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Journal of Pediatric Orthopedics Oct 2023Juvenile hallux valgus (JHV) is a pediatric deformity characterized by the varus deviation of the first metatarsal and valgus deviation of the proximal phalanx. Among...
INTRODUCTION
Juvenile hallux valgus (JHV) is a pediatric deformity characterized by the varus deviation of the first metatarsal and valgus deviation of the proximal phalanx. Among the several surgical techniques available, hemiepiphysiodesis consists of the unilateral growth arrest of the first metatarsal physis. Despite this technique has been proposed over 70 years ago, only a few studies including clinical and radiological outcomes have been published, making the procedure unclear in terms of results. This systematic review aimed to evaluate the outcomes of hemiepiphysiodesis of the first metatarsal in the treatment of JHV.
METHODS
Google Scholar, Embase, PubMed, and Cochrane databases were searched for all the articles reporting on clinical and radiological results of hemiepiphysiodesis of the first metatarsal in the treatment of JHV. The selected articles were reviewed to extract demographic data, surgical techniques, complications, clinical outcomes, and radiological parameters.
RESULTS
Six articles were included in the qualitative analysis. A total of 85 patients with 144 halluces valgus were treated through hemiepiphysiodesis of the first metatarsal. The mean age at surgery was 10.7 years (range 5 to 15). The mean follow-up was 2.7 years (range 1 to 7.5). Hemiepiphysiodesis was performed through 2 different techniques. Eighteen (12.5%) complications occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score increased from 70.6 (range 49 to 93) preoperatively to 89.4 (range 72 to 100) postoperatively. The mean HVA improved from 28.3 (range 14 to 46) to 24.03 degrees (range 0 to 54), and the mean IMA improved from 13 (range 8 to 33) to 10.9 degrees (range 8 to 33).
CONCLUSIONS
This review showed that hemiepiphysiodesis of the first metatarsal is a safe treatment for JHV. Improvement in both clinical and radiological results has been observed in all the studies, sometimes being statistically significant. Despite the improvement, mean postoperative radiological angles remained altered and consistent with mild-moderate hallux valgus. This suggests that hemiepiphysiodesis plays a bigger role in preventing the worsening of the deformity rather than correcting it. Randomized controlled trials with longer follow-up and a larger number of patients are needed to further investigate the efficacy and safety of this treatment.
Topics: Humans; Child; Child, Preschool; Adolescent; Hallux Valgus; Metatarsal Bones; Treatment Outcome; Hallux; Osteotomy
PubMed: 37526093
DOI: 10.1097/BPO.0000000000002485 -
Foot and Ankle Surgery : Official... Aug 2023Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low... (Review)
Review
BACKGROUND
Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications.
METHODS
EMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.
RESULTS
Six studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7-23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1-11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery.
CONCLUSION
This systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes.
LEVEL OF EVIDENCE
Level IV, Systematic review.
Topics: Humans; Hallux Valgus; Hallux; Treatment Outcome; Osteotomy; Metatarsophalangeal Joint; Bunion; Metatarsal Bones; Retrospective Studies
PubMed: 37419765
DOI: 10.1016/j.fas.2023.06.010 -
Journal of Orthopaedics Mar 2024Brachymetatarsia is marked by the shortened length of one or more metatarsal bones. Several operative options have been suggested without demonstrating the superiority... (Review)
Review
PURPOSE
Brachymetatarsia is marked by the shortened length of one or more metatarsal bones. Several operative options have been suggested without demonstrating the superiority of one treatment over another. This study aims to assess the main available treatment, bone lengthening achieved, clinical outcomes, and complications pertaining to congenital brachymetatarsia interventions.
METHODS
A literature search of PubMed, Embase, Scopus, and Cochrane databases was performed according to PRISMA guidelines.
RESULT
After the screening process, 13 articles were included in the review. Brachymetatarsia mainly occurs in females at a ratio of 14.8:1, and bilateral involvement in 25.8 % of cases. The fourth metatarsal is most affected, followed by the first metatarsal. The main surgical procedures are one-stage approach which results in limited length gain but fewer complications, and gradual lengthening which achieves greater length but has a higher complication rate, including metatarsophalangeal or interphalangeal subluxation, fractures, and infections. The first metatarsal reported better values concerning lengthening rate and healing index compared to fourth metatarsal, while no differences were observed in distraction rates or clinical outcomes. More complications, such as stiffness, fractures, and cavus foot were associated with first metatarsal lengthening.
CONCLUSIONS
It is not possible to identify a gold standard technique for addressing this condition. The two predominant surgical techniques bear advantages and drawbacks. A judicious case-by-case assessment is mandatory to determine the optimal surgical approach. Exploring the combination of techniques could be promise in mitigating the limitations associated with the main two methods and achieving better forefoot balance.
LEVEL OF EVIDENCE
Level II, systematic review.
PubMed: 38094980
DOI: 10.1016/j.jor.2023.11.046 -
Foot and Ankle Surgery : Official... Dec 2023The purpose of this systematic review is to examine the learning curve associated with minimally invasive surgery (MIS) for the treatment of hallux valgus (HV). (Review)
Review
BACKGROUND
The purpose of this systematic review is to examine the learning curve associated with minimally invasive surgery (MIS) for the treatment of hallux valgus (HV).
METHODS
A systematic review was performed using PubMed, ScienceDirect, Web of Science, CINAHL and MEDLINE databases from database inception to February 16th, 2023. Inclusion criteria was articles with level of evidence I-III, any outcomes associated with learning curve, minimally invasive surgery, and diagnosis of hallux valgus' in adult patients.
RESULTS
Six articles out of 165 articles meet inclusion criteria. For all six articles, 368 total patients (422 total feet) were included in the study with an average age of 55.69 years. Three studies reported the number of surgeries needed to reach the plateau phase of the learning curve of MIS for HV, with a frequency weighted mean of 35.5 surgeries (range 27 - 40). In the selected articles, significant results were found for increased operating room (OR) time and fluoroscopy shots in the learning phase. There was no significant increase in complications in the learning phase. There was no significant decrease in patient outcomes, or the quality of correction performed during the learning phase.
CONCLUSION
An average of 35.5 surgeries (range 27 - 40) are needed to reach the plateau phase for MIS for HV. The learning phase of the learning curve of MIS for HV has a significant increase in OR time and fluoroscopy usage. However, the learning phase of the learning curve of MIS for HV is not associated with decreased outcomes or higher complication rates based on the small sample size in this study.
LEVEL OF EVIDENCE
Level III, Systematic Review.
Topics: Adult; Humans; Middle Aged; Hallux Valgus; Learning Curve; Osteotomy; Bunion; Minimally Invasive Surgical Procedures; Treatment Outcome; Retrospective Studies; Metatarsal Bones
PubMed: 37524619
DOI: 10.1016/j.fas.2023.07.012 -
BMC Musculoskeletal Disorders Nov 2023To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
PURPOSE
To evaluate the radiographic diagnostic criteria and propose standardised radiographic criteria for Lisfranc injuries.
METHODS
A systematic review of the PubMed and Embase databases was performed according to the PRISMA guidelines. The various radiographic criteria for the diagnosis of Lisfranc injuries were extracted. Descriptive statistics were presented for all continuous (as mean ± standard deviation) and categorical variables (as frequencies by percentages).
RESULTS
The literature search included 29 studies that totalled 1115 Lisfranc injuries. The risk of bias ranged from "Low" to "Moderate" risk according to the ROBINS-I tool. The overall recommendations according to the GRADE assessment ranged from "Very Low" to "High". 1 metatarsal to 2 metatarsal diastasis was the most common of the 12 various radiographic diagnostic criteria observed, as was employed in 18 studies. This was followed by 2 cuneiform to 2 metatarsal subluxation, as was employed in 11 studies.
CONCLUSION
The radiographic diagnostic criteria of Lisfranc injuries were heterogeneous. The proposition for homogenous radiographic diagnostic criteria is that the following features must be observed for the diagnosis of Lisfranc injuries: 1 metatarsal to 2 metatarsal diastasis of ≥ 2 mm on anteroposterior view or 2 cuneiform to 2 metatarsal subluxation on anteroposterior or oblique views. Further advanced imaging by CT or MRI may be required in patients with normal radiographs but with continued suspicion for Lisfranc injuries.
LEVEL OF EVIDENCE
4, systematic review.
Topics: Humans; Joint Dislocations; Magnetic Resonance Imaging; Radiography; Metatarsal Bones; Foot Injuries
PubMed: 38012651
DOI: 10.1186/s12891-023-07043-z -
Knee Surgery, Sports Traumatology,... Mar 2024The purpose of this systematic review was to evaluate outcomes following both operative and nonoperative management of spiral oblique fractures of the fifth metatarsal.
PURPOSE
The purpose of this systematic review was to evaluate outcomes following both operative and nonoperative management of spiral oblique fractures of the fifth metatarsal.
METHODS
During November 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following operative and nonoperative management of dancer's fractures. Data regarding subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed.
RESULTS
Ten studies were included in this review. In total, 125 patients underwent operative treatment for dancer's fractures and 365 patients underwent nonoperative treatment for dancer's fractures. The weighted mean follow-up in the operative cohort was 15.3 ± 32.7 months and the weighted mean follow-up in the nonoperative cohort was 30.6 ± 24.3 months. The overall union rate in the operative cohort was 99.2% and the overall union rate in the nonoperative cohort was 98.6%. The weighted mean time to return to sport was 15.4 ± 6.7 and 22.4 ± 4.4 weeks in the operative cohort and nonoperative cohort, respectively. The complication rate in the operative cohort and nonoperative cohort was 12.0% and 15.1%, respectively.
CONCLUSION
This current systematic review demonstrated comparable radiographic outcomes together with low failure rate and low complication rate following both operative and nonoperative management of dancer's fracture at short-term follow-up. However, faster return to sport rates was observed in the operative cohort, suggesting that surgical management of displaced spiral oblique fractures of the fifth metatarsal should be the mainstay treatment option. However, the under-reporting of data, marked heterogeneity between studies and paucity of comparative studies limits the generation of any robust conclusions; thus, further high-quality comparative studies are warranted.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Metatarsal Bones; Return to Sport; Fractures, Bone; Sports; Athletes; Retrospective Studies; Treatment Outcome
PubMed: 38410840
DOI: 10.1002/ksa.12098