Radiographic Analysis and Patient Reported Outcomes (PROMIS) in Zone 2 and 3 Fifth Metatarsal Fracture Surgery

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Proximal (zone 2 and 3) fifth metatarsal fractures are common fractures. Due to poor blood supply, these fractures are generally treated operatively due to an increased risk of nonunion. A recent study by this group used 3D CT imaging to determine guidelines for choosing the optimal screw. The study found that the screw length should stop short of the bow of the metatarsal and the screw diameter should be larger than the commonly used 4.5 mm screw to ensure endosteal fixation. The purpose of this study is to determine how well these guidelines translate to surgical outcomes, measured using Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Methods: A retrospective review yielded 24 patients with zone 2 or 3 fractures between 2013 and 2016. Twenty-three patients met inclusion criteria and 18 patients completed preoperative and postoperative PROMIS PF and PI surveys. Radiographic measurements included pitch angle, metatarsus adductus angle, AP talo-1st metatarsal angle, Meary’s angle, and medial cuneiform height. Length of the fifth metatarsal, width of the medullary canal at the bow, and distance of fracture from the proximal tip of the fifth metatarsal were also measured. Correlation coefficients were calculated between postoperative PROMIS scores and repair characteristics (radiographic measurements, screw length, and screw diameter). Correlation coefficients were also calculated comparing change in PROMIS scores from preoperative baseline and repair characteristics. T-tests were used to determine the relationship between repair characteristics, PROMIS scores, and incidence of surgical complications - re-fractures (n=3) and non- unions (n=3). Results: The average screw parameters adhered to the guidelines established by our previous study. Average screw length was 42.17+-4.96mm and screw diameter was 5.38+-0.28mm. Preoperatively, PROMIS PI = 57.26+-11.03 and PROMIS PF = 42.27+- 15.45 after injury. Postoperatively, PROMIS PI = 44.15+-7.36 and PROMIS PF = 57.22+-10.93. Patients who had complications had significantly lower postoperative PROMIS PF scores (p=0.0432) compared to patients without complications. There was no significant difference (p>0.05) in other repair characteristics between those with and without complications. Metatarsus adductus angle (MAA) correlated inversely with postoperative PROMIS PF scores (r=-0.478; p=0.045). AP talo--1st metatarsal angle (r=- 0.611; p=0.007), medial cuneiform height (r=-0.59; p=0.01), and screw diameter (r=-0.525; p=0.025) had significant inverse relationships with change in PROMIS PF scores from baseline. Conclusion: Patients treated according to guidelines from our prior study achieved excellent outcomes as measured by PROMIS PI and PF scores. Patients with complications or excessive lateral column loading on radiograph had worse functional outcomes. Larger diameter screws may not be as important clinically as thought in radiographic/cadaveric studies, perhaps because slightly smaller diameter screws allow sufficient endosteal fixation while allowing more functionality through the metatarsal. Future studies should better characterize how screw diameter affects outcomes and whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.

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Radiographic analysis of specific morphometrics and patient-reported outcomes (PROMIS) for surgical repair of zones 2 and 3 fifth metatarsal fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02331-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Rusheel Nayak ◽

Joshua Barrett ◽

Milap S. Patel ◽

Mauricio P. Barbosa ◽

Anish R. Kadakia

Keyword(s):

Patient Reported Outcomes ◽

Correlation Coefficients ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Hardware Complications ◽

Increased Risk ◽

Screw Length ◽

Patient Reported ◽

Metatarsal Fractures ◽

Metatarsus Adductus

Abstract Background Zones 2 and 3 fifth metatarsal fractures are often treated with intramedullary fixation due to an increased risk of nonunion. A previous 3-dimensional (3D) computerized tomography (CT) imaging study by our group determined that the screw should stop short of the bow of the metatarsal and be larger than the commonly used 4.5 millimeter (mm) screw. This study determines how these guidelines translate to operative outcomes, measured using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) surveys. Radiographic variables measuring the height of the medial longitudinal arch and degree of metatarsus adductus were also obtained to determine if these measurements had any effect on outcomes. And lastly, this study aimed to determine if morphologic differences between males and females affected surgical outcomes. Methods We retrospectively identified 23 patients (14 male, 9 female) who met inclusion criteria. Eighteen patients completed PROMIS surveys. Preoperative PROMIS surveys were completed prior to surgery, rather than retroactively. Weightbearing radiographs were also obtained preoperatively to assist with surgical planning and postoperatively to assess interval healing. Correlation coefficients were calculated between PROMIS scores and repair characteristics (hardware characteristics [screw length and diameter] and radiographic measurements of specific morphometric features). T tests determined the relationship between repair characteristics, PROMIS scores, and incidence of operative complications. PROMIS scores and correlation coefficients were also stratified by gender. Results The average screw length and diameter adhered to guidelines from our previous study. Preoperatively, mean PROMIS PI = 57.26±11.03 and PROMIS PF = 42.27±15.45 after injury. Postoperatively, PROMIS PI = 44.15±7.36 and PROMIS PF = 57.22±10.93. Patients with complications had significantly worse postoperative PROMIS PF scores (p=0.0151) and PROMIS PI scores (p=0.003) compared to patients without complications. Females had non-significantly worse preoperative and postoperative PROMIS scores compared to males and had a higher complication rate (33 percent versus 21 percent, respectively). Metatarsus adductus angle was shown to exhibit a significant moderate inverse relationship with postoperative PROMIS PF scores in the overall cohort (r=−0.478; p=0.045). Metatarsus adductus angle (r=−0.606; p=0.008), lateral talo-1st metatarsal angle (r=−0.592; p=0.01), and medial cuneiform height (r=−0.529; p=0.024) demonstrated significant inverse relationships with change in PROMIS PF scores for the overall cohort. Within the male subcohort, significant relationships were found between the change in PROMIS PF and metatarsus adductus angle (r=−0.7526; p=0.005), lateral talo-1st metatarsal angle (r=−0.7539; p=0.005), and medial cuneiform height (r=−0.627; p=0.029). Conclusion Patients treated according to guidelines from our prior study achieved satisfactory patient reported and radiographic outcomes. Screws larger than 4.5mm did not lead to hardware complications, including screw failure, iatrogenic fractures, or cortical blowouts. Females had non-significantly lower preoperative and postoperative PROMIS scores and were more likely to suffer complications compared to males. Patients with complications, higher arched feet, or greater metatarsus adductus angles had worse functional outcomes. Future studies should better characterize whether patients with excessive lateral column loading benefit from an off-loading cavus orthotic or plantar-lateral plating.

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Patient-Reported Outcomes and Radiographic Assessment in Primary and Revision Stage II, III, and IV Progressive Collapsing Foot Deformity Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011421992111 ◽

2021 ◽

Vol 6 (1) ◽

pp. 247301142199211

Author(s):

Rusheel Nayak ◽

Milap S. Patel ◽

Anish R. Kadakia

Keyword(s):

Patient Reported Outcomes ◽

Statistical Significance ◽

Stage Ii ◽

Foot Deformity ◽

Primary Stage ◽

Radiographic Outcomes ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Significant Difference ◽

Patient Reported

Background: Progressive collapsing foot deformity (PCFD) is a progressive hindfoot and midfoot deformity causing pain and disability. Although operative treatment is stage dependent, few studies have looked at patient-reported and radiographic outcomes stratified by primary vs revision stage II, III, and IV reconstruction surgery. Our goal was to assess operative improvement using Patient-Reported Outcomes Measurement Information System (PROMIS) and to determine whether radiographic parameter improvement correlates with patient-reported outcomes. Methods: PROMIS Physical Function (PF) and Pain Interference (PI) scores were prospectively obtained on 46 consecutive patients who underwent PCFD reconstruction between November 2013 and January 2019. Thirty-six patients completed pre- and postoperative PROMIS surveys, 6 patients completed only preoperative PROMIS surveys, and 4 patients completed 12-month postoperative PROMIS surveys but did not complete preoperative PROMIS surveys. Minimum follow-up was 12 (average, 23) months. Radiographic correction was measured with pre- and postoperative weightbearing radiographs and correlated with PROMIS scores. Measurements included the talonavicular uncoverage angle, talonavicular uncoverage percentage, anteroposterior talo–first metatarsal angle, Meary angle, medial cuneiform height (MCH), and medial cuneiform–fifth metatarsal height. Results: For the overall cohort, PROMIS PF increased significantly from 37.5±5.6 to 42.3±7.1 ( P = .0014). PROMIS PI improved significantly from 64.5±6.0 to 55.1±9.8 ( P < .0001). Preoperative, postoperative, and change in PROMIS scores were not statistically different between PCFD stages. Change in PROMIS PI was significantly greater in primary (–12.3) vs revision (–3.7) surgery ( P = .0157). Change in PROMIS PF was greater in primary (+6.0) vs revision surgery (+2.3) but did not reach statistical significance. All radiographic measurements improved significantly ( P < .05). In primary stage II PCFD, postoperative PROMIS scores correlated with postoperative MCH (PF: r = 0.7725, P = .0020; PI: r = –0.5692, P = .0446). Conclusion: Patient-reported and radiographic outcomes improved significantly after PCFD reconstruction. We found no significant difference in preoperative, postoperative, or change in PROMIS scores between PCFD stages. However, stage III patients had smaller improvements in PROMIS PF, which we feel may be secondary to change in function after arthrodesis. Primary operations had better patient-reported outcomes compared to revision operations. In primary stage II PCFD, reconstructing the medial arch height correlated significantly with improvement in pain and functionality. Level of Evidence: Level II, prospective cohort study.

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Does improved radiographic alignment truly enhance dynamic functional balance?

Studies in Health Technology and Informatics - Research into Spinal Deformities 9 ◽

10.3233/shti210433 ◽

2021 ◽

Author(s):

R Haddas ◽

S Kisinde ◽

D Mar ◽

I Lieberman

Keyword(s):

Patient Reported Outcomes ◽

Added Value ◽

Functional Balance ◽

Radiographic Measurements ◽

Patient Reported ◽

Before And After ◽

Gait Abnormalities ◽

The Relationship ◽

Radiographic Alignment

Prospective, concurrent-cohort study. To establish the relationship between radiographic alignment parameters and functional CoE measurements at one week before and at three months after realignment surgery in ADS patients. Adult degenerative scoliosis (ADS) represents a significant healthcare burden with exceedingly high and increasing prevalence, particularly among the elderly. Radiographic alignment measures and patient-reported outcomes currently serve as the standard means to assess spinal alignment, deformity, and stability. Neurological examinations have served as qualitative measures for indicating muscle strength, motor deficits, and gait abnormalities. Three-Dimensional motion analysis is increasingly being used to identify and measure gait and balance instability. Recently, techniques have been established to quantify balance characteristics described by Dubousset as the “cone of economy” (CoE). The relationship between radiographic alignment parameters and CoE balance measures of ADS patients before and after realignment surgery is currently unknown. 29 ADS patients treated with realignment surgery. Patients were evaluated at one week before realignment surgery and at their three-month follow-up examination. During each evaluation, patients completed self-reported outcomes (visual analog scales for pain, Oswestry Disability Index, SRS22r) and a functional balance test. Mean changes in dependent measures from before to after surgery were compared using paired t-tests. Pearson correlations were used to test for significant correlations between changes in radiographic and CoE measures. Significant improvements were found for all patient-reported outcomes, in several radiographic measures, and in CoE measures. Improvements of scoliosis Cobb angle, coronal pelvic tilt, lumbar lordosis, and thoracic kyphosis showed significant correlations with CoE sway and total distance measures at both the center of mass and center of the head. Improved radiographic alignment measures significantly correlated with improved CoE balance measures among ADS patients treated with realignment surgery at their three-month follow-up. These findings indicate that functional balance evaluations when used in conjunction with radiographic measurements, may provide a more robust and improved patient-specific sensitivity for postoperative assessments. CoE balance may represent a new measure of added value for surgical intervention of ADS.

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Correction of Severe Flexible Pes Planovalgus Deformity Using Trabecular Metallic Wedges

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000287 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Elizabeth McDonald ◽

Justin Tsai ◽

Steven Raikin ◽

Ryan Sutton

Keyword(s):

Weight Bearing ◽

Attractive Alternative ◽

Complication Rates ◽

Pes Planovalgus ◽

Lateral Column ◽

Radiographic Parameters ◽

Metatarsal Angle ◽

Radiographic Measurements ◽

Picture Archiving And Communication

Category: Hindfoot, Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening and a medial cuneiform plantarflexion (Cotton) osteotomy are procedures commonly used in the treatment of symptomatic flexible pes planovalgus. Traditionally, structural autograft or allograft have been used for both osteotomies. While union rates for both types of graft have been shown to be comparably high, the use of allograft or autograft each come with their own set of inherent risks and/or potential complications. A trabecular titanium wedge implant provides an attractive alternative that avoids the concerns associated with autograft and allograft use, and has previously been shown in the literature to demonstrate similar union rates. The purpose of this study was to retrospectively review the radiographic outcomes of corrective osteotomies utilizing trabecular metal wedges to address severe flexible pes planovalgus deformity. Methods: 115 feet in 109 patients who were treated with corrective osteotomies using a trabecular titanium wedges performed by one surgeon were retrospectively reviewed. All patients had symptomatic flexible pes planovalgus, mostly secondary to stage IIB posterior tibialis tendon dysfunction. Other diagnoses included pes planovalgus secondary to the adolescent idiopathic flexible subtype, traumatic posterior tibialis tendon rupture, coalition, or an accessory navicular. Preoperative radiographic parameters assessing severity of deformity were recorded and compared to the postoperative measurements taken at the time of most recent follow up visit to assess for correction. The radiographic measurements included the (1) AP talo-1st metatarsal angle (2) Lateral talo-1st metatarsal angle (3) Calcaneal pitch (4) Lateral talo-calcaneal angle and (5) Talonavicular uncoverage angle. All angles were measured off standard weight-bearing radiographs by one author using our institution’s picture archiving and communication system (PACS) software. All complications were also recorded. Results: At an average follow up time of 40 weeks, there were statistically significant corrective changes in the AP-talo-1st metatarsal angle (-12.56), lateral talo-1st metatarsal angle (+14.15), calcaneal pitch (+5.23), lateral talo-calcaneal angle (-3.87) and talonavicular uncoverage angle (-17.76). There were 3 nonunions (2.6%) confirmed by CT, 2 of which were eventually revised. There were a total of 9 complications (7.8%). Other than the nonunion revisions, none of these complications required a return to the operating room. There were no cases of collapse or loss of correction at the time of followup, as compared to the initial post-operative radiographs. Conclusion: In our study population corrective osteotomies using a trabecular titanium wedge was effective in improving radiographic parameters associated with flexible pes planovalgus deformity. The nonunion and overall complication rates using a trabecular titanium wedge were shown to be comparable or superior to what has previously been reported in the literature using allograft or autograft.

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Predicting clinical outcomes after total knee arthroplasty from preoperative radiographic factors of the knee osteoarthritis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-3029-7 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Kaoru Toguchi ◽

Arata Nakajima ◽

Yorikazu Akatsu ◽

Masato Sonobe ◽

Manabu Yamada ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Knee Injury ◽

Postoperative Patient ◽

Radiographic Measurements ◽

Patient Reported ◽

Total Knee ◽

End Stage

Abstract Background Total knee arthroplasty (TKA) is the major surgical treatment for end-stage osteoarthritis (OA). Despite its effectiveness, there are about 20% of patients who are dissatisfied with the outcome. Predicting the surgical outcome preoperatively could be beneficial in order to guide clinical decisions. Methods One-hundred and ten knees of 110 consecutive patients who underwent TKAs for varus knees resulting from OA were included in this study. Preoperative varus deformities were evaluated by femorotibial angle (FTA), medial proximal tibial angle (MPTA) and lateral distal femoral angle (LDFA), and classified as a severe varus (SV) or a mild varus (MV) group. The osteophyte score (OS), which we developed originally, was also calculated based on the size of the osteophytes and classified as groups with more or less osteophytes. We compared preoperative and 1-year postoperative range of motion, the Knee Society Score, and Japanese Knee injury Osteoarthritis Outcome Score (KOOS) between SV and MV groups (varus defined by FTA, MPTA, or LDFA), in each group with more or less osteophytes. Results When varus deformities were defined by FTA, regardless of OS, postoperative KOOS subscales and/or the improvement rates were significantly higher in the SV group than in the MV group. When varus defined by MPTA, regardless of OS, there were no significant differences in postoperative KOOS subscales between groups. However, when varus defined by LDFA, scores for pain, activities of daily living (ADL), and quality of life (QOL) on postoperative KOOS and/or the improvement rates were significantly higher in the SV group than in the MV group only in patients with less osteophytes. No significant differences were found between groups in patients with more osteophytes. Conclusions We classified OA types by radiographic measurements of femur and tibia in combination with OS. Postoperative patient-reported outcomes were better in patients with SV knees but were poor in patients with knees with MV deformity and less osteophytes.

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Contribution of First Tarsometatarsal Joint Fusion to Deformity Correction in the Treatment of Adult Acquired Flatfoot Deformity

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00184 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0018

Author(s):

Jonathan Day ◽

Matthew S. Conti ◽

Nicholas Williams ◽

Scott J. Ellis ◽

Jonathan T. Deland ◽

...

Keyword(s):

Clinical Outcomes ◽

Patient Reported Outcomes ◽

Interobserver Reliability ◽

Deformity Correction ◽

Measurement Information ◽

Radiographic Parameters ◽

Metatarsal Angle ◽

Patient Reported ◽

Adult Acquired Flatfoot Deformity

Category: Midfoot/Forefoot; Other Introduction/Purpose: Severe adult-acquired flatfoot deformity (AAFD) is often associated with painful medial column collapse at the naviculocuneiform (NC) joint. The purpose of this study was to examine the role of first tarsometatarsal (1st TMT) fusion combined with subtalar fusion in correcting deformity at this joint. Methods: We retrospectively analyzed 40 patients (41 feet) who underwent 1st TMT and subtalar (ST) fusion as part of a flatfoot reconstructive procedure. We assessed six radiographic parameters both preoperatively and at a minimum of 6 months postoperatively, including talonavicular (TN) coverage angle, lateral talo-first metatarsal angle, lateral talocalcaneal angle, calcaneal pitch, hindfoot moment arm, and a newly defined navicular-cuneiform incongruency angle (NCIA). Patient-Reported Outcomes Measurement Information System (PROMIS) clinical outcomes were assessed preoperatively and at a minimum 1 year follow-up. Results: The NCIA demonstrated excellent interobserver reliability, with no significant change between pre- and postoperative measurements. All other radiographic parameters, except calcaneal pitch, demonstrated statistically significant improvement postoperatively (p <0.01). Overall, patients had statistically significant improvement in all PROMIS domains (p <0.01), except for depression. Worsening NC deformity was not associated with worse patient-reported outcomes. Conclusion: Our data suggests that when addressing collapse of the medial arch in patients with AAFD, fusion of the 1st TMT joint in combination with other procedures leads to acceptable radiographic and clinical outcomes. There was no change in deformity at the NC joint at short-term follow-up, and patients achieved significant improvement in multiple PROMIS domains. Based on our findings, deformity through the NC joint does not significantly impact clinical outcomes. In addition, the NCIA was established as a reliable radiographic parameter that can be used to assess NC deformity in the presence of talonavicular and/or 1st TMT fusion. [Table: see text]

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A Comparative Study Between Darrach and Sauvé-Kapandji Procedures for Post-Traumatic Distal Radioulnar Joint Dysfunction

Hand ◽

10.1177/1558944719855447 ◽

2019 ◽

pp. 155894471985544 ◽

Cited By ~ 1

Author(s):

Svenna H. W. L. Verhiel ◽

Sezai Özkan ◽

Marco J. P. F. Ritt ◽

Neal C. Chen ◽

Kyle R. Eberlin

Keyword(s):

Patient Reported Outcomes ◽

Distal Radioulnar Joint ◽

Reoperation Rate ◽

Measurement Information ◽

Radioulnar Joint ◽

Radiographic Outcomes ◽

Radiographic Measurements ◽

Patient Reported ◽

Post Traumatic

Background: There are various treatments for post-traumatic distal radioulnar joint (DRUJ) dysfunction. The present study aimed to assess differences in long-term patient-reported outcomes on physical function, pain, and satisfaction between the Darrach and Sauvé-Kapandji procedures. Secondary aims were to describe the radiographic outcomes and to assess the difference in rate and type of complications and reoperations between these 2 procedures. Methods: We retrospectively analyzed 85 patients who had a post-traumatic DRUJ derangement and had been treated by either a Darrach (n = 57) or Sauvé-Kapandji procedure (n = 28). Fifty-two patients (61%) completed patient-rated outcomes surveys at a median of 8.4 years after their procedure. Radiographic measurements consisted of ulnar distance, radioulnar distance, and ulnar gap (only in Sauvé-Kapandji group). Results: There were no significant differences in Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) Function score, pain score, satisfaction score, complications, and reoperations between patients who had a Darrach procedure or a Sauvé-Kapandji procedure. Seventeen patients (30%) in the Darrach group experienced a complication, and 14 patients (50%) in the Sauvé-Kapandji group experienced a complication ( P = .09). The most common complication was instability of the ulnar stump (n = 10), followed by symptoms of the dorsal sensory branch of the ulnar nerve (n = 8). Patients who underwent a Sauvé-Kapandji procedure had more reoperations for excision of heterotopic ossification. Conclusions: Darrach and Sauvé-Kapandji procedures show comparable long-term patient-reported outcomes in treatment of post-traumatic DRUJ dysfunction. Complication and reoperation rate are relatively high, with non-significant differences between the 2 procedures.

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Patient-Reported and Radiographic Outcomes in Primary and Revision Stage II, III, and IV Adult- Acquired Flatfoot Deformity Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00063 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0006

Author(s):

Rusheel Nayak ◽

Milap Patel ◽

Anish R. Kadakia

Keyword(s):

Patient Reported Outcomes ◽

Stage Iv ◽

Stage Ii ◽

Stage Iii ◽

Primary Stage ◽

Radiographic Outcomes ◽

Medial Cuneiform ◽

Significant Difference ◽

Patient Reported ◽

Adult Acquired Flatfoot Deformity

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult-Acquired Flatfoot Deformity (AAFD) is a progressive hindfoot and midfoot deformity that causes pain and disability. It presents as a plano-valgus deformity from the failure of static and dynamic medial osteoligamentous stabilizers. Stage II presents as a passively correctable, flexible deformity of the foot; stage III presents as a fixed or arthritic deformity of the foot; and stage IV presents with marked deformity of the foot caused by failure of the deltoid ligament and subsequent peritalar instability. Although operative treatment of AAFD is dependent on the stage, there is little data on patient- reported and radiographic outcomes stratified by primary versus revision stage II, III, and IV reconstruction surgery. Methods: Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) scores were prospectively obtained on 46 consecutive patients who underwent AAFD reconstruction between November 2013 and January 2019 with minimum 12-month follow-up (average 23 months). Twenty patients underwent stage II reconstruction, 5 of which were revision surgeries; 19 patients underwent stage III reconstruction, 8 of which were revision surgeries; and 7 patients underwent stage IV reconstruction, all of which were primary surgeries. Radiographic correction was measured pre- and post-operatively and correlated with PROMIS scores. Measurements included the talonavicular uncoverage angle, talonavicular uncoverage percent, AP talo-first metatarsal angle, Meary’s angle, medial cuneiform height, and medial cuneiform-fifth metatarsal height. Results: For the overall cohort, PROMIS PF increased significantly from 37.6+-5.7 to 42.4+-6.8 (p=0.0014). PROMIS PI improved significantly from 64.7+-6.3 to 54.6+-9.5 (p<0.0001). PROMIS scores were not statistically different between AAFD stages. Change in PROMIS PI was significantly greater in primary (-12.3) versus revision (-3.7) surgery (p=0.0157). Change in PROMIS PF was non- significantly greater in primary (+4.0) versus revision surgery (+2.3). All radiographic measurements improved significantly (p<0.05). In primary stage II AAFD, pre-operative PROMIS PI scores correlated with pre-operative medial cuneiform-fifth metatarsal height (r = -0.606, p = 0.0479). In addition, in primary stage II AAFD, post-operative PROMIS scores correlated with post-operative medial cuneiform height (PROMIS PF: r=0.7725, p=0.0020; PROMIS PI: r=-0.5692, p=0.0446). Conclusion: Patient-reported and radiographic outcomes improve significantly after AAFD reconstruction. There was no significant difference in PROMIS scores between AAFD stages. However, stage III patients had non-significantly lower improvements in PROMIS PF, likely due to loss of function after arthrodesis. Primary operations had better patient-reported outcomes compared to revision operations. In primary stage II AAFD, reconstructing the medial arch correlates significantly with improvement in pain and functionality. This survey of outcomes after primary and revision stage II, III, and IV reconstruction should help clinical decision making by providing data on expected surgical improvement.

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Correlation of Physician-Assessed Psoriasis Area and Severity Index Scores With Patient-Reported Psoriasis Symptoms and Signs Diary Scores Among Patients With Moderate-to-Severe Psoriasis: Results From VOYAGE 1 and VOYAGE 2 Studies

Journal of Psoriasis and Psoriatic Arthritis ◽

10.1177/2475530319854781 ◽

2019 ◽

Vol 4 (3) ◽

pp. 147-152

Author(s):

Kenneth B. Gordon ◽

Chenglong Han ◽

Shu Li ◽

Yin You ◽

Michael Song ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Severity Index ◽

Double Blind ◽

Patient Reported ◽

Clinical Responses ◽

Highly Correlated ◽

Symptoms And Signs ◽

Free Status

Background: Patient-reported and clinician-determined outcomes do not always correlate in clinical trials for psoriasis, even among those with clear skin. Objective: To compare clinical responses with patient-reported outcomes among patients with psoriasis enrolled in 2 phase 3, double-blind, controlled trials of guselkumab (VOYAGE 1 and VOYAGE 2). Methods: Overall, 1432 patients randomized to guselkumab, placebo, or adalimumab at baseline were included in the pooled patient population; measures were assessed at baseline and week 16. End points included proportions of patients achieving 100% improvement in their Psoriasis Area and Severity Index (PASI 100) score and summary scores = 0 on the Psoriasis Symptoms and Signs Diary (PSSD). Proportions of patients with PSSD symptom/sign summary scores = 0 and mean PSSD summary scores were summarized by PASI 100 status. Association between PASI and PSSD scores were evaluated using Pearson correlation coefficients. Results: Among week-16 PASI 100 responders, 46.8% and 34.1% reported PSSD symptom and sign summary scores = 0, respectively, and 30.9% and 49.0% reported minimal symptoms/signs (scores = 1 to <10), respectively; mean scores (scale 0-100) were 6.4 for symptoms and 5.8 for signs. Among PASI 100 nonresponders, only 11.1% (symptoms) and 7.5% (signs) reported PSSD summary scores = 0; mean scores were 25.7 and 26.7, respectively. Correlation coefficients between overall PASI response and PSSD scores were 0.63 (symptoms) and 0.68 (signs; both P < .0001). Conclusion: While PASI and PSSD scores were highly correlated and most PASI 100 responders reported no/minimal symptoms or signs at week 16, substantial discrepancies were found between complete clearance from the clinician’s view versus symptom/sign-free status from patients’ perspectives.

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Clinical and Radiological Evaluation of Results of Surgical Correction of Forefoot Adduction by Cuneiform and Cuboid Osteotomy Using Radiological Forefoot Measurements

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.4226 ◽

2020 ◽

Vol 22 (5) ◽

pp. 263-272

Author(s):

Barbara Jasiewicz ◽

Tomasz Potaczek ◽

Sławomir Duda ◽

Jakub Adamczyk ◽

Jacek Lorkowski

Keyword(s):

First Metatarsal ◽

Radiologic Evaluation ◽

Care Givers ◽

Metatarsal Angle ◽

Medial Cuneiform ◽

Age At Surgery ◽

First Ray ◽

Metatarsus Adductus ◽

The Mean

Background. Forefoot adduction is a relatively common problem. It is usually mild or it can be effectively managed conservatively. Severe deformities may require surgical treatment. The aim of the study was to perform a clinical and radiologic evaluation of forefoot adduction correction using medial cuboid and cuneiform osteotomy with a transposed wedge. Material and methods. This is a retrospective study involving 16 patients who underwent 20 procedures. Mean age at surgery was 6 years (3-13). Clinical evaluation was based on measurements of forefoot deviation and patients’/care-givers’ subjective opinion. The radiologic parameters assessed comprised the first ray angle, talar-first metatarsal angle, calcaneal-fifth metatarsal angle, talocalcaneal angle, metatarsus adductus angle, and Kilmartin’s angle. Results were then compared in children below and above 6 years of age. The mean duration of follow-up was 4.6 years (2-9). Results. The clinical and subjective outcome was rated as good in 16 procedures and satisfactory in 4. The talar-first metatarsal angle, calcaneal-fifth metatarsal angle, metatarsus adductus angle, and Kilmartin’s angle were significantly reduced, while the talocalcaneal and first ray angle remained unchanged. A significantly better correction of metatarsus adductus and talar-first metatarsal angle was achieved In children below 6 years of age compared to older patients. Conclusions. 1. Medial cuneiform and cuboid osteotomy with a transposed wedge improves both clinical and radiological parameters, especially in children under the age of 6. 2. Besides the metatarsus adductus angle, the talar-first metatarsal, calcaneal-fifth metatarsal and Kilmartin’s angles appear to be good radiologic indicators of correction.

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