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The Journal of Foot and Ankle Surgery :... 2009Percutaneous and minimum incision metatarsal osteotomies have received increasing recognition because of the perceived efficacy comparable to traditional open approaches... (Review)
Review
UNLABELLED
Percutaneous and minimum incision metatarsal osteotomies have received increasing recognition because of the perceived efficacy comparable to traditional open approaches but with purported less cost, fewer complications, and higher patient satisfaction. The use of these treatments has also been proposed for medically compromised patients who are not expected to recover well from traditional open approaches, a patient population that comprises a substantial proportion of the author's practice. Therefore, the author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the use of percutaneous and minimum incision metatarsal osteotomies. Information from peer-reviewed journals, as well as that from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, was also considered. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they were prospective, involved consecutively enrolled patients undergoing the same percutaneous or minimum incision surgical treatment, evaluated patients at a mean follow-up of 12 months or longer duration, and included outcome measurements consisting of subjective patient satisfaction, radiographic measurements, and details of complications. Three studies involving percutaneous surgical treatment specific to hallux valgus were identified that met the inclusion criteria, all of which were case series of relatively poor methodological quality. Rather than providing strong evidence for or against the use of percutaneous minimum incision metatarsal osteotomies, the results of this review make clear the need for methodologically sound prospective cohort studies and randomized controlled trials that focus on the use of this form of surgical intervention.
LEVEL OF EVIDENCE
1.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Patient Satisfaction; Research Design
PubMed: 19423043
DOI: 10.1053/j.jfas.2009.01.007 -
The American Journal of Sports Medicine Mar 2022While some studies have failed to reveal any significant relationship between magnetic resonance imaging (MRI) grading and return to sports after bone stress injuries,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
While some studies have failed to reveal any significant relationship between magnetic resonance imaging (MRI) grading and return to sports after bone stress injuries, others have reported either a linear or nonlinear relationship.
PURPOSE
To evaluate the prognostic value of MRI grading for time to return to sports and rate of return to sports after bone stress injuries.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A systematic search was performed in PubMed, Web of Science, SPORTDiscus, and Google Scholar. Studies reporting return to sports data after bone stress injuries using MRI grading systems were included in this review. The risk of bias was evaluated using the Quality in Prognosis Studies tool. Meta-analyses were performed to summarize the mean time to return to sports. The Pearson correlation was used to determine the relationship between time to return to sports and MRI grade. A meta-analysis of proportions was conducted to determine the percentage of athletes who successfully returned to sports.
RESULTS
A total of 16 studies with 560 bone stress injuries met inclusion criteria. Higher MRI-based grading was associated with an increased time to return to sports ( < .00001). Pooled data revealed that higher MRI-based grading correlated with a longer time to return to sports ( = 0.554; = .001). Combining all anatomic locations, the mean time to return to sports was 41.7 days (95% CI, 30.6-52.9), 70.1 days (95% CI, 46.9-93.3), 84.3 days (95% CI, 59.6-109.1), and 98.5 days (95% CI, 85.5-112.6) for grade 1, 2, 3, and 4 injuries, respectively. Trabecular-rich sites of injury (eg, pelvis, femoral neck, and calcaneus) took longer to heal than cortical-rich sites of injury (eg, tibia, metatarsal, and other long-bone sites of injury). Overall, more than 90% of all athletes successfully returned to sports.
CONCLUSION
The findings from this systematic review indicate that MRI grading may offer a prognostic value for time to return to sports after the nonsurgical treatment of bone stress injuries. Both MRI grade and location of injury suggest that individually adapted rehabilitation regimens and therapeutic decisions are required to optimize healing and a safe return to sports.
Topics: Athletes; Athletic Injuries; Fractures, Stress; Humans; Magnetic Resonance Imaging; Return to Sport; Sports
PubMed: 33720786
DOI: 10.1177/0363546521993807 -
The Journal of Foot and Ankle Surgery :... 2016Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many... (Meta-Analysis)
Meta-Analysis Review
Transmetatarsal amputations have generally been accepted as a relatively more definitive amputation compared with other lesser ray resections. However, many investigators have reported a high occurrence of more proximal amputation after transmetatarsal amputation. A systematic review was performed to evaluate the occurrence of reamputation and reoperation after transmetatarsal amputations. A search of the Medline, CINAHL, and Cochrane Central databases yielded 159 abstracts. After review, 24 reports were included in the study. A total of 391 (26.9%) reoperations were identified after 1453 transmetatarsal amputations. Any level reamputation occurred in 152 (29.7%) of 365 transmetatarsal amputations and major amputation occurred in 380 (33.2%) of 1146 transmetatarsal amputations. Using a random effects model, the reoperation rate was estimated at 24.43% (95% confidence interval 11.64% to 37.21%), the reamputation rate was estimated at 28.37% (95% confidence interval 19.56% to 37.19%), and the major amputation rate was estimated at 30.16% (95% confidence interval 23.86% to 36.47%). These findings raise questions about the conventional wisdom of performing primary transmetatarsal amputation in lieu of other minor amputations, such as partial first ray amputation, and suggest that the choice between transmetatarsal amputation and other minor amputations might be a decision that depends on very patient-specific factors.
Topics: Aged; Amputation, Surgical; Diabetic Foot; Female; Humans; Male; Metatarsal Bones; Middle Aged; Prognosis; Reoperation; Risk Assessment; Severity of Illness Index; Wound Healing
PubMed: 27475711
DOI: 10.1053/j.jfas.2016.05.011 -
Foot (Edinburgh, Scotland) Dec 2015This study assesses the outcomes of surgical vs. conservative management in the treatment of the Jones fracture. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study assesses the outcomes of surgical vs. conservative management in the treatment of the Jones fracture.
MATERIALS AND METHODS
A systematic review using four databases from their inception until September 2014 was undertaken. Six studies were found evaluating operative therapy compared to conservative treatment.
RESULTS
Six relevant studies were included, with a total of 237 patients. Of these, 51% were treated non-operatively, and 49% had surgical intervention. Those in the non-operative group were found to have a significantly higher odds ratio (OR) of fracture non-union (OR 5.74, 95% confidence interval (CI) 2.65-12.40, P<0.001). Studies also reported a prolonged healing time and a longer time to return to sports. Of the trials with time to union as an outcome measure, 3 of 4 trials found favourable results in the operative cohort.
CONCLUSIONS
Surgical intervention is recommended for patients presenting with a Jones fracture as it is found to result in a lesser non-union rate and an improved time to union.
Topics: Athletic Injuries; Fracture Fixation, Internal; Fracture Healing; Fractures, Stress; Humans; Metatarsal Bones
PubMed: 26481787
DOI: 10.1016/j.foot.2015.08.001 -
The Journal of Foot and Ankle Surgery :... 2011First metatarsal-cuneiform joint arthrodesis is a commonly performed procedure to correct first ray pathology. The most widely accepted approach is curettage and 2... (Comparative Study)
Comparative Study Review
First metatarsal-cuneiform joint arthrodesis is a commonly performed procedure to correct first ray pathology. The most widely accepted approach is curettage and 2 crossed compression screw fixation followed by a period of non-weight-bearing. Despite adequate joint preparation and stable internal fixation, nonunion has been cited as a known complication. This can lead to the need for revision surgery, which is undesirable and drives healthcare costs. To further investigate this topic, we conducted a systematic review to determine the rate of nonunion after the first metatarsal-cuneiform joint arthrodesis using curettage and 2 crossed compression screw fixation. Studies were eligible for inclusion only if they involved the following: arthrodesis of the first metatarsal-cuneiform joint with curettage and 2 crossed compression screw fixation, a minimum of 25 feet, with a mean follow-up of at least 6 months, and a period of postoperative non-weight-bearing. After considering all the potentially eligible references, 1 (1.8%) evidence-based medicine level I and 4 (7.3%) evidence-based medicine level IV studies met our inclusion criteria. A total of 537 patients (599 feet), 54 (10%) males and 483 (90%) females, with a weighted mean age of 49.4 years, were included. For those studies that specified the exact follow-up, the weighted mean was 30.9 months. A total of 30 nonunions (5%) were reported, with 17 (56.7%) symptomatic. The results of our systematic review revealed a relatively high rate of nonunion for first metatarsal-cuneiform joint arthrodesis with curettage and 2 crossed compression screw fixation, even when performed by experienced surgeons. Therefore, given the available data, additional prospective investigations are warranted, especially in the evaluation and comparison of fixation constructs and postoperative management.
Topics: Arthrodesis; Bone Screws; Combined Modality Therapy; Curettage; Female; Follow-Up Studies; Fractures, Ununited; Humans; Incidence; Male; Metatarsal Bones; Metatarsophalangeal Joint; Risk Assessment
PubMed: 21908206
DOI: 10.1053/j.jfas.2011.08.003 -
The British Journal of Oral &... Feb 2017To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015.... (Review)
Review
To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015. A total of 9499 mandibular defects were reconstructed with 6178 fibular, 1380 iliac crest, 1127 composite radial, 709 scapular, 63 serratus anterior and rib, 32 metatarsal, and 10 lateral arm flaps including humerus. The failure rate was higher for the iliac crest (6.2%, 66/1059) than for fibular, radial, and scapular flaps combined (3.4%, 202/6018) (p<0.001). We evaluated rates of osteotomy, non-union, and fistulas. Implant-retained prostheses were used most often for rehabilitation after reconstruction with iliac crest (44%, 100/229 compared with 26%, 605/2295 if another flap was used) (p<0.001). There were no apparent changes in the choice of flap or in the complications reported. Although we were able to show some significant differences relating to the types of flap used, we were disappointed to find that fundamental outcomes such as the need for osteotomy, and rates of non-union and fistulas were under-reported. This review shows the need for more comprehensive and consistent reporting of outcomes to enable the comparison of different techniques for similar defects.
Topics: Bone Transplantation; Free Tissue Flaps; Humans; Mandibular Reconstruction; Time Factors
PubMed: 28065645
DOI: 10.1016/j.bjoms.2016.12.010 -
The Journal of Foot and Ankle Surgery :... 2013The Keller-Brandes arthroplasty has well-documented outcomes, including many complications that culminate in arthrodesis of the first metatarsal-phalangeal joint. In the... (Review)
Review
Incidence of nonunion of first metatarsal-phalangeal joint arthrodesis with autogenous iliac crest bone graft after failed Keller-Brandes arthroplasty: a systematic review.
The Keller-Brandes arthroplasty has well-documented outcomes, including many complications that culminate in arthrodesis of the first metatarsal-phalangeal joint. In the setting of a large osseous defect, the autogenous iliac crest is the most commonly referenced source for the autogenous bone graft. We undertook a systematic review of electronic databases and other relevant sources regarding the incidence of nonunion after arthrodesis of the first metatarsal-phalangeal joint using autogenous iliac crest bone graft for failed Keller-Brandes arthroplasty. Six studies involving 42 arthrodeses met our inclusion criteria. The incidence of nonunion was 4.8% (2 of 42). It has been inherently accepted that revisional surgery can increase the incidence of nonunion. Our systematic review of the available data revealed that the use of an autogenous iliac crest bone graft results in a high incidence of primary union (95.2%) for salvage arthrodesis. However, additional appropriately weighted prospective studies and comparative analyses are needed regarding this topic.
Topics: Aged; Aged, 80 and over; Arthrodesis; Arthroplasty; Female; Humans; Ilium; Male; Metatarsophalangeal Joint; Middle Aged; Reoperation; Salvage Therapy; Transplantation, Autologous; Treatment Failure
PubMed: 23063206
DOI: 10.1053/j.jfas.2012.06.001 -
Journal of Biomechanics Jan 2012Bone strain is the governing stimuli for the remodeling process necessary in the maintenance of bone's structure and mechanical strength. Strain gages are the gold... (Review)
Review
Bone strain is the governing stimuli for the remodeling process necessary in the maintenance of bone's structure and mechanical strength. Strain gages are the gold standard and workhorses of human bone experimental strain analysis in vivo. The objective of this systematic literature review is to provide an overview for direct in vivo human bone strain measurement studies and place the strain results within context of current theories of bone remodeling (i.e. mechanostat theory). We employed a standardized search strategy without imposing any time restriction to find English language studies indexed in PubMed and Web of Science databases that measured human bone strain in vivo. Twenty-four studies met our final inclusion criteria. Seven human bones were subjected to strain measurements in vivo including medial tibia, second metatarsal, calcaneus, proximal femur, distal radius, lamina of vertebra and dental alveolar. Peak strain magnitude recorded was 9096 με on the medial tibia during basketball rebounding and the peak strain rate magnitude was -85,500 με/s recorded at the distal radius during forward fall from standing, landing on extended hands. The tibia was the most exposed site for in vivo strain measurements due to accessibility and being a common pathologic site of stress fracture in the lower extremity. This systematic review revealed that most of the strains measured in vivo in different bones were generally within the physiological loading zone defined by the mechanostat theory, which implies stimulation of functional adaptation necessary to maintain bone mechanical integrity.
Topics: Animals; Bone Remodeling; Bone and Bones; Humans; Sprains and Strains; Stress, Mechanical
PubMed: 21889149
DOI: 10.1016/j.jbiomech.2011.08.004 -
Foot & Ankle Specialist Jun 2023The aim of this review was to determine operative indications for Lisfranc injuries. (Review)
Review
OBJECTIVE
The aim of this review was to determine operative indications for Lisfranc injuries.
METHODS
A systematic review using a MEDLINE literature search was performed using the index "Lisfranc Injury" from 1980 onward using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines where applicable. Inclusion criteria were all clinical studies reporting on the management of Lisfranc injuries obtained via the search index, including case reports, review articles, cohort studies, and randomized trials. Non-English-language articles, inaccessible articles, those not relevant to the management of Lisfranc injuries (biomechanical, cadaveric, and technique articles), and those that did not explicitly state operative indications (vague or absent indications) were excluded.
RESULTS
After identifying 737 studies, the full text of 391 studies was reviewed, and 58 reports providing explicit operative indications were included in the final analysis. Fifty-one (81.1%) studies provided diastasis cutoffs varying ≥2 mm (35/58; 60.4%), ≥ ≥3 mm (3; 5.2%); the diastasis location was most commonly unspecified (31/58; 53.5%) or varied between combinations of metatarsal, tarsal, cuboid, and cuneiform bones (20/58; 27.6%). Specific imaging criteria for surgery included an avulsion fracture or fleck sign (3/58; 5.2%), arch height loss (3/58; 5.2%), and a tear on magnetic resonance imaging (5; 8.6%). The 11 (19%) studies defining operative indications in terms of classification schemes used the Nunley and Vertullo (8/58; 13.8%), Myerson (2; 3.5%), and Buehren (1; 1.7%) systems. Twenty-one (36.2%) studies provided multiple operative indications.
CONCLUSION
The most common Lisfranc operative indications among the limited reporting studies varied from a 1- to 3-mm diastasis across several locations. It is imperative for operative indications to be reported with an increased frequency and in a homogenous fashion to guide the clinical management of these subtle injuries.
LEVELS OF EVIDENCE
Level IV; systematic Review.
PubMed: 37278226
DOI: 10.1177/19386400231175376 -
Knee Surgery, Sports Traumatology,... Jun 2013The aim of this study is to better inform the sports surgeon of current evidence for the treatment of Jones fractures of the base of the 5th metatarsal. The study aimed... (Review)
Review
PURPOSE
The aim of this study is to better inform the sports surgeon of current evidence for the treatment of Jones fractures of the base of the 5th metatarsal. The study aimed to establish what the outcomes were for different treatments modalities. By doing this, the clinician will be better prepared to institute a logical, evidence-based approach to the treatment of their patients with this injury.
METHODS
A thorough literature search was performed from 1980 to present day. Studies were included based on set criteria and analysed for their validity, and their results were scrutinised. Jones fractures were segregated into acute fractures, delayed unions and non-unions.
RESULTS
Twenty-six studies were included, of which 22 were level 4 evidence, with only 1 randomised controlled trial. Functional outcome data were limited to return to sports in most studies with few studies using established scoring systems. Return to sports following intra-medullary screw fixation for acute fractures ranged from 4 to 18 weeks. Acute fractures treated non-operatively had a union rate of 76 % (pooled), whereas in fractures treated with a screw it was 96 % (pooled). Delayed unions treated non-operatively had a union rate of 44 and 97 % treated operatively. Non-unions treated with screw fixation healed in 97 % of cases.
CONCLUSIONS
Although supported by mostly level 4 evidence, intra-medullary screw fixation is more likely to lead to successful union of all types of Jones fractures compared to non-operative treatments. Early return to play in athletes prior to full radiological union is not advised in case of re-fracture.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Athletic Injuries; Bone Screws; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Metatarsal Bones; Middle Aged; Young Adult
PubMed: 22956165
DOI: 10.1007/s00167-012-2138-8