scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

Porous Tantalum as a Structural Graft in Foot and Ankle Surgery

2012 ◽  
Vol 33 (3) ◽  
pp. 179-189 ◽  
Author(s):  
Bernard H. Sagherian ◽  
Richard J. Claridge
Keyword(s):  
Bone Graft ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Porous Tantalum ◽  
Native Bone ◽  
Structural Support ◽  
Ankle Surgery ◽  
Structural Graft

Background: Structural bone grafts are often used in foot and ankle surgery to fill gaps, maintain height, length or correction. Bone graft, whether autograft or allograft, has limitations and disadvantages. With porosity and mechanical properties similar to native bone, porous tantalum has been used successfully in hip and knee applications. This study investigates the potential advantages of porous tantalum as a substitute for conventional bone graft in foot and ankle surgery. Methods: A retrospective review of 27 arthrodesis procedures was performed of foot and ankle procedures using Trabecular Metal™ porous tantalum over a period of 5 years. Twenty-five patients were involved. Mean age at the time of surgery was 63 (range, 41 to 80) years. All the patients had pathologies in the foot and ankle that required arthrodesis with structural graft. Average followup was 27 (range, 12 to 72) months. Results: At final followup the mean American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot / Midfoot score improved from 40.6 (range, 16 to 64) preoperatively to 86.3 (range, 57 to 100) postoperatively ( p < 0.001). When the pain component of the AOFAS was examined, the score improved from a mean of 8.2 (range, 0 to 20) to 35.2 (range, 20 to 40), ( p < 0.001). At the time of last followup, 56% of patients reported no pain, 40% reported mild occasional pain, and 4% reported moderate pain. Conclusion: Porous tantalum therefore, was found to be a viable alternative to conventional bone graft when structural support was required. Level of Evidence: IV; Retrospective Case Series

Triple Nerve Block at the Knee for Foot and Ankle Surgery Performed by the Surgeon: Difficulties and Efficiency

2009 ◽  
Vol 30 (9) ◽  
pp. 854-859 ◽  
Author(s):  
Sokratis E. Varitimidis ◽  
Aaron I. Venouziou ◽  
Zoe H. Dailiana ◽  
Dimitrios Christou ◽  
Apostolos Dimitroulias ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Nerve Block ◽  
Case Series ◽  
Orthopaedic Surgeon ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Simple Method ◽  
Ankle Surgery

Background: Combined nerve blocks at the knee can provide safe anesthesia below the knee avoiding the potential complications of general or spinal anesthesia while reducing the need for opioids in the postoperative period. This study presents the outcomes of a large series of patients that underwent foot and ankle surgery receiving a triple nerve block at the knee. Materials and Methods: Three hundred eighty patients underwent foot and ankle surgery receiving anesthesia with triple nerve block at the knee (tibial, common peroneal and saphenous nerve). Surgery included a variety of bone and soft tissue procedures. The nerve block was performed by an orthopaedic surgeon in the lateral decubitus position. Results: The successful nerve block rate was 91 percent. There was no need to convert to general or spinal anesthesia, although 34 patients (9%) needed additional analgesia intraoperatively. Complete anesthesia required 25 to 30 minutes from the time of performing the block. No complication occurred secondary to the use of the anesthetic agent (ropivacaine 7.5%). Postoperative analgesia lasted from 5 to 12 hours, reducing the need of additional analgesics. Hospitalization averaged 1.4 days (from 0 to 5) with the majority of patients discharged the day after the operation (248/380). A high satisfaction rate was reported by the patients with no adverse effects and complications. Conclusion: We found triple nerve block at the knee to be a safe and reliable method of regional anesthesia providing low morbidity, high success rate, long acting analgesia, and fewer complications than general or spinal anesthesia. It is a simple method that can be performed by the orthopaedic surgeon. Level of Evidence: IV, Retrospective Case Series

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

scholarly journals Arthroscopic-assisted arthrodesis in the foot and ankle. Subtalar, tibiotalar, tibiocalcaneal, and metatarsophalangeal: 25 years of experience

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Luis Perez-Carro ◽  
Carlos Rodrigo-Arriaza ◽  
Lorena Trueba-Sanchez ◽  
Gustavo Gutierrez-Castanedo ◽  
Guillermo Menendez-Solana ◽  
...  
Keyword(s):  
Case Series ◽  
Invasive Procedure ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Non Union ◽  
End Stage ◽  
Mean Time ◽  
Radiographic Union

Objectives: Arthritis of the foot and ankle joints provoke pain and restricts function. The arthroscopic assisted arthrodesis (AAA) is a minimally invasive procedure for end stage arthritis to eliminate pain and achieve painless mobilization, with numerous benefits like faster time to union, less blood loss, less morbidity, less infection rate, and less soft tissue complications compared with open surgery. The objective of this paper is to retrospectively evaluate our case series (136 patients) of arthroscopic assisted foot and ankle fusion that includes the subtalar, tibiocalcaneal, tibiotalar and metatarsophalangeal joint in our last 25 years of practice. Level of Evidence: Level IV, retrospective case series. Materials and Methods: Patients who underwent arthroscopic assisted arthrodesis in the foot and ankle were identified by review of a registry. Minimum follow-up was 24 months. Patient demographics characteristics, time to radiographic union, and preoperative and postoperative American Orthopaedic Foot and Ankle Society score (AOFAS) were obtained. Results: Subtalar fusion: 43 patients. Radiographic union was seen in 40 patients at a mean time of 10 weeks (8-14) and non union was seen in three patients, of which 1 required open revision surgery. AOFAS score improved from 43 preoperatively (27-57) to 83 (67-93) postoperatively. Tibiotalar fusion: 55 patients. Radiographic union in a mean time of 12 weeks (7-15) in all 55 cases. AOFAS score improved from 50.5 preoperatively (25-60) to 82 (62-94) postoperatively. Tibiotalocalcaneal fusion: 3 patients. 2 patients with radiographic union at 14 and 16 weeks and 1 showed a fibrotic union of the subtalar joint without pain. AOFAS score improved from 43 preoperatively (34-58) to 78 (67-81) postoperatively. Metatarsophalangeal fusion: 35 patients. Radiographic union in 33 patients at a mean time of 8 weeks (6-11). Two patients presented asymptomatic non union. AOFAS score improved from 38 preoperatively (30-60) to 86 (75-93) postoperatively. Conclusion: Arthroscopic assisted arthrodesis in the foot and ankle is an excellent procedure for end stage degenerated joint.

scholarly journals Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2517 ◽  
Author(s):  
Michael Tirgan
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Medical Literature ◽  
Preventive Measures ◽  
Case Series ◽  
Retrospective Case ◽  
Ear Piercing ◽  
Keloid Formation ◽  
History Of ◽  
Triggering Factor

Keloid disorder (KD) is an inherited wound healing ailment, frequently seen among Africans /African Americans and Asians.  Genetics of this disorder continues to be obscure and poorly understood.  Clinical manifestation of KD is quite variable and very diverse, spanning from individuals with one or very few small keloidal lesions, to those with numerous and very large lesions covering large portion of their skin. Ears are common locations for development of keloids.  Ear piercing is by far the leading triggering factor for ear keloid formation in genetically predisposed individuals. Although there are numerous publications about ear and earlobe keloids, there is a void in medical literature about massive ear keloids.  This paper focuses on the natural history of massive ear keloids and risk factors that lead to formation of these life-changing and debilitating tumors and recommendations for prevention.

Risk Factors for Failure in Hammertoe Surgery

2020 ◽  
Vol 41 (5) ◽  
pp. 562-571 ◽  
Author(s):  
Rachel H. Albright ◽  
Moiz Hassan ◽  
Jacob Randich ◽  
Robert O’Keefe ◽  
Erin E. Klein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Elective Surgery ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Cox Regression Analysis ◽  
First Ray ◽  
Pip Joint

Background: Hammertoe correction is perhaps the most common elective surgery performed in the foot, yet rates of symptomatic recurrence and revision surgery can be high. In this study, we aimed to identify patient and provider risk factors associated with failure after hammertoe surgery. Methods: Consecutive patients with a minimum of 6 months’ follow-up undergoing hammertoe surgery within a single, urban foot and ankle practice between January 1, 2011, and December 31, 2013, served as the basis of this retrospective cohort study. Cox regression analysis was used to identify important predictor variables obtained through chart and radiographic review. One hundred fifty-two patients (311 toes) with a mean age of 60.8 ± 11.2 years and mean follow-up of 29.5 ± 21.2 months were included. Results: Statistically significant predictors of failure were having a larger preoperative transverse plane deviation of the digit (hazard ratio [HR], 1.03 for each degree; P < .001; 95% CI, 1.02, 1.04), operating on the second toe (vs third or fourth) (HR, 2.23; P = .003; 95% CI, 1.31, 3.81), use of a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint (HR, 2.77; P = .005; 95% CI, 1.36, 5.64), and using less common/conventional operative techniques to reduce the PIP joint (HR, 2.62; P = .03; 95% CI, 1.09, 6.26). Concomitant performance of first ray surgery reduced hammertoe recurrence by 50% (HR, 0.51; P = .01; 95% CI, 0.30, 0.87). Conclusion: We identified risk factors that may provide guidance for surgeons during preoperative hammertoe surgery consultations. This information may better equip patients with appropriate postoperative expectations when contemplating surgery. Level of Evidence: Level III, retrospective case series.

Prevalence and Safety of Left-Footed Driving Following Right Foot Surgery Patients Including a Driving Simulation

2019 ◽  
Vol 40 (7) ◽  
pp. 818-825 ◽  
Author(s):  
Haley M. McKissack ◽  
Yvonne E. Chodaba ◽  
Tyler R. Bell ◽  
Eva J. Lehtonen ◽  
Ibukunoluwa B. Araoye ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Recovery Period ◽  
Significant Proportion ◽  
Case Series ◽  
Postoperative Recovery ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
The Right

Background: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study was to describe the driving habits of patients after right-sided foot surgery and assess the safety of left-footed driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via a REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 volunteer subjects to compare characteristics of left- versus right-footed driving. Results: Thirty-six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left-footed driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more ( P < .001) and hit other vehicles more ( P < .026) when driving with the right foot than the left. The time to fully brake and fully release the throttle in response to vehicular hazards was significantly prolonged in left-footed driving compared with right ( P = .019 and P = .034, respectively). Conclusion: A significant proportion of right foot ankle surgery patients engaged in left-footed driving during postoperative recovery. Driving with both the right and left foot presents a risk of compromised safety. This study provides novel objective data regarding the potential risks of unipedal left-footed driving using a standard right-footed console, which indicates that driving with the left foot may prolong brake and throttle release times. Further studies are warranted for physicians to be able to appropriately advise patients about driving after foot and ankle surgery. Level of Evidence: Level IV, case series.

Surgical Treatment for Stenosing Peroneal Tenosynovitis

2018 ◽  
Vol 40 (3) ◽  
pp. 282-286 ◽  
Author(s):  
Geoffrey I. Watson ◽  
Sydney C. Karnovsky ◽  
David S. Levine ◽  
Mark C. Drakos
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Tendon Sheath ◽  
Symptomatic Improvement ◽  
Peroneal Tendon ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
History Of ◽  
Diagnostic Injection

Background: Stenosing peroneal tenosynovitis (SPT) is an uncommon entity that is equally difficult to diagnose. We evaluated our outcomes with a local anesthetic diagnostic injection followed by surgical release of the sheath and calcaneal exostectomy. Methods: Eleven patients diagnosed with SPT underwent surgery between 2006 and 2014. Upon initial presentation, all patients reported a persistent history of pain along the ankle. Ultrasound-guided injections of anesthetics were administered into the peroneal tendon sheath to confirm the diagnosis. In patients with a confirmed diagnosis of SPT, we proceeded with surgical intervention with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Retrospective chart review was performed, and functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). FAOS results were collected pre- and postoperatively and were successfully obtained at 1 year or greater. Results: Of these patients, all showed significant improvements ( P < .05) in 4 of 5 categories of the FAOS (pain, daily activities, sports activities, and quality of life). Conclusion: We present a case series in which the peroneal tendon sheath was diagnostically injected with anesthetic to confirm a diagnosis of SPT. In each of these cases, symptomatic improvement was obtained following the injection. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe that this diagnostic injection is paramount for the success of surgical outcome. Level of Evidence: Level IV, retrospective case series.

scholarly journals Subsequent Pain or Injury After Foot and Ankle Surgery in Patients Receiving Workers’ Compensation

2019 ◽  
Vol 41 (1) ◽  
pp. 17-24
Author(s):  
Gabrielle Bui ◽  
Yubo Gao ◽  
Natalie Glass ◽  
Christopher Cychosz ◽  
John Lawrence Marsh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retrospective Chart Review ◽  
Anatomical Location ◽  
Workers Compensation ◽  
Foot And Ankle ◽  
Chi Square ◽  
Level Of Evidence ◽  
Legal Representation ◽  
Ankle Surgery

Background: Workers’ compensation (WC) has been associated with poor outcomes following a variety of injuries and surgeries, but rates of subsequent pain or injury (SPI) following surgery have not been studied. The purpose of this study was to investigate the rates, locations, and risk factors of SPI in WC patients and non-WC patients who underwent the same surgeries. Methods: With institutional review board approval, records from foot or ankle surgery performed by author P.P. from 2009 to 2015 were obtained. A retrospective chart review was performed on all WC and non-WC patients with at least 1 Current Procedural Terminology code of interest. SPI was defined as a new injury at a different anatomical location occurring 2 months to 2 years after the index surgery. Chi-square and 2-tailed t tests were used to compare risk factors and rates of SPI in both groups. Results: The WC population had higher rates of SPI than the non-WC population. Specifically, 13 of 56 WC patients (23.2%) vs 12 of 165 non-WC patients (7.3%) reported SPI ( P = .001). The hip, knee, and contralateral foot and ankle were common areas of SPI in both groups. Legal representation and increased age were risk factors for SPI in the WC population. Specifically, 10 of 13 WC patients with SPI had legal representation vs 16 of 43 WC patients without SPI ( P = .02). Female sex was a risk factor for SPI in the non-WC population. Conclusions: WC patients had higher rates of subsequent pain or injury than non-WC patients. Legal representation was a risk factor for SPI in the WC population. Level of Evidence: Level III, comparative series.

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