load applied, with the legs extended and the ankle in the neutral position. Next, a load equivalent to body weight was applied for weightbearing CT imaging. Distal bone displacement relative to the proximal bone was quantified three-dimensionally under both conditions. ResultsIn the HV group, the talonavicular joint showed significantly greater eversion (P=.011) compared with the control group and significantly greater dorsiflexion (P=.027) and eversion (P<.01) compared with the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (P<.01) and abduction (P=.011) than the control group. For the first tarsometatarsal joint, the HV group showed significantly greater dorsiflexion (P=.014), inversion (P=.028), and adduction (P<.01) than the control group, and greater inversion (P<.01) and adduction (P<.01) than the HR group. Dorsiflexion of the first tarsometatarsal joint was significantly greater in the HR group compared with the control group (P=.026). ConclusionHypermobility of the first ray appears to be three-dimensional: in hallux valgus, it is centered at the first tarsometatarsal joint, while in hallux rigidus it is mainly in the sagittal plane at the first tarsometatarsal joint only. This difference may explain the different deformities ultimately observed in each condition.

Radiological Heatmap of Tarsometatarsal Capsule Locations: A Cadaveric Study

Introduction/Purpose: Minimal invasive proximal metatarsal osteotomy (PMO) offers a successful approach for addressing metatarsus adductus while avoiding exposure of all metatarsals, thereby reducing the risk of complications such as wound infections and non-unions. An important hurdle is the absence of direct visualization for precise osteotomy placement. Staying within the tarsometatarsal (TMT) capsule enhances the chances of better union due to improved blood supply, although operating outside the capsule can aid in correcting more significant deformities. Despite having a macroscopic understanding of anatomical locations through specimens, there has been a lack of prior reports on their mapping in fluoroscopic images. Developing such maps could significantly improve the navigational skills of surgeons. This study aims to present heatmaps that illustrate the positions of distal attachments of TMT capsules. Methods: A total of nine specimens below the knee, devoid of any prior bone or joint abnormalities, were thawed a day prior to the experiments. After dissecting the dorsal skin, neurovascular structures, and tendons, only the bones and capsules remained. Flexible wires were placed alongside the distal edges of TMT capsules, encompassing the 1st, 2nd, 3rd, and 4th tarsometatarsal joints. This arrangement aimed to make the paths of these capsules visible when observed through X-ray imaging. The wires were then securely attached to the structures using a soft tissue adhesive. Fluoroscopy images were captured, including a calibration marker of a known diameter, in addition to taking macroscopic photographs. The specific coordinates of these structures were marked in a three-dimensional space within specialized 3D software. Subsequently, these coordinates were imported into a custom-designed Python script crafted for the purpose of generating heatmaps. Results: The heatmaps were successfully produced encompassing all TMT capsules spanning from the 1st to the 4th, and these were overlaid onto an anteroposterior fluoroscopy image of the foot (refer to Figure 1). This gradient of colors serves as a visual representation of differing magnitudes, with red denoting the most prevalent areas of the distal attachment of the TMT capsule, while blue corresponds to lower occurrences. Conclusion: These heatmaps not only showcase the predominantly observed sites of distal TMT attachments, depicted in red, but also signify diverse deviations, identifiable by the presence of less frequent zones indicated in blue. Consequently, surgeons are advised to consider these findings while planning their osteotomies based on their preferred positions. By furnishing surgeons with an extensive heatmap that outlines potential tarsometatarsal capsule insertions, this research not only furnishes them with a dependable guiding resource but also establishes a foundation for more assured and prosperous minimally invasive midfoot fusion procedures. Figure 1: The heatmap of 1st to 4th tarsometatarsal capsules on AP fluoroscopy.

First tarsometatarsal joint mobility in hallux valgus during gait: A synchronized ultrasound and three-dimensional motion capture analysis

PurposeTo quantify the vertical translation between the first metatarsal and medial cuneiform during the stance phase of gait in young individuals with and without hallux valgus.DesignThis cross-sectional observational study included 34 young adults (male, n = 4; female, n = 30) who were divided into three groups according to the hallux valgus angle: control (< 20°, n = 13), mild hallux valgus (≥ 20° to < 30°, n = 12), and moderate hallux valgus (≥ 30°, n = 9). The mobility of the first tarsometatarsal joint was evaluated during the stance phase using B-mode ultrasound synchronized with a motion analysis system.ResultsThe medial cuneiform shifted more plantar during the early phase in mild hallux valgus and during the middle and terminal phases in moderate hallux valgus than in control. The severity of the hallux valgus was correlated with a trend toward plantar shift of the medial cuneiform. The first metatarsal was located more dorsal than the medial cuneiform; however, there was no significant variation. No significant differences in the peak ankle plantarflexion angle and moment were noted between the groups.ConclusionThe hypermobility of the first tarsometatarsal joint, especially plantar displacement of the medial cuneiform in the sagittal plane, was found in young individuals with hallux valgus during the stance phase of gait, and the mobility increased with the severity of hallux valgus. Our findings suggest the significance of preventing hallux valgus deformity early in life.

Peroneus Brevis to Longus Tendon Transfer in the Treatment of Flexible Progressive Collapsing Foot Deformity: A Cadaveric Study.

Although operative treatment of the flexible progressive collapsing foot deformity (PCFD) remains controversial, correction of residual forefoot varus and stabilization of the medial column are important components of reconstruction. A peroneus brevis (PB) to peroneus longus (PL) tendon transfer has been proposed to address these deformities. The aim of our study was to determine the effect of an isolated PB-to-PL transfer on medial column kinematics and plantar pressures in a simulated PCFD (sPCFD) cadaveric model. The stance phase of level walking was simulated in 10 midtibia cadaveric specimens using a validated 6-degree of freedom robot. Bone motions and plantar pressure were collected in 3 conditions: intact, sPCFD, and after PB-to-PL transfer. The PB-to-PL transfer was performed by transecting the PB and advancing the proximal stump 1 cm into the PL. Outcome measures included the change in joint rotation of the talonavicular, first naviculocuneiform, and first tarsometatarsal joints between conditions. Plantar pressure outcome measures included the maximum force, peak pressure under the first metatarsal, and the lateral-to-medial forefoot average pressure ratio. Compared to the sPCFD condition, the PB-to-PL transfer resulted in significant increases in talonavicular plantarflexion and adduction of 68% and 72%, respectively, during simulated late stance phase. Talonavicular eversion also decreased in simulated late stance by 53%. Relative to the sPCFD condition, the PB-to-PL transfer also resulted in a 17% increase (P = .045) in maximum force and a 45-kPa increase (P = .038) in peak pressure under the first metatarsal, along with a medial shift in forefoot pressure. The results from this cadaver-based simulation suggest that the addition of a PB-to-PL transfer as part of the surgical management of the flexible PCFD may aid in correction of deformity and increase the plantarflexion force under the first metatarsal. This study provides biomechanical evidence to support the addition of a PB-to-PL tendon transfer in the surgical treatment of flexible PCFD.

Lapidus Arthrodesis for Correction of Hallux Valgus Deformity: A Systematic Review and Meta-Analysis.

The aim of this study was to evaluate and compare different fixation methods to achieve Tarsometatarsal joint I (TMT-1) arthrodesis in patients with hallux valgus regarding radiographic correction, complication profile, and clinical outcomes. A systematic review and meta-analysis included primary literature results of evidence level 1 to 3 studies in German and English. Inclusion and exclusion criteria were established and applied, along with parameters suitable for comparison of data. 16 studies with a total of 1176 participants met the inclusion criteria for this analysis. Twelve evaluation criteria were compared among 3 fixation techniques; comprised of a screw-only, dorsomedial plating- and plantar plating cohort. There was no statistical difference in deformity correction (both intermetatarsal- and hallux valgus angle), or AOFAS score between the cohorts. The complication rate was 13% in the plantar-, 19.5% in the dorsomedial-, and 24.5% in the screw cohort. Nonunion was seen in 0.7% of participants in the plantar, 1.4% in the dorsomedial, and 5.3% in the screw group. The time until complete weightbearing correlated positively with the development of nonunion, with a coefficient of 0.376 (P = .009). Hardware removal was performed in 11.8% of patients in the dorsomedial cohort, 7.7% in the screw cohort, and 3.6% in the plantar cohort. Based on the results of meta-analysis of heterogeneous studies, plantar plating facilitated early weightbearing and patient mobilization compared to the other fixation methods, while carrying the lowest nonunion, hardware removal, and general complication risk. However, owing to the relatively small number of patients in the plantar plating group, more work is necessary to elucidate the benefits of plantar plating for a first tarsometatarsal joint arthrodesis. Development of complications appears to be largely dependent on the fixation model, rather than patient mobilization alone.Level of Evidence: 3.

In-silico techniques to inform and improve the personalized prescription of shoe insoles.

Background: Corrective shoe insoles are prescribed for a range of foot deformities and are typically designed based on a subjective assessment limiting personalization and potentially leading to sub optimal treatment outcomes. The incorporation of in silico techniques in the design and customization of insoles may improve personalized correction and hence insole efficiency. Methods: We developed an in silico workflow for insole design and customization using a combination of measured motion capture, inverse musculoskeletal modelling as well as forward simulation approaches to predict the kinematic response to specific insole designs. The developed workflow was tested on twenty-seven participants containing a combination of healthy participants (7) and patients with flatfoot deformity (20). Results: Average error between measured and simulated kinematics were 4.7 ± 3.1, 4.5 ± 3.1, 2.3 ± 2.3, and 2.3 ± 2.7° for the chopart obliquity, chopart anterior-posterior axis, tarsometatarsal first ray, and tarsometatarsal fifth ray joints respectively. Discussion: The developed workflow offers distinct advantages to previous modeling workflows such as speed of use, use of more accessible data, use of only open-source software, and is highly automated. It provides a solid basis for future work on improving predictive accuracy by adapting the currently implemented insole model and incorporating additional data such as plantar pressure.

Midfoot width changes after first metatarsal osteotomy in hallux valgus surgery: A biomechanical effect?

Hallux valgus is a challenging pathology characterized by a valgus deformity in the metatarsophalangeal area of the first ray. The aim of this study was to analyze the influence of first metatarsal osteotomy on the relationship between midfoot bones in patients with hallux valgus. The sample consisted of patients from the orthopedics and traumatology outpatient clinic who underwent surgical treatment for hallux valgus. Preoperative and postoperative X-rays were compared regarding the width of the midfoot and the tarsometatarsal joint. The sample consisted of 17 women, with 22 feet assessed in each group. The distance from the medial cuneiform to the cuboid, the distance from the intermediate cuneiform to the cuboid, the distance between the first and fifth metatarsals, and the distance between the second and fifth metatarsals reduced significantly between pre- and postoperative assessments. Hallux valgus correction through osteotomy of the first metatarsal leads to a structural change in the midfoot. Further studies should determine whether these changes persist over time.

An unusual case report: Dorsal dislocation of the intermediate cuneiform associated with a lateral cuneiform fracture

Introduction: The intermediate cuneiform, positioned between the medial and lateral cuneiform bones, takes on a wedge shape and is firmly connected to the first metatarsal through robust ligaments. It is recessed at the second metatarsal base and forms the “keystone” of the Lisfranc tarsometatarsal joint complex. An isolated dislocation of the cuneiform is an exceedingly uncommon injury. Dislocation of intermediate cuneiform with non-displaced lateral cuneiform fracture is so rare that is worthy of report. Case report: A 35-year-old man, presented to the emergency department, after a closed trauma to the left foot resulting from a sport accident, involving a mechanism of plantar hyperflexion. The initial clinical examination of his foot revealed swelling and tenderness on dorsomedial aspect of the left foot. An initial plain radiograph showed dorsal dislocation of the intermediate cuneiform bone and a nondisplaced fracture of the lateral cuneiform. Discussion: Closed reduction has little chance in these injuries. Although the failure rates of closed reduction are high, it should be attempted before open procedures. In this case, closed reduction was successful. Due to the rarity of this injury and technique, our case adds to the literature a novel reduction method.

Assessing the Biomechanical, Kinematic, and Force Distribution Properties of the Foot Following Tarsometatarsal Joint Arthrodesis: A Systematic Review

The Lisfranc joint connects the forefoot to the midfoot. Tarsometatarsal (TMT) arthrodesis is commonly employed for Lisfranc joint injuries; however, there is active discussion regarding the optimal method of fixation for TMT arthrodesis. The purpose of this systematic review is twofold: to assess the stability of various constructs used in TMT arthrodesis and to evaluate joint motion and force distribution in the foot following arthrodesis. The PubMed, CINAHL, MEDLINE, and Web of Science databases were searched for articles evaluating biomechanical and kinetic properties of TMT arthrodesis constructs in accordance with PRISMA guidelines. The preliminary search yielded 367 articles and the final review included 14 articles with 195 cadaveric and 70 synthetic bone constructs. Plantar plates and intramedullary screw fixation at the first TMT joint were consistently found to bear significantly greater loads and resist diastasis more effectively than crossed screws. Furthermore, whole foot and lateral column arthrodesis significantly elevate calcaneocuboid and lateral column pressures. This increase was not observed with isolated fourth or fifth TMT arthrodesis. TMT arthrodesis should aim to avoid the lateral column and fuse as few joints as possible. Overall, plantar plates are an effective construct for first TMT arthrodesis due to their ability to withstand both compressive and tensile forces while maintaining stable alignment of the foot via reinforcement of the transverse arch. Intramedullary fixation devices are an alternative option that provide a high degree of active compression across the joint space while avoiding irritation of surrounding soft tissue structures.

Subchondral bone sequestrum formation in the proximal intra-articular and osteochondral region of the third metatarsal bone of an Appaloosa mare treated for septic arthritis

Abstract OBJECTIVE To raise awareness of the potential for intra-articular subchondral bone sequestrum formation secondary to a traumatic or septic process to enable more rapid identification of this uncommon but possible outcome in future cases. ANIMAL A client-owned 12-year-old Appaloosa mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The mare had a wound to the lateral aspect of the fourth metatarsal bone (MT4) that communicated with the distal tarsal joints. Radiographs revealed a displaced, comminuted fracture of MT4. TREATMENT AND OUTCOME The horse underwent aggressive debridement of the wound and MT4 as well as, on 2 occasions, needle joint lavage. Systemic, regional, and IA antibiotic therapy was also performed together with a bone graft from the tuber coxae. The horse’s comfort improved, and the wound appeared to be healing. Five weeks following discharge, the horse re-presented with a non–weight-bearing lameness and radiographs revealed marked osteomyelitis of the tarsometatarsal and distal intertarsal joints. Postmortem examination of the limb identified a sequestrum within the proximal articular surface of the third metatarsal bone. CLINICAL RELEVANCE The present report highlights the importance of arthroscopic lavage to visualize the cartilage surface and the benefits of advanced imaging to detect associated changes within the bone earlier than conventional radiographs. To our knowledge, no reports exist of intra-articular subchondral bone sequestra in the tarsometatarsal joint in horses.

Depth variations of second and third tarsometatarsal joints during dorsal compression staple fixation using two different bridge lengths: an anatomic study

Fusion of the second and third tarsometatarsal joints is utilized for various arthritic pathologies and traumatic conditions. A cadaveric study using 20 fresh-frozen transtibial specimens were used for a stimulated arthrodesis study. Half of the specimens underwent drilling via drill guide for a respective 15 mm and 20 mm dorsal bridge length staples. Each drill guide was placed equidistant from each joint at 7.5 mm for the 15 mm bridge length and 10 m for the 20 m bridge length, then drilled bicortically in parallel with the joint line. For the 15 mm bridge length on the second metatarsal, the mean depth was 22.5 mm ± 2.2, and was 26.7 mm ± 3.8 proximal on the intermediate cuneiform. For the 20 mm bridge length on the second metatarsal, the mean depth was 22.3 mm ± 2.2 and was 27.2 mm ± 2.0 proximal on the intermediate cuneiform. For the 15 mm bridge length for the third metatarsal mean depth was 21.5 mm ± 3.2, and was 24.2 mm ± 2.9 proximal on the lateral cuneiform. For the 20 mm bridge length on the third metatarsal, the mean depth was 20.3 mm ± 2.4 and was 24.6 mm ± 2.4 proximal on the lateral cuneiform. A student's two tailed homoscedastic t-Test was calculated for the 7.5 mm vs 10 mm distal and proximal distances for both second and third TMT data sets and found there was no significant differences in depth.The current study found that for both 15 mm and 20mm bridge lengths for 2nd TMT fusions a 22 mm leg length can be used appropriate and similarly for 3rd TMT fusions, a 20 m leg length appears to be appropriate fixation. Although variations will exist, advances towards indication specific fixation may allow for varied leg length for optimal boney purchase.

Incidence and impact of the presence of tarsometatarsal joint arthritis in patients with hallux rigidus: A retrospective radiographic study

Osteoarthritis is a common condition frequently found throughout various joints in the foot and ankle, including the tarsometatarsal joints (TMTJ) and the first metatarsophalangeal joint (MTPJ). It has been well established that the presence of arthritis and decreased motion in a joint often results in increased stress to the joints immediately distal and proximal. The primary aim of this study was to evaluate the incidence and impact of the presence of TMTJ arthritis in patients with symptomatic end-stage osteoarthritis of the first MTPJ, commonly referred to as hallux rigidus (HR). Retrospective radiographic review was performed on 138 patients with HR. TMTJ arthritis was identified in 27 of 138 (19.6%) of patients with HR, most commonly at the second TMTJ (25/27). Additionally, 30 of 138 (21.7%) patients eventually pursued surgical intervention for painful HR. The presence of TMTJ arthritis was found to be a significant independent risk factor for patients who failed conservative management and needed surgical intervention (p = 0.039). The results of the present study suggest that the presence of TMTJ arthritis has an impact on HR, especially when evaluating the potential failure of conservative management and need for surgical intervention.

Role of laparoscopic lumbar sympathectomy in chronic limb-threatening ischemia due to nonreconstructable peripheral arterial disease

Background Lumbar sympathectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularization for that indication. However, it retains a role in the management of chronic limb-threatening ischemia and other conditions causing lower limb pain with or without ischemia. In this study, we identify its role in the management of chronic limb-threatening ischemia in cases of nonreconstructable peripheral arterial disease. Aim The main aim of this study is to determine if LS procedure has an effective role in limb salvage and pain control for patients with nonreconstructable peripheral limb ischemia. The primary endpoint was limb salvage in the target limb, while the secondary endpoint targeted assessment of pain improvement in the same limb. Patients and methods This study is a prospective single-arm cohort study conducted using 21 patients between the January 1, 2021 and the January 1, 2023 at two hospitals, Ain Shams University Hospital and Nasser Institute Hospital. Patients complained of nonreconstructable peripheral arterial disease and there was no chance for revascularization either endovascular or surgical bypass. Results This study included 60 patients; one patient was excluded due to being lost to follow-up, and presented with nonconstructable critical limb ischemia between the January 1, 2021 and the January 1, 2023. There were 42 (70%) males and 18 (30%) females. Follow-up for all patients was subjected to measurement of ankle brachial pressure index, digital pulse oximetry, toe pressure and numerical rating scale for pain scoring preoperative and postoperative. On follow-up we noticed that there was no change in either ankle brachial pressure index or toe pressure immediately postoperatively and after 12 months. However, the digital pulse oximetry showed significant improvement immediately postoperatively from 68.40±7.36 to 81.15±12.23 with a P value of 0.001. The most remarkable improvement was found in pain scoring immediately, 1, 3, 6, and 12 months postoperatively with P values showing statistical significance. As for limb salvage, there was a 100% limb survival for 3 months. After 6 months, only nine cases underwent above-knee amputation, one of them was due to severe limb infection, and three cases had minor amputation ‘toe amputation.’ We noticed that three out of the nine cases suffering major amputations had femoropopliteal disease. Of the patients, 80% suffered no minor or major amputation, while 15% had major amputations beyond the tarsometatarsal joint and only 5% underwent minor toe amputation or debridement. Fortunately, there was no mortality among the studied cases. Conclusion Retroperitoneoscopic LS is significantly less invasive than open surgical technique with fewer wound complications and less hospital stay period and offers a longer duration of pain relief and less incidence of recurrence of manifestations.

An Unusual Presentation of Low-grade Chondrosarcoma of the First Metatarsal Bone requiring extensive Resection: A Case Report

Chondrosarcoma (CS) is one of the common malignant bone tumours arising from chondrocytes with variable degrees of malignancy. It is mainly noted in flat bones like the pelvis and scapula, and sometimes in long bones like the proximal femur. This case report describes a 40-year-old female who presented with pain over her right great toe for six months and swelling for four months. An open biopsy revealed low-grade CS. Subsequently, the patient underwent amputation of the first ray till the tarsometatarsal joint with meticulous dissection of the tumour mass. At eight years of follow-up, the patient had no recurrence and no functional disability. Therefore, in cases of low-grade CS, first ray amputation along with excision of the tumour mass helps avoid recurrence and metastasis, providing a satisfactory functional outcome.

Surgical planning for staple fixation of the first tarsometatarsal joint: An anatomic study

First tarsometatarsal (TMT) arthrodesis is a common procedure utilized by foot and ankle surgeons for the management of a variety of first TMT pathology including hallux valgus and arthritis. The present study was undertaken to determine the average staple leg depth that allows for adequate purchase within the medial cuneiform and first metatarsal base at 2 different staple bridge lengths for dorsal compression across the 1st TMT joint. A cadaveric study was performed using 20 fresh-frozen below knee specimens. After TMT dissection was performed, drill holes were then created from dorsal to plantar and parallel to the first TMT joint at the distances utilized for 20 mm and 25 mm staple bridge lengths. The depths of each drill hole were measured and recorded. The mean medial cuneiform depth corresponding to a 20 mm and 25 mm staple bridge was 31.9 mm +/- 2.8 mm and 31.1 mm +/- 2.1 mm respectively (P-value = 0.38). The mean first metatarsal depth corresponding to a 20 mm and 25 mm staple bridge was 27.9 mm +/- 2.2 mm and 25.4 mm +/- 3.4 mm respectively (P-value = 0.04), showing statistical significance. Based on our anatomic data it is suggested that a 20 mm staple leg depth is consistently a safe depth when using 20×20 and 25×20 mm dorsal compression staples. However, further studies must be conducted to compare the amount of compression between the two respective staples.

MRI ankle in juvenile idiopathic arthritis and its comparison with clinical disease activity scores

Objectives: Juvenile idiopathic arthritis (JIA) is a common cause of morbidity and consequent disability among youth up to 16 years of age. Our study aims to image the ankle joints of JIA patients and correlate the findings with the clinical disease activity scores. Juvenile Arthritis Disease Activity Score (JADAS-27) is used by pediatricians to assess disease activity in JIA patients. There are four factors that determine this score – Global assessment of disease activity by the physician as well as patient/parent, joint count with active disease, and erythrocyte sedimentation rate (ESR). However, these clinical scores are dependent on the clinician’s experience and observation and, therefore, subjective. Material and Methods: Thirty patients of either sex with a clinical diagnosis of JIA as per the International League of Association for Rheumatology definition with clinically involved ankle joints were included in the study. Chronic arthritis due to other causes, such as infection, trauma, and so on, was excluded. All clinically diagnosed cases of JIA were subjected to magnetic resonance imaging (MRI) evaluation on Siemens Skyra 3 Tesla High-Resolution MR system using a dedicated coil for the ankle joint. Six sub-joints for each patient are evaluated, namely - The tibiotalar joint, subtalar joint, calcaneocuboid joint, calcaneonavicular joint, naviculocuneiform joint, and tarsometatarsal joint. Image analysis and scoring shall be done for each patient at each joint as per the Juvenile Arthritis MRI SCORE, consisting of the following parameters-synovial hypertrophy score, cartilage lesion score, bone erosion score, and bone marrow change score. Each of these scores is calculated individually based on the percentage of involved bone volume. All individual scores were summed to get the total MRI Score. The data collected were then statistically analyzed. Results: A positive correlation was sought between the JADAS-27 score and the total MRI score with the P-value being 0.03. A positive correlation was also found between the total MRI score and the ESR value of the patient (P - 0.02). Conclusion: MRI findings can be a potential marker of disease activity in JIA patients and these findings could also predict the prognosis accurately in these patients. The findings are objective and comparable to the aforementioned clinical scores.

Adverse events related to triplanar 1st tarsometatarsal joint arthrodesis: 5-year analysis of the united states food and drug administration manufacturer and user facility device experience database

BackgroundThe Lapiplasty® 3D Bunion Correction™ system represents an instrumented, jig-guided system to facilitate performing triplanar 1st tarsometatarsal joint arthrodesis. Literature available for this system is positive, although the vast majority is from inventor/consultant surgeons. The purpose of this manuscript is to review adverse event submissions recorded in the Manufacturer and User Facility Device Experience database specific to this system. MethodsThe Manufacturer and User Facility Device Experience database was retrospectively reviewed from inception to 30 June 2023 for adverse events submitted for the Lapiplasty® 3D Bunion Correction™ system. Submissions that involved a medical device product other than this system, duplicate entries, and submissions with data extracted from already published literature were excluded. ResultsA total of 180 unique reports that met inclusion criteria during the 5-year period available were reviewed. The mean time between event occurrence and submission was 46.7-days. The most common entity submitting to the database were the manufacturer company representative or distributor in 66.4%. The most frequently encountered patient problems were pain in 41.9%, non-union in 18.2%, and hardware-related irritation in 11.7%. Reports that detailed a revision surgery described partial/complete hardware removal in 62.7% and revision with additional hardware implantation in 23.3%. ConclusionWhile no direct conclusions regarding the Lapiplasty® 3D Bunion Correction™ system can be drawn from the data as it consists of only adverse event reports, this study demonstrates the need for more non-inventor/consultant literature to further investigate adverse events related this particular system.

X-Ray CT-Based Evaluation of Dorsal Rotation Angles and Axes of the 1st–5th Tarsometatarsal Joints

X-Ray CT-Based Evaluation of Dorsal Rotation Angles and Axes of the 1st–5th Tarsometatarsal Joints

1st to 2nd metatarsal base cross-screw in the modified Lapidus proc

First tarsometatarsal (TMT) arthrodesis or the modified Lapidus (ML) is a common procedure utilized by foot and ankle surgeons for the management large bunion deformities, particularly in the presence of medial column instability. The purpose of the present anatomic study was to assist surgeons in preoperative planning for ML procedure utilizing the first metatarsal to second metatarsal cross-screw technique by assessing the average length of screw guidewire placed bi-cortically through the first metatarsal and second metatarsal at a location specific to the ML procedure with metatarsal to second metatarsal cross-screw technique. This was a cadaveric study utilizing 20 fresh-frozen below-the-knee specimens. After dissection, joint preparation, and stabilization, a cannulated 4.0 screw was then placed across the first and second metatarsal bases from medial to lateral starting 1 cm distal to the 1st TMT joint. Once appropriate length and orientation was achieved the guidewire was measured using a cannulated depth gage and values were then recorded on a spreadsheet and analyzed. Amongst the 20 specimens the mean guidewire length was found to be 34 mm +/- 3.2 mm. The median guidewire length was found to be 34 mm (range: 29 – 41 mm). The present anatomic study defined the mean and median lengths of a first metatarsal to second metatarsal screw utilized for medial column stabilization and spot weld arthrodesis in the ML procedure.

Determination of the Inter- and Intra-rater Reliability of Fusion Assessment in First Tarsometatarsal Joint Arthrodesis Using CT Scan: An Observational Study.

First tarsometatarsal joint arthrodesis is a common procedure performed by podiatrists and orthopedic surgeons. There remains debate on how useful CT scans are in assessing fusion status in the post-operative patient. The purpose of our study was to determine the reliability among both orthopedic surgeons and radiologists in reviewing both postoperative radiographs and CT in order to determine if fusion had occurred in patients undergoing 1st tarsometatarsal arthrodesis. A secondary purpose of this study was to determine if CT offered improved inter- and intra-rater reliability when compared to plain radiographs. Patients who underwent 1st tarsometatarsal arthrodesis were retrospectively reviewed and those who underwent CT post-operatively for persistent pain were identified. Orthopedic surgeons and radiologists then analyzed the radiographs and CT of these patients for union with a threshold for union being set at 50% of the joint being fused. Imaging was then re-evaluated by the same provider 6months later. 24 patients were identified meeting inclusion criteria. Inter-rater reliability and intra-rater reliability for assessment of 1st tarsometatarsal arthrodesis were better with CT compared to radiographs; however, this association was not deemed reliable. Both imaging modalities were not able to assess union status confidently and reliably across reviewers, although CT scan had better intra-rater reliability. While CT is frequently used to assess fusion in patients who have underwent 1st tarsometatarsal arthrodesis, it was not found to be better than radiographs. Practitioners should reconsider the use CT as the gold standard when assessing fusion in this population.