scholarly journals The SUPERankle procedure in the treatment of foot and ankle deformities in fibular hemimelia

2021 ◽  
Vol 15 (3) ◽  
pp. 217-222
Author(s):  
Carlos Eduardo Cabral Fraga ◽  
Gabriel João Francisco Souza ◽  
Jefferson Soares Martins ◽  
Marcos Vinicius Muniz Lemos Souto ◽  
Rodolfo Amoedo de Castilho Candido Pinto ◽  
...  
Keyword(s):  
Case Series ◽  
Limb Amputation ◽  
Radiographic Evaluation ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Fibular Hemimelia ◽  
Number Of Patients ◽  
Objective Evidence ◽  
Study Case ◽  
Type 3

Objective: To review indications for limb amputation or reconstruction using the SUPERankle procedure in patients diagnosed with Paley type 3 or 4 fibular hemimelia; To evaluate the correction of deformities needed to achieve a stable plantigrade foot, review variations of the original technique and their applicability, and describe challenges encountered in their execution. Methods: Qualitative, retrospective, descriptive study of 4 patients who underwent the SUPERankle procedure between 2019 and 2020 for treatment of foot and ankle deformities in fibular hemimelia. Pre- and postoperative clinical and radiographic evaluations were performed to identify objective evidence of the correction of foot and ankle deformities. The operative techniques employed are described. Results: The included patients met anatomical and psychosocial criteria for reconstruction, as established in the literature. Clinical correction of foot and ankle deformities was achieved, but on radiographic evaluation, there was no statistical difference; this was likely due to the small number of patients, given the rarity of fibular hemimelia. Conclusion: The procedure is reproducible, but requires a knowledgeable, well-trained surgical team. Correction of foot and ankle deformities can be achieved. The choice between amputation or reconstruction should be the result of an informed decision by Family members, supported by a multidisciplinary team. Level of Evidence IV; Qualitative Study; Case Series.

scholarly journals Assessment of orthopedist exposure to occupational doses of radiation in foot and ankle surgeries

2019 ◽  
Vol 13 (2) ◽  
pp. 147-153
Author(s):  
Thiago Pavani Zigovski ◽  
Larissa Lopes Endlich ◽  
Aleksei Dickow Sato ◽  
Danielle Filipov ◽  
Janine Nicolosi Corrêa
Keyword(s):  
Protective Clothing ◽  
Case Series ◽  
Whole Body ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Thermoluminescent Dosimetry ◽  
Lead Apron ◽  
The Mean ◽  
Study Case ◽  
Occupational Radiation

Objective: To measure the doses of occupational radiation to which a physician who performs orthopedic surgery of the foot and ankle using a fluoroscopy device is exposed during work and to compare those doses with the values provided in the current legislation and propose measures of radioprotection. Methods: Thermoluminescent dosimetry (TLD) was used to measure radiation in critical target areas (whole-body, lens, thyroid, right and left hands) of the surgeon’s body during all the surgical procedures performed by him between 12/19/2017 and 2/5/2018. From the mean dose values obtained for the procedures, the dose of annual radiation exposure was estimated for each of the regions analyzed and compared with the current legislation. Results: The estimate of the annual radiation dose received by the surgeon to the chest region, above the lead apron, was 5 times higher than that established by the national legislation. However, considering the use of the lead apron, the dose was acceptable. Estimates of equivalent doses for the limbs and thyroid had results within the levels required by the current legislation. The equivalent dose for the lens, on the other hand, was 4 times higher than that established by the legislation. Conclusion: During the workday, the foot and ankle orthopedic surgeon is exposed to doses of radiation higher than those considered acceptable. The data corroborate the need to wear radiological protective clothing, especially a lead apron and goggles. Level of Evidence IV; Prognostic Study; Case Series.

scholarly journals 4-in-1 and 5-in-1 blocks in percutaneous forefoot surgery

2020 ◽  
Vol 14 (1) ◽  
pp. 79-83
Author(s):  
César Lima Oliveira ◽  
Lucio Carlos de Azevedo Torres Filho ◽  
Luiz Carlos Ribeiro Lara ◽  
Gabriel Lopes de Faria Cervone ◽  
Rafael Nogueira Figueiredo ◽  
...  
Keyword(s):  
Case Series ◽  
Anesthetic Technique ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Forefoot Surgery ◽  
Ankle Surgery ◽  
Study Case ◽  
Therapeutic Study ◽  
Male Subjects

Objective: To analyze the effectiveness of peripheral nerve blocks in the ankle in percutaneous forefoot surgery and their potential complications. Methods: Retrospective study with a survey of the medical records of patients who underwent percutaneous orthopedic surgery onthe forefoot between 2009 and 2015, performed by the orthopedic foot  and ankle surgery group of our hospital, in which 4-in-1 and 5-in-1 anesthetic nerve blocks were used. We evaluated 239 cases, consisting of 222 female and 17 male subjects with a mean age of 61.2 years, seeking to observe the effectiveness and potential complications of the anesthetic technique. Results: Complications were observed in 3.34% of the 239 patients, with seven cases of neuritis and one case of tachycardia. Regarding the anesthetic technique, there were nine cases of block failure (3.76%), with four cases requiring supplementary local anesthetic, one case spinal anesthesia, and four cases general anesthesia. Conclusion: Having observed the low rate of complications and the almost complete success of 5-in-1 blocks in percutaneous forefoot surgery, we concluded that it is a safe and effective anesthetic technique. Level of Evidence IV, Therapeutic Study; Case Series.

Foot and Ankle Injections in Athletes

2021 ◽  
pp. 194173812110036
Author(s):  
Jonathan K. Ochoa ◽  
Christopher E. Gross ◽  
Robert B. Anderson ◽  
Andrew R. Hsu
Keyword(s):  
English Language ◽  
Platelet Rich Plasma ◽  
Empirical Studies ◽  
Autologous Blood ◽  
Case Series ◽  
Placental Tissue ◽  
Ankle Injuries ◽  
Extensive Literature ◽  
Foot And Ankle ◽  
Level Of Evidence

Context: Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. Evidence Acquisition: An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. Study Design: Clinical review. Level of Evidence: Level 4. Results: Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. Conclusions: Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.

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 Novel Radiographic Indexes for Elbow Stability Assessment: Part B—Preliminary Clinical Study

2021 ◽  
Author(s):  
Francesco Luceri ◽  
Davide Cucchi ◽  
Enrico Rosagrata ◽  
Carlo Eugenio Zaolino ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Case Series ◽  
Radiographic Evaluation ◽  
Healthy Population ◽  
X Rays ◽  
The Novel ◽  
Level Of Evidence ◽  
Orthopaedic Surgeons ◽  
Joint Congruency ◽  
Radiological Parameters ◽  
The Mean

Abstract Introduction The coronoid process plays a key-role in preserving elbow stability. Currently, there are no radiographic indexes conceived to assess the intrinsic elbow stability and the joint congruency. The aim of this study is to present new radiological parameters, which will help assess the intrinsic stability of the ulnohumeral joint and to define normal values of these indexes in a normal, healthy population. Methods Four independent observers (two orthopaedic surgeons and two radiologists) selected lateral view X-rays of subjects with no history of upper limb disease or surgery. The following radiographic indexes were defined: trochlear depth index (TDI); anterior coverage index (ACI); posterior coverage index (PCI); olecranon–coronoid angle (OCA); radiographic coverage angle (RCA). Inter-observer and intra-observer reproducibility were assessed for each index. Results 126 subjects were included. Standardized lateral elbow radiographs (62 left and 64 right elbows) were obtained and analysed. The mean TDI was 0.46 ± 0.06 (0.3–1.6), the mean ACI was 2.0 ± 0.2 (1.6–3.1) and the mean PCI was 1.3 ± 0.1 (1.0–1.9). The mean RCA was 179.6 ± 8.3° (normalized RCA: 49.9 ± 2.3%) and the mean OCA was 24.6 ± 3.7°. The indexes had a high-grade of inter-observer and intra-observer reliability for each of the four observers. Significantly higher values were found for males for TDI, ACI, PCI and RCA. Conclusion The novel radiological parameters described are simple, reliable and easily reproducible. These features make them a promising tool for radiographic evaluation both for orthopaedic surgeons and for radiologists in the emergency department setting or during outpatient services. Level of evidence Basic Science Study (Case Series). Clinical relevance The novel radiological parameters described are reliable, easily reproducible and become handy for orthopaedic surgeons as well as radiologists in daily clinical practice.

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.

Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

2021 ◽  
pp. 229255032110499
Author(s):  
Rebecca Miller ◽  
Sheina Macadam ◽  
Daniel Demsey
Keyword(s):  
Breast Reconstruction ◽  
Citation Analysis ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Number Of Patients ◽  
Acellular Dermal

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options.

scholarly journals Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142096631
Author(s):  
Luke D. Cicchinelli ◽  
Jurij Štalc ◽  
Martinus Richter ◽  
Stuart Miller
Keyword(s):  
Adverse Events ◽  
Prospective Trial ◽  
Case Series ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Radiographic Evaluation ◽  
Fiber Reinforced ◽  
Level Of Evidence ◽  
Surgery Patient ◽  
Patient Reported

Background: A novel biointegrative implant was developed for proximal interphalangeal joint (PIPJ) arthrodesis to treat hammertoe deformity. Composed of continuous reinforcing mineral fibers bound by bioabsorbable polymer matrix, the implant demonstrated quiescent, gradual degradation with complete elimination at 104 weeks in animal models. This prospective trial assessed the implant’s safety, clinical performance, and fusion rate of PIPJ arthrodesis for hammertoe correction. Methods: Twenty-five patients (mean age 63.9±7.5 years) who required PIPJ arthrodesis were enrolled at 3 centers. Outcomes included radiographic joint fusion, adverse events, pain visual analog scale (VAS) score, Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) score, and patient satisfaction. Patients were evaluated 2, 4, 6, 12, and 26 weeks postoperatively. Results: Twenty-two patients (88%) achieved radiographic fusion at 26 weeks. All joints (100%) were considered clinically stable, with no complications or serious adverse events. Pain VAS improved from 5.3±2.5 preoperatively to 0.5±1.4 at 26 weeks postoperatively. FAAM-ADL total scores and level of functioning improved by mean 19.5±19.0 points and 24.4±15.7 percentage points, respectively, from preoperation to 26 weeks postoperation. Improvements in pain VAS and FAAM scores surpassed established minimal clinically important differences. All patients were very satisfied (84%) or satisfied (16%) with the surgery. Patient-reported postoperative results greatly exceeded (72%), exceeded (20%), or matched (8%) expectations. Conclusion: This prospective, multicenter, first-in-human clinical trial of a novel biointegrative fiber-reinforced implant in PIPJ arthrodesis of hammertoe deformity demonstrated a favorable rate of radiographic fusion at 12 and 26 weeks, with no complications and good patient-reported clinical outcomes. Level of Evidence: Level IV, prospective case series.

scholarly journals Functional assessment of foot and ankle tendinopathies treated with tendoscopy

2021 ◽  
Vol 15 (2) ◽  
pp. 128-132
Author(s):  
Rodrigo Guimarães Huyer ◽  
Mário Sérgio Paulillo Cillo ◽  
Carlos Daniel Cândido Castro Filho ◽  
Hallan Douglas Bertelli ◽  
Renato Morelli Berg
Keyword(s):  
Functional Assessment ◽  
Descriptive Analysis ◽  
Case Series ◽  
P Value ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Treatment Results ◽  
Duration Of Treatment ◽  
Aofas Score ◽  
Level Of Evidence

Objective: To assess postoperative clinical functional outcomes, based on the American Orthopaedic Foot & Ankle Society (AOFAS) score, of tendoscopies performed in the treatment of foot and ankle pathologies. Methods: Our comparative assessment used AOFAS scores obtained preoperatively and at early and late postoperative stages - 1 month and 6 to 12 months after surgery - of 14 patients with foot and ankle tendinopathies. These included peroneal tendon dislocation, peroneal tendonitis, and tearing of the peroneus longus or brevis, all treated with tendoscopy for peroneal reconstruction and tenorrhaphy. The AOFAS score was obtained by functional assessment during outpatient physical examination. We presented a descriptive analysis of cases, comparing scores over time through the Friedman test followed by Dunn’s test. The relationship between score variations and sex was assessed using the Mann-Whitney test; their comparison with age used Spearman’s linear correlation coefficient. Significance levels were 5%.Results: The AOFAS score showed important improvements such as preoperative scores of 56 and 67 followed by postoperative scores of 100 both in the early and late stages, supporting the efficacy and persistence of this treatment strategy. The p-value obtained after statistical analysis was <0.0001. Conclusion: We concluded that the treatment of foot and ankle comorbidities with tendoscopy, in addition to being less invasive, shows consistency and efficacy as demonstrated by the AOFAS score and functional assessment via postoperative physical examinations. AOFAS scores were increased and maintained at high levels in the postoperative period, demonstrating the efficacy of this procedure and the duration of treatment results. Level of Evidence IV; Case Series; Therapeutic Studies - Investigation of Treatment Results.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

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