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PM & R : the Journal of Injury,... Apr 2021Acute metatarsal fractures are a common lower extremity injury. Although surgery may be recommended in specific cases, most are treated nonoperatively. Treatment...
OBJECTIVE
Acute metatarsal fractures are a common lower extremity injury. Although surgery may be recommended in specific cases, most are treated nonoperatively. Treatment protocols vary significantly among practitioners, with no consensus on the most efficacious approach. This systematic review aims to identify the effect of treatment protocols on union rate and functional outcome after an acute fifth metatarsal tuberosity fracture.
LITERATURE SURVEY
Multiple databases, including CINAHL, EMBASE, MEDLINE, and the Cochrane CEntral Register of Controlled Trials (CENTRAL) were searched from database inception to March 4, 2018 to identify clinical studies addressing nonoperative management of metatarsal fractures reporting nonunion, pain, and/or length of recovery.
METHODOLOGY
Two reviewers independently completed title, abstract, and full-text screening. Data abstraction was completed in duplicate. Outcome measures and complications were descriptively analyzed.
SYNTHESIS
A total of 1941 studies were eligible for screening. Seven studies (four randomized controlled trials and three prospective cohort studies) satisfied inclusion criteria. This resulted in a total of 388 patient with acute fifth metatarsal tuberosity fractures in 12 different treatment arms, with the most common treatment including plaster casting (7). The mean age was 42 years (27 to 56 years), and the overall nonunion rate was low (1.1%). Four unique functional scores were reported across all studies, and all showed good to excellent short-term results. The overall qualities of studies were moderate, with particular limitations in randomization and concealment allocation.
CONCLUSION
Most acute fifth metatarsal tuberosity fractures heal well, with good-to-excellent functional outcomes with nonoperative treatment, regardless of technique. We recommend a conservative rehabilitation framework, including 2 to 3 weeks of immobilization in a walking cast, followed by gradual increase in activity and strengthening until clinical union is achieved.
Topics: Ankle Injuries; Fractures, Bone; Humans; Metatarsal Bones; Prospective Studies
PubMed: 32472589
DOI: 10.1002/pmrj.12427 -
Foot and Ankle Clinics Mar 2020Minimally invasive (MIS) or percutaneous surgery has evolved rapidly through the development of novel techniques with precise description, correct indications, and the...
Minimally invasive (MIS) or percutaneous surgery has evolved rapidly through the development of novel techniques with precise description, correct indications, and the incorporation of modifications of safe and effective techniques described in open surgery. The correct term to describe these procedures should be percutaneous and MIS should be reserved for procedures between percutaneous and open surgery (eg, osteosynthesis). According to results, third-generation techniques are useful, effective, and easier than open procedures. It seems that MIS surgery has an extensive learning curve, and therefore it may be difficult to duplicate the results shown on already-published data.
Topics: Hallux Valgus; Humans; Learning Curve; Metatarsal Bones; Minimally Invasive Surgical Procedures; Osteotomy
PubMed: 31997749
DOI: 10.1016/j.fcl.2019.10.010 -
Foot and Ankle Surgery : Official... Dec 2020Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus,...
BACKGROUND
Valente Valenti proposed in 1976 a "V" resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed.
METHODS
Titles and abstracts of all selected articles were independently screened by two authors to assess their suitability to the research focus.
RESULTS
Selection produced 8 articles as full-text, for a total of 347 patients, with a mean follow-up of 6±7.1 (range 0.2-17.5) years. Most common complication was transient sesamoiditis in 21 (7.4%) patients. No substantial differences in clinical outcomes were found between the original and modified techniques.
CONCLUSIONS
VP appears to allow an early recovery with few complications, if compared to fusion, interposition arthroplasties or osteotomies. The wide joint resection does not prevent, if necessary, further procedures such as fusion or implants.
LEVEL OF EVIDENCE
Level I, systematic review.
Topics: Arthroplasty; Hallux Rigidus; Humans; Metatarsal Bones; Osteotomy; Toe Phalanges
PubMed: 31839478
DOI: 10.1016/j.fas.2019.11.009 -
Acta Orthopaedica Et Traumatologica... Nov 2019The aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation.
OBJECTIVE
The aim of this systematic review was to present the outcome of Lisfranc joint injuries treated with closed reduction and screw percutaneous fixation.
METHODS
We searched in Pubmed and Google Scholar Databases for articles regarding screw percutaneous fixation of Lisfranc injuries. Seven studies in total were found to be compatible to our search, according to PRISMA guidelines. Four of those met the criteria of the review and they were included in the meta-analysis. A total number of 106 patients were separated into five groups according to the type of injury and the mean AOFAS score of each group was calculated. Cases in which percutaneous fixation was converted to open treatment due to poor reduction were not included in the study. In addition we compared the outcome score between types of injury according to Myerson classification as well as between purely ligamentous and osseoligamentous injuries. The characteristics of all seven selected studies, such as kind of screw used for fixation, post operative protocol, complications and outcome are mentioned as well.
RESULTS
Average AOFAS score was 86,2 for type A, 87,54 for type B, and 85 for type C injuries respectively. In pure dislocation group the average AOFAS score was 86,43 and in fracture dislocation group was 87,36. Good to excellent outcome can be expected in patients with different types of injury according to Myerson classification following percutaneous fixation of lisfranc joint injury. Patients with type B injury or a fracture dislocation injury might have better outcome, although this difference was not found to be statistically significant.
CONCLUSION
Percutaneous fixation of tarsometatarsal joint injuries is a relatively simple and safe method of treatment, leading to a good functional outcome, especially for Myerson type B as well as for fracture dislocation type of injuries, provided that an anatomical reduction has been achieved.
LEVEL OF EVIDENCE
Level III, Therapeutic Study.
Topics: Bone Screws; Fracture Dislocation; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Radiography; Tarsal Joints
PubMed: 31575479
DOI: 10.1016/j.aott.2019.08.005 -
Zhongguo Gu Shang = China Journal of... Aug 2019To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate efficacy of radiographic and clinical of Chevron osteotomy versus Scarf osteotomy for hallux valgus at moderate and severe degree.
METHODS
Randomized controlled trial (RCT) about Chevron and Scarf osteotomy for hallux valgus, in PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang Data were searched by computer from establishing database to June 2018. According to inclusion and exclusion criteria, two researchers independently screened the literatures, evaluated risk of bias and extracted related observation index, RevMan 5.3.5 software was used to perform Meta-analysis. Postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), AOFAS score, complications and patients' satisfaction degree between Chevron and Scarf osteotomy.
RESULTS
Six RCT literatures were included, involving 507 patients, 92.5% patients were at moderate and severe degree, and 261 patients were performed by Chevron osteotomy and 246 patients were performed by Scarf osteotomy. Meta analysis results showed that Chevron osteotomy was better than Scarf osteotomy in correcting HVA [MD=-1.95, 95%CI(-2.64, -1.27), <0.000 01]. While there were no statistical differences in IMA [MD=-0.42, 95%CI(-1.04, 0.21), =0.19], DMAA[MD=0.78, 95%CI(-0.72, 2.29), =0.31], AOFAS score [MD=2.47, 95%CI(-2.38, 7.33), =0.32], complications [RR=1.09, 95%CI(0.54, 2.20), =0.82], and patients' satisfaction degree [RR=1.00, 95%CI(0.96, 1.05), =0.92].
CONCLUSIONS
Chevron osteotomy, which has advantages in simple operation, shorten metatarsal bone, less trauma, was better in correcting HVA of hallux valgus at moderate and severe degree, and had similar effects in IMA, DMAA, AOFAS score, complications and patients' satisfactory degree.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Metatarsophalangeal Joint; Osteotomy; Treatment Outcome
PubMed: 31533392
DOI: 10.3969/j.issn.1003-0034.2019.08.018 -
Skeletal Radiology Jan 2020To systematically review current diagnostic imaging options for assessment of the Lisfranc joint.
OBJECTIVES
To systematically review current diagnostic imaging options for assessment of the Lisfranc joint.
MATERIALS AND METHODS
PubMed and ScienceDirect were systematically searched. Thirty articles were subdivided by imaging modality: conventional radiography (17 articles), ultrasonography (six articles), computed tomography (CT) (four articles), and magnetic resonance imaging (MRI) (11 articles). Some articles discussed multiple modalities. The following data were extracted: imaging modality, measurement methods, participant number, sensitivity, specificity, and measurement technique accuracy. Methodological quality was assessed by the QUADAS-2 tool.
RESULTS
Conventional radiography commonly assesses Lisfranc injuries by evaluating the distance between either the first and second metatarsal base (M1-M2) or the medial cuneiform and second metatarsal base (C1-M2) and the congruence between each metatarsal base and its connecting tarsal bone. For ultrasonography, C1-M2 distance and dorsal Lisfranc ligament (DLL) length and thickness are evaluated. CT clarifies tarsometatarsal (TMT) joint alignment and occult fractures obscured on radiographs. Most MRI studies assessed Lisfranc ligament integrity. Overall, included studies show low bias for all domains except patient selection and are applicable to daily practice.
CONCLUSIONS
While conventional radiography can demonstrate frank diastasis at the TMT joints; applying weightbearing can improve the viewer's capacity to detect subtle Lisfranc injury by radiography. Although ultrasonography can evaluate the DLL, its accuracy for diagnosing Lisfranc instability remains unproven. CT is more beneficial than radiography for detecting non-displaced fractures and minimal osseous subluxation. MRI is clearly the best for detecting ligament abnormalities; however, its utility for detecting subtle Lisfranc instability needs further investigation. Overall, the available studies' methodological quality was satisfactory.
Topics: Foot Injuries; Foot Joints; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Radiography; Tomography, X-Ray Computed; Ultrasonography; Weight-Bearing
PubMed: 31368007
DOI: 10.1007/s00256-019-03282-1 -
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 -
The Journal of Foot and Ankle Surgery :... Mar 2019This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with... (Comparative Study)
Comparative Study Meta-Analysis
This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, a systematic review was carried out. MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify both randomised controlled trials (RCTs) and nonrandomised studies comparing the outcomes of ORIF and primary arthrodesis for Lisfranc injuries. Random- and fixed-effect statistical models were applied to calculate the pooled outcome data. Two RCTs and 3 observational studies were identified, compiling a total of 187 subjects with acute Lisfranc injuries and a mean follow-up duration of 62.3 months. Our results demonstrate that ORIF is associated with a significantly higher need for revision surgery (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.68 to 15.11, p < .0001) and a significantly higher rate of persistent pain (OR 6.29, 95% CI 1.07 to 36.89, p = .04) compared with primary arthrodesis. However, we found no significant difference between the groups in terms of visual analogue scale pain score, American Orthopaedic Foot & Ankle Society functional score, or rates of infection. Separate analysis of RCTs showed that ORIF was associated with a more frequent need for revision surgery (OR 17.56, 95% CI 5.47 to 56.38, p < .00001), higher visual analogue scale pain score (mean difference 2.90, 95% CI 2.84 to 2.96, p < .00001), and lower American Orthopaedic Foot & Ankle Society score (mean difference -29.80, 95% CI -39.82 to -19.78, p < .00001). The results of the current study suggest that primary arthrodesis may be associated with better pain and functional outcomes and lower need for revision surgery compared with ORIF. The available evidence is limited and is not adequately robust to make explicit conclusions. The current literature requires high-quality and adequately powered RCTs.
Topics: Arthrodesis; Female; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Male; Metatarsal Bones; Open Fracture Reduction; Postoperative Complications; Prognosis; Randomized Controlled Trials as Topic; Reoperation; Risk Assessment; Tarsal Bones
PubMed: 30850102
DOI: 10.1053/j.jfas.2018.08.061 -
International Orthopaedics May 2019This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and... (Comparative Study)
Comparative Study
PURPOSE
This systematic review aimed to compare radiographic correction, clinical outcomes, complications, and re-operations between lateral column lengthening (LCL) and arthroereisis (AR) for treating symptomatic flatfoot in children.
METHODS
We conducted a comprehensive search on MEDLINE, EMBASE, and Cochrane Library databases. Literature search, data extraction, and quality assessment were conducted by two independent reviewers. The outcomes analyzed included radiographic parameters, clinical scores, satisfaction, complications, and re-operations.
RESULTS
Twenty-one and 13 studies were included in the LCL and AR groups, respectively. The change in anteroposterior talo-first metatarsal angle was greater in the LCL (9.5° to 21.7°) than in the AR group (10.6° to 12.8°). The change in calcaneal pitch was greater in the LCL (2.1° to 26.53°) than in the AR group (- 1.3° to 3.23°). Improvements in the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were greater in the LCL (27.7 to 39.1) than in the AR group (17 to 22). The percentage of satisfaction was similar between the LCL (68% to 89%) and AR (78.5% to 96.4%) groups. The complication rate was higher in the LCL (0% to 86.9%) than in the AR group (3.5% to 45%). The most common complications were calcaneocuboid subluxation and persistent pain in the LCL and AR groups, respectively. The re-operation rate was similar between the LCL (0% to 27.3%) and AR (0% to 36.4%) groups.
CONCLUSIONS
The LCL group has achieved more radiographic corrections and more improvements in the AOFAS score than the AR group. Complications were more common in the LCL group than in the AR group, and the re-operation rates were similar between the two groups.
Topics: Bone Transplantation; Child; Flatfoot; Foot Bones; Humans; Retrospective Studies; Subtalar Joint
PubMed: 30701302
DOI: 10.1007/s00264-019-04303-3 -
Foot and Ankle Surgery : Official... Oct 2019Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness...
BACKGROUND
Weil's osteotomy (WO) is the most applied surgical treatment for metatarsalgia, a persistent pain in the lesser metatarsals' heads. We aim to review its effectiveness and safety compared to the percutaneous technique known as distal metatarsal mini-invasive osteotomy (DMMO).
METHODS
Systematic review in Medline, Pubmed, Embase, Cinahl and Cochrane Library. We included studies that directly compared WO and DMMO for the treatment of primary metatarsalgia. Data on pain, function, complications and patients' satisfaction were extracted and narratively synthesized.
RESULTS
Four retrospective studies were identified. There were no significant differences in clinical effectiveness or patients' satisfaction. Time to bone healing was significantly longer for DMMO, whereas WO showed more wound problems and metatarsophalangeal stiffness. Other complications were infrequent in the two procedures.
CONCLUSION
Evidence on the direct comparison of WO and DMMO is scarce and of low quality. Randomized studies are needed in order to control for potential confounders.
Topics: Arthrodesis; Humans; Metatarsal Bones; Metatarsalgia; Metatarsophalangeal Joint; Minimally Invasive Surgical Procedures; Osteotomy; Patient Satisfaction; Plastic Surgery Procedures; Treatment Outcome
PubMed: 30321939
DOI: 10.1016/j.fas.2018.06.004