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Foot (Edinburgh, Scotland) Mar 2023Historically, most Lisfranc injuries have been considered to be unstable and treated with surgical intervention. However, with better access to cross-sectional imaging,... (Review)
Review
BACKGROUND
Historically, most Lisfranc injuries have been considered to be unstable and treated with surgical intervention. However, with better access to cross-sectional imaging, stable injury patterns are starting to be recognised. The aims of the current study were to perform a systematic review of outcomes of Lisfranc injuries treated non-operatively.
METHODS
A literature review was performed of studies reporting nonoperative management of Lisfranc injuries (PROSPERO registered and following PRISMA guidelines). Following exclusions, 8 papers were identified: 1 prospective and 7 retrospective studies. A total of 220 patients were studied with a mean age of 39.8 years and a mean follow-up of 4.3 years. Outcomes included function, displacement, and rates of surgery.
RESULTS
High heterogeneity was observed with variable outcomes. Four papers reported good outcomes, with adjusted functional scores ranging from 82.6 to 100 (out of 100). However, one study reported late displacement in 54 % of patients. Rates of secondary osteoarthritis ranged from 5 % to 38 %. Rates of surgical intervention were as high as 56 %. Several studies compared operative to non-operative treatment, reporting superior outcomes with surgery. Those injuries with no displacement on CT, measured at the medial cuneiform-second metatarsal had the best outcomes.
CONCLUSION
Reported outcomes following nonoperative treatment of Lisfranc injuries vary widely, including high rates of conversion to surgery. In contrast, some studies have reported excellent functional outcomes. CT seems to be an important diagnostic tool in defining a stable injury. Due to limited data and lack of a clear definition of a stable injury or treatment protocol, prospective research is needed to determine which Lisfranc injuries can be safely treated nonoperatively.
Topics: Adult; Humans; Foot Injuries; Fracture Fixation, Internal; Fractures, Bone; Metatarsal Bones; Prospective Studies; Retrospective Studies; Conservative Treatment; Foot Joints; Joint Dislocations; Tomography, X-Ray Computed
PubMed: 36841140
DOI: 10.1016/j.foot.2023.101977 -
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 -
The American Journal of Sports Medicine Oct 2021Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population.
PURPOSE
To provide an updated summary of the return-to-play (RTP) rate and time to RTP after Jones fractures in athletes with regard to their management, whether operative or nonoperative, and to explore the union rate and time to union as well as the rate of complications such as refractures.
STUDY DESIGN
Meta-analysis.
METHODS
Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through November 2019 to identify studies reporting on Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the RTP rate and time to RTP, whereas the secondary outcomes were the number of games missed, time to union, and union rate as well as the rates of nonunion, delayed union, and refractures.
RESULTS
Of 168 studies identified, 22 studies were eligible for meta-analysis with a total of 646 Jones fractures. The overall RTP rate was 98.4% (95% CI, 97.3%-99.4%) in 626 of 646 Jones fractures. The RTP rate with IM screw fixation only was 98.8% (95% CI, 97.8%-99.7%), with other surgical fixation methods (plate, Minifix) was 98.4% (95% CI, 95.8%-100.0%), and with nonoperative management was 71.6% (95% CI, 45.6%-97.6%). There were 3 studies directly comparing RTP rates with surgical versus nonoperative management, which showed significant superiority in favor of surgery (odds ratio, 0.033 [95% CI, 0.005-0.215]; < .001). The RTP rate according to type of sport was 99.0% (95% CI, 97.5%-100.0%) in football, 91.1% (95% CI, 82.2%-99.4%) in basketball, and 96.6% (95% CI, 92.6%-100.0%) in soccer. The overall time to RTP was 9.6 weeks (95% CI, 8.5-10.7 weeks). The time to RTP in the surgical group (IM screw fixation) was 9.6 weeks (95% CI, 8.3-10.9 weeks), which was significantly less than that in the nonoperative group of 13.1 weeks (95% CI, 8.2-18.0 weeks). The pooled union rate in the operative group (excluding refractures) was 97.3% (95% CI, 95.1%-99.4%), whereas the pooled union rate in the nonoperative group was 71.4% (95% CI, 49.1%-93.7%). The overall time to union was 9.1 weeks (95% CI, 7.7-10.4 weeks). The time to union with IM screw fixation (8.2 weeks [95% CI, 7.5-9.0 weeks]) was shorter than that with nonoperative treatment (13.7 weeks [95% CI, 12.7-14.6 weeks]). The rate of delayed union was 2.5% (95% CI, 1.2%-3.7%), and the overall refracture rate was 10.2% (95% CI, 5.9%-14.5%).
CONCLUSION
The RTP rate and time to RTP after the surgical management of Jones fractures in athletes were excellent, regardless of the implant used and type of sport. IM screw fixation was superior to nonoperative management, as it led to a higher rate of RTP, shorter time to RTP, higher rate of union, shorter time to union, and improved functional outcomes. We recommend surgical fixation for all Jones fractures in athletes.
Topics: Athletes; Fractures, Bone; Humans; Metatarsal Bones; Retrospective Studies; Return to Sport
PubMed: 33740393
DOI: 10.1177/0363546521990020 -
Strategies in Trauma and Limb... 2023Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing... (Review)
Review
BACKGROUND
Juvenile hallux valgus (JHV) is a forefoot deformity that causes pain and functional limitation. Treatment poses a challenge in terms of the optimal technique and timing of intervention. A systematic review of the literature on the use of growth modulation in treating JHV was conducted.
MATERIALS AND METHODS
The literature review was performed using PubMed and EMBASE searches for articles investigating growth modulation in the treatment of JHV published before December 1st, 2021. Seven articles were included in the final review that matched the inclusion and exclusion criteria. The primary outcomes included the degree of correction of hallux valgus angle and intermetatarsal angle. A qualitative assessment of the articles was done due to the heterogeneity of the growth modulation methods used in these articles.
RESULTS
A total of 135 feet from 78 patients were included from the reviewed articles. Growth modulation methods included temporary screw lateral hemiepiphysiodesis of the first metatarsal, lateral drilling hemiepiphysiodesis of the first metatarsal, and a trephine plug removal of the lateral epiphysis followed by cancellous bone graft insertion. The degree of correction of the hallux valgus and intermetatarsal angles were found to be statistically significant in all studies, regardless of the technique.
CONCLUSION
Growth modulation for JHV by lateral hemiepiphysiodesis using minimally invasive techniques produced favourable radiologic outcomes with some evidence of clinical improvement. Larger, prospective and comparative studies with objective clinical outcome measures may further consolidate this surgical approach as a mean to treating this deformity.
HOW TO CITE THIS ARTICLE
AlZeedi M, Park JP, Marwan Y, . Growth Modulation for the Treatment of Juvenile Hallux Valgus: A Systematic Review of Literature. Strategies Trauma Limb Reconstr 2023;18(1):51-55.
PubMed: 38033921
DOI: 10.5005/jp-journals-10080-1579 -
Foot and Ankle Surgery : Official... Apr 2020Injuries to the Lisfranc complex, although relatively rare carry a high morbidity and are often associated with other injuries. Despite a number published studies to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Injuries to the Lisfranc complex, although relatively rare carry a high morbidity and are often associated with other injuries. Despite a number published studies to determine the best operative management, there is an ongoing debate to whether open reduction and internal fixation (ORIF) or primary arthrodesis (PA) produces the best outcomes for patients. There have been further studies published in the last few years that have not been assessed as part of the wider literature and therefore we wished to perform an updated systematic review and meta-analysis with inclusion of outcomes not assessed in the previous studies.
METHODS
We performed a structured search for retrospective and prospective comparative papers and identified 8 relevant articles (2 RCT studies and 6 non-RCT studies) that compared the outcomes of ORIF versus PA; these studies included a total of 547 patients. Each of the studies was assessed for suitability and quality before inclusion. We performed a statistical analysis of the aggregated results as part of the review.
RESULTS
We found no statistically significant difference between the outcomes of ORIF versus PA in terms of return to work or activity (Odds Ratio 0.80 (CI 95%, 0.32-2.02, P=0.64)) and satisfaction rates (Odds Ratio 0.15 (CI 95%, 0.01-.00, P=0.25)). Patients undergoing ORIF have a higher risk of undergoing further surgery to remove the metalwork (Odds Ration 13.13 (CI 95%, 7.65-22.54, P<0.00001)) or to undergo secondary fusion, but, the overall complication rates appear to be equivalent in both groups (risk difference 0.03 (CI 95%, -0.15-0.21, P=0.76)).
CONCLUSIONS
Although there were no significant differences in the functional outcomes, the overall power of the studies is low. The rates of metalwork removal and secondary fusion were higher in the ORIF group and this risk should be presented to the patient when counselling them for any procedure. We noted that there is a high level of heterogeneity in the type of injuries and measured outcomes included in each study and, therefore, further trials are needed to determine the best treatment across the spectrum of Lisfranc complex injuries.
Topics: Arthrodesis; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Open Fracture Reduction
PubMed: 31103276
DOI: 10.1016/j.fas.2019.04.003 -
Foot and Ankle Surgery : Official... Aug 2021We reviewed the rates of and reasons for hallux valgus (HV) recurrence and the rates of avascular necrosis following Scarf osteotomy. (Review)
Review
BACKGROUND
We reviewed the rates of and reasons for hallux valgus (HV) recurrence and the rates of avascular necrosis following Scarf osteotomy.
METHODS
We searched the Cochrane Library, PubMed, and Embase databases for studies reporting operative management of HV using Scarf osteotomy. The primary endpoints were reasons for and rates of HV recurrence. The secondary endpoint was the rate of avascular necrosis.
RESULTS
We included 15 studies with 946 operations for HV. Seven studies reported no recurrence, six reported recurrence rates of 3.6-11.3%, one reported a recurrence rate of 30%, and one reported a recurrence rate of 78%. Thirteen studies (678 feet) reported other complications from Scarf osteotomy without avascular necrosis.
CONCLUSIONS
Although HV recurrence is not uncommon following Scarf osteotomy, patient-related factors, surgical competence, and longer follow-up are more likely to be associated with recurrence. Avascular necrosis is an infrequent complication in HV patients treated using Scarf osteotomy.
Topics: Bunion; Foot; Hallux Valgus; Humans; Metatarsal Bones; Osteonecrosis; Osteotomy; Treatment Outcome
PubMed: 32891491
DOI: 10.1016/j.fas.2020.08.009 -
The Journal of Foot and Ankle Surgery :... 2021The optimal method of fixation of acute Lisfranc injuries is yet to be established. We aim to systematically review the literature to identify the impact of fixation... (Meta-Analysis)
Meta-Analysis Review
The optimal method of fixation of acute Lisfranc injuries is yet to be established. We aim to systematically review the literature to identify the impact of fixation method on postoperative functional outcomes. A systematic review was undertaken using the PRISMA framework to identify all studies reporting postoperative functional outcomes in patients who underwent open-reduction internal fixation of acute Lisfranc injuries. Studies reporting outcomes of numerous fixation methods were divided into fixation subcohorts. Studies comparing bridge plate with transarticular screw fixation were included for meta-analysis, conducted using a random-effects model. Seventeen studies (20 subcohorts) with 462 patients were included. Mean patient age was 29.6 (rang, 15-81) years. Mean follow-up was 38.7 (range 11 to 287) months. American Academy of Orthopaedic Surgeons midfoot score (AOFAS-MF) was the most frequently reported functional outcome (16/20 subcohorts). Overall weighted mean AOFAS-MF was 76.3 ± 9.4 for all cases, with 74.2 ± 9.4 for transarticular screws and 79.2 ± 8.3 for bridge plates. The mean difference between screw and plate was not statistically significant (mean difference = 5.0, 95% confidence interval, -4.8 - 14.8, p = .3). A single study reported AOFAS-MF mean of 92 using suture button fixation. Meta-analysis of the 2 available comparative studies revealed higher postoperative AOFAS-MF with bridge plate fixation (pooled standardized mean difference, 0.51; 95% confidence interval, 0.15-0.87, p = .006). There is scarcity of literature examining the impact of fixation method on postoperative functional outcomes in acute Lisfranc injuries. A small number of studies have reported superior functional outcomes with use of bridge plate fixation. Further evidence is needed to ascertain which injuries are best managed with each fixation method or whether 1 fixation construct is universally superior.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Plates; Bone Screws; Fracture Fixation, Internal; Humans; Metatarsal Bones; Middle Aged; Open Fracture Reduction; Young Adult
PubMed: 33039319
DOI: 10.1053/j.jfas.2020.04.005 -
International Wound Journal Mar 2022Lapidus arthrodesis is an established standard procedure to correct various foot surgery problems and hallux limitus, hypermobility of the first ray, hallux abductus...
Lapidus arthrodesis is an established standard procedure to correct various foot surgery problems and hallux limitus, hypermobility of the first ray, hallux abductus valgus, and symptomatic lesser metatarsal. After decades, many fixation methods in the orthopaedic surgery industry have been developed for decreasing complications and improving this technique. The aim of this PRISMA compliant systematic review is to analyse the effectiveness of several lapidus plate systems in foot surgery. We have carried out the first systematic review of the relevant published literature so as to systematically evaluate the scientific knowledge available now on this association, assigning predefined eligibility criteria. Fourteen studies were selected which had an overall of 738 cases. The first tarsal metatarsal joint and hallux valgus were treated by the application of different types of Lapidus plate system. The optimal level of the fixation in these procedures is related with the type and system insertion place of the plate with or without screw in each specific foot disease. There is an insufficient number of studies about the effectiveness of the different types of Lapidus plate system in foot surgery, and there is a need to increase outcomes knowledge on the level of the fixation, sort of the system, and insert place in foot surgery.
Topics: Arthrodesis; Bone Screws; Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint
PubMed: 34255939
DOI: 10.1111/iwj.13649 -
Archives of Orthopaedic and Trauma... Jul 2023It is unclear whether lateral soft tissue release (LSTR) is required as part of percutaneous hallux valgus (PHV) surgery. The primary aim of this systematic review was... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It is unclear whether lateral soft tissue release (LSTR) is required as part of percutaneous hallux valgus (PHV) surgery. The primary aim of this systematic review was to assess whether LSTR reduces the risk of recurrence of hallux valgus deformity. The secondary aims were to assess if LSTR increases the risk of complications, improves the clinical outcome and leads to a greater radiographic correction.
METHODS
We performed a PRISMA-compliant PROSPERO-registered systematic review, pooling clinical papers reporting results after PHV surgery into two categories (PHV with (Group 1, G1) and without LSTR (Group 2, G2)) and comparing them. Data regarding the study design, demographics, the surgical procedure and the clinical and radiological outcome were extracted and compared. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS).
RESULTS
Sixteen studies were selected (G1:594 feet; G2:553 feet). The pooled proportion of recurrence at a minimum 21-month follow-up (2%, 95%CI 0-3 vs 2%, 95%CI 0-5; p = 0.70) did not differ in the two groups. Similarly, the pooled proportion of complications (27%, 95%CI 17-38 vs 25%, 95%CI 12-37; p = 0.79) was similar. The pre- (p = 0.23) and post-operative AOFAS scores (p = 0.16), the pre-(HVA: p = 0.23) (IMA: p = 0.94) and post-operative radiological angles (HVA: p = 0.47) (IMA: p = 0.2) and the methodological quality of studies (p = 0.2) did not differ either between G1 and G2.
CONCLUSION
There is no evidence that LSTR performed during percutaneous HV surgery reduces the risk of recurrence of the deformity at a mean 4-year follow-up nor improves the clinical and radiological outcome.
LEVEL OF EVIDENCE
Level IV systematic review of Level I to IV studies.
Topics: Humans; Hallux Valgus; Treatment Outcome; Osteotomy; Retrospective Studies; Radiography; Metatarsal Bones
PubMed: 36352268
DOI: 10.1007/s00402-022-04693-x -
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