Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction

Background: Bunionette is a common foot disorder, and several types of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region has become a suitable area for this type of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for a percutaneous approach. Methods: We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent operative correction on a total of 42 feet between 2017 and 2019 after failure of conservative treatment. Clinical outcomes such as pain (visual analog scale [VAS]), function (American Orthopaedic Foot & Ankle Society [AOFAS] Lesser Toe Metatarsophalangeal-Interphalangeal Scale scoring system), personal satisfaction, and complications were evaluated. Radiographic aspects were also examined. Shapiro and Mann-Whitney statistical tests were conducted. The average age of the patients was 69.5 years, and the average follow-up was 13.1 months. Results: After the operative procedure, there was a decrease of 6.6 points on the VAS for pain ( P < .001) and an increase of 34.9 in the AOFAS score ( P < .001). Radiographic correction was achieved for both the fifth metatarsophalangeal angle ( P < .001) and the intermetatarsal angle ( P < .001), which showed decreased values. There was 1 case of superficial infection and 2 cases of nonunion (asymptomatic). A large majority of patients regarded the procedure outcome as satisfactory. Conclusion: This percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity produced improvements in pain and function and a high rate of satisfaction, with a low incidence of complications and a high capacity for correcting the deformity. Level of Evidence: Level II, prospective cohort study.

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Percutaneous Oblique Distal Osteotomy of the Fifth Metatarsal for Bunionette Correction: A Prospective Cohort Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00039 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0003

Author(s):

Gabriel F. Ferraz ◽

Tatiana F. Santos ◽

Daniel Oksman ◽

Miguel V. Pereira Filho

Keyword(s):

Statistical Tests ◽

High Capacity ◽

High Rate ◽

Personal Satisfaction ◽

Superficial Infection ◽

Tailor’S Bunion ◽

Distal Osteotomy ◽

Low Incidence ◽

And Function ◽

Suitable Area

Category: Lesser Toes; Midfoot/Forefoot Introduction/Purpose: Bunionette is a very common foot disorder, and several kinds of corrective surgery have been described. With the popularization of minimally invasive surgeries, the forefoot region became a suitable area for this kind of technique. The aim of this study was to evaluate the results of oblique distal osteotomy of the fifth metatarsal adapted for the percutaneous approach. Methods: We prospectively evaluated 31 consecutive tailor’s bunion patients who underwent surgical correction after failure of conservative treatment between 2016 and 2019, totaling 42 feet. Clinical outcomes such as pain (VAS), function (AOFAS), criteria of personal satisfaction, and complications were evaluated. Radiographic aspects were also included. The Shapiro and Mann- Whitney statistical tests were run in the Stats package within the R environment. Results: The average age of the patients was 69.54 years, and the average follow-up was 13.14 months. There was a decrease of 6.67 points in the VAS for pain (p<0.001) and an increase of 34.94 in AOFAS (p<0.001) after the surgical procedure. Radiographic correction was achieved at both the fifth metatarsophalangeal angle (p<0.001) and intermetatarsal angle (p<0.001), which showed decreased values. There was one case of superficial infection and two cases of nonconsolidation (asymptomatic). A large majority of patients considered the procedure outcome satisfactory. Conclusion: The percutaneous oblique distal osteotomy of the fifth metatarsal for bunionette deformity showed improvement in pain and function and a high rate of personal satisfaction with a low incidence of complications and high capacity to correct the deformity.

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Sliding Oblique versus Segmental Resection Osteotomies for Lesser Metatarsophalangeal Joint Pathology

Foot & Ankle International ◽

10.3113/fai.2008.1009 ◽

2008 ◽

Vol 29 (10) ◽

pp. 1009-1014 ◽

Cited By ~ 25

Author(s):

Rishi Garg ◽

David B. Thordarson ◽

Mark Schrumpf ◽

Deborah Castaneda

Keyword(s):

Surgical Technique ◽

Metatarsophalangeal Joint ◽

Segmental Resection ◽

High Rate ◽

Metatarsal Osteotomy ◽

Retrospective Case ◽

Level Of Evidence ◽

Joint Pathology ◽

Wound Healing Problems ◽

American Orthopaedic

Background: Oblique shortening osteotomy (Weil) can address lesser MP pathology but can have a high rate of complications. The purpose of this study was to review the results of a modification of the Weil osteotomy, the segmental resection metatarsal osteotomy. Materials and Methods: Between 2004 and 2006, 48 patients underwent the segmental resection osteotomy with a mean followup of 13 (range, 6 to 26) months. All the patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and a questionnaire addressing distances they were able to walk, work limitations, sporting activity, and overall satisfaction. Results: The postoperative AOFAS forefoot score was an average of 87.6 (range, 59 to 100; SD, 10.97) and the overall satisfaction rate was 85.4%. The complication rate was 18.8% for transfer metatarsalgia, 27.1% for floating toes, 35.4% for toe weakness, 14.6% for infection, and 10.4% for wound healing problems. Conclusions: Despite the complications, the patients who underwent segmental osteotomy were satisfied with the outcome for lesser MTP joint pain and deformity. This is a preliminary study with significant refinement of the operative method as detailed in the surgical technique section. Further followup will elucidate whether additional changes are necessary in the surgical technique. Level of Evidence: IV, Retrospective Case Study

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Cheilectomy With or Without Cryopreserved Amniotic Membrane–Umbilical Cord Allograft for Hallux Rigidus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420967999 ◽

2021 ◽

Vol 6 (1) ◽

pp. 247301142096799

Author(s):

Sara Heintzman Galli ◽

Chad M. Ferguson ◽

W. Hodges Davis ◽

Robert Anderson ◽

Bruce E. Cohen ◽

...

Keyword(s):

Range Of Motion ◽

Umbilical Cord ◽

Amniotic Membrane ◽

Hallux Rigidus ◽

Level Of Evidence ◽

Motion Data ◽

Significant Difference ◽

Pain Outcomes ◽

American Orthopaedic ◽

And Function

Background: For hallux rigidus, dorsal cheilectomy remains a treatment option even with advances in interposition techniques and devices. Cheilectomy aims to alleviate dorsal impingement and improve pain and function as well as range of motion. Cryopreserved umbilical cord allograft, with properties to mitigate inflammation and scar formation, has theoretical benefit for improving outcomes following cheilectomy. In this first prospective randomized and blinded cheilectomy study reported, we aimed to compare outcomes between cheilectomy alone and cheilectomy with umbilical cord allograft. Methods: Patients were randomized to cheilectomy alone (CA) or cheilectomy with cryopreserved umbilical cord (ie, amniotic membrane–umbilical cord [AM-UC]). Patients were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS), Foot Function Index (FFI), and visual analog scale (VAS) pain outcomes collected preoperatively and at 6 months and 1 year postoperatively. In addition, radiographic range of motion data were collected using stress radiographs. Fifty-one patients (26 AM-UC, 25 CA) completed the study, with 5 bilateral surgeries in the AM-UC group and 2 in the CA group, totaling 31 and 27 feet, respectively. Results: The AM-UC group had statistically significant improved AOFAS and FFI scores at 1 year compared with the CA group, but there was no difference at 6 months. There was no significant difference between groups for VAS-pain scores at any time point, but overall VAS-pain improved in both groups from preoperative values. There was no significant difference in range of motion (total arc) between groups and changes in range of motion (total arc) in both groups from preoperative to 1 year postoperative were small. Conclusion: We present the results of the first randomized and blinded prospective study of cheilectomy surgery patients. When appropriately selected, cheilectomy remains a good option for patients with symptomatic hallux rigidus. Cryopreserved umbilical cord is a potential adjuvant to cheilectomy, with 1-year results showing improvements in functional outcome scores. Level of Evidence: Level II, prospective comparative study.

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Improved Injection Technique of Ethanol for Morton’s Neuroma

Foot & Ankle International ◽

10.1177/1071100720903096 ◽

2020 ◽

Vol 41 (5) ◽

pp. 590-595

Author(s):

Christof Pabinger ◽

Isabella Malaj ◽

Harald Lothaller ◽

Elena Samaila ◽

Bruno Magnan

Keyword(s):

Success Rate ◽

Daily Life ◽

Short Form ◽

High Rate ◽

Injection Technique ◽

Morton’S Neuroma ◽

Level Of Evidence ◽

Localization Technique ◽

Morton's Neuroma ◽

American Orthopaedic

Background: Morton’s neuroma is a common cause of forefoot pain. Various conservative methods (injections of various pharmacologic agents) have been published with an outcome of 6%-75% success rate (free of pain in daily life) per injection. The aim of the present study was to assess the outcome of an improved localization technique, a higher dosage, and a higher percentage of ethanol. Methods: Using fluoroscopic and electroneurographic guidance, 2.5 mL of 70% ethanol were injected into 33 feet with a magnetic resonance imaging (MRI)–verified neuroma. We evaluated patients at up to 5-year follow-up. Results: A “success rate” of more than 82% per single injection (defined as free of pain in daily life) was achieved and no recurrence was seen over 5 years. All scores (visual analog scale; Short Form–36 subscales, American Orthopaedic Foot & Ankle Society ankle-hindfoot score) showed significant improvement ( P < .0001). Mean 1.2 injections were necessary. No significant side effects were seen. However, some mild pain persisted in some patients who participated in sports. Conclusion: The injection of 2.5 mL of 70% ethanol under fluoroscopic and electroneurographic guidance was a safe method for the treatment of MRI-verified Morton’s neuromas. Combining the effect of a higher percentage of alcohol and a higher dosage and an improved localization technique resulted in a high rate of patients without pain. Level of Evidence: Level IV, cases series, prospective.

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Rates of Displacement and Patient-Reported Outcomes Following Conservative Treatment of Minimally Displaced Lisfranc Injury

Foot & Ankle International ◽

10.1177/1071100719895482 ◽

2019 ◽

Vol 41 (4) ◽

pp. 387-391 ◽

Cited By ~ 3

Author(s):

Pengchi Chen ◽

Nathan Ng ◽

Gordon Snowden ◽

Samuel P. Mackenzie ◽

Jamie A. Nicholson ◽

...

Keyword(s):

Conservative Treatment ◽

Patient Reported Outcome ◽

University Teaching ◽

High Rate ◽

Level Of Evidence ◽

Patient Demographics ◽

Patient Reported ◽

Fracture Dislocations ◽

American Orthopaedic ◽

Lisfranc Injuries

Background: While surgery is indicated in Lisfranc fracture-dislocations, the natural history and optimal management of minimally displaced injures are unclear. The aim of this study was to define the rate of subsequent displacement and to determine the clinical outcome after conservative treatment of minimally displaced Lisfranc injuries. Methods: Over a 5-year period (2011-2016), 26 consecutive patients with minimally displaced Lisfranc injuries presenting to a single university teaching hospital were identified retrospectively using hospital electronic records. Patient demographics, injury mechanism, and radiological outcomes were recorded. Patient-reported outcome scores (PROMS) were collated at least 1 year postinjury and included the American Orthopaedic Foot & Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ). Results: The rate of displacement was 54% (14/26). The median time to displacement was 18 days (range, 2-141 days). Forty-six percent (12/26) of the Lisfranc injuries remained minimally displaced after 12 weeks of conservative treatment. Initial weightbearing status was not associated with the risk of subsequent displacement ( P = .9). At a mean follow-up of 54 months, PROMS were comparable between patients whose injury remained minimally displaced and those that required surgery for further displacement, despite the delay to surgery (AOFAS 78.0 vs 75.9, MOXFQ 24.8 vs 26.3, P > .1). Conclusion: There was a high rate of displacement after initial conservative management of the minimally displaced Lisfranc injuries. Subsequent surgical management of displaced injuries resulted in outcomes comparable to those that remained minimally displaced. Level of Evidence: Level III, retrospective comparative series.

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Outcomes of ulnotriquetral split tear repair: a report of 96 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419876066 ◽

2019 ◽

Vol 44 (10) ◽

pp. 1036-1040 ◽

Cited By ~ 2

Author(s):

Nicholas J. Clark ◽

Nicholas Munaretto ◽

David Ivanov ◽

Richard A. Berger ◽

Sanjeev Kakar

Keyword(s):

Range Of Motion ◽

Visual Analogue Scale Pain ◽

Level Of Evidence ◽

Superficial Infection ◽

Excellent Outcome ◽

Pain Scores ◽

Analogue Scale Pain ◽

The Mean ◽

And Function

Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15–77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assessed after a mean follow-up of 21 months (range 6–112 months). Ulnotriquetral split tear repair resulted in substantial improvements in pain and function. The mean Mayo wrist score improved from 57 preoperatively to 81 postoperatively, with 84% of patients achieving a good or excellent outcome. Pain scores decreased from 5.8 to 1.2. Grip improved from 25 kg to 29 kg. There was no significant change in range of motion of the wrist. Complications were noted in eight patients, with three experiencing continued pain, four with dysaesthesia of the dorsal sensory ulnar nerve, and one superficial infection. Arthroscopic ulnotriquetral split tear repair significantly reduced pain and improved Mayo wrist scores. Level of evidence: IV

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The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03993-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hai Huang ◽

Bin-Fei Zhang ◽

Ping Liu ◽

Hong-Li Deng ◽

Peng-Fei Wang ◽

...

Keyword(s):

Pelvic Fractures ◽

Definitive Treatment ◽

Lateral Compression ◽

Level Of Evidence ◽

Conservative Group ◽

Medical Records System ◽

The Stability ◽

And Function ◽

Compression Type

Abstract Background It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. Methods Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients’ baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. Results In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). Conclusions The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. Level of evidence Level III.

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Controllable synthesis of Li3VO4/N doped C nanofibers toward high-capacity and high-rate Li-ion storage

Electrochimica Acta ◽

10.1016/j.electacta.2021.138386 ◽

2021 ◽

pp. 138386

Author(s):

Zhen Xu ◽

Daobo Li ◽

Jie Xu ◽

Junlin Lu ◽

Dongmei Zhang ◽

...

Keyword(s):

High Capacity ◽

High Rate ◽

Controllable Synthesis ◽

Ion Storage ◽

Li Ion

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Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121989729 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712198972

Author(s):

Anis Jellad ◽

Amine Kalai ◽

Mohamed Guedria ◽

Mahbouba Jguirim ◽

Sana Elmhamdi ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Pain Syndrome ◽

Patellofemoral Pain Syndrome ◽

Patellofemoral Pain ◽

Level Of Evidence ◽

Randomized Controlled ◽

Group Standard ◽

Hip Muscle ◽

And Function

Background: Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms ( P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

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