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Journal of Foot and Ankle Research 2017The accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Such measurement is particularly valuable in...
BACKGROUND
The accurate and reliable measurement of foot bone density is challenging and there is currently no gold standard technique. Such measurement is particularly valuable in populations at risk of foot bone pathology such as in those with long term diabetes. With research and development, computed tomography may prove to be a useful tool for this assessment. The aim of this study was to establish the reliability of a novel method of foot bone density measurement in people with diabetes using computed tomography.
METHODS
Ten feet in people with diabetes were scanned with computed tomography twice with repositioning. Bone density (in Hounsfield units) was assessed in the trabecular and cortical bone in all tarsals and metatarsals. Reliability was assessed with intra-class correlation coefficients (95% confidence intervals), limits of agreement and standard error of measurement.
RESULTS
The reliability of the trabecular density of most bones was excellent with intra-class correlation coefficients ranging from 0.68 to 0.91. Additionally, cortical bone density showed fair to good reliability at the talus (0.52), calcaneus (0.59), navicular (0.70), cuboid (0.69), intermediate cuneiform (0.46) and first metatarsal (0.61).
CONCLUSIONS
The study established the reliability of a practical method of assessing the trabecular and cortical foot bone density using computed tomography scanning. This methodology may be useful in the investigation of foot bone disease occurring in diabetes and its early diagnosis, intervention and assessment of treatment efficacy. Further development of this method is warranted.
Topics: Aged; Bone Density; Cancellous Bone; Cortical Bone; Diabetic Foot; Female; Humans; Male; Metatarsal Bones; Reproducibility of Results; Tarsal Bones; Tomography, X-Ray Computed
PubMed: 28270861
DOI: 10.1186/s13047-017-0192-7 -
Journal of Anatomy Apr 2018Aspects of trabecular bone architecture are thought to reflect regional loading of the skeleton, and thus differ between primate taxa with different locomotor and... (Comparative Study)
Comparative Study
Aspects of trabecular bone architecture are thought to reflect regional loading of the skeleton, and thus differ between primate taxa with different locomotor and postural modes. However, there are several systemic factors that affect bone structure that could contribute to, or be the primary factor determining, interspecific differences in bone structure. These systemic factors include differences in genetic regulation, sensitivity to loading, hormone levels, diet, and activity levels. Improved understanding of inter-/intraspecific variability, and variability across the skeleton of an individual, is required to interpret properly potential functional signals present within trabecular structure. Using a whole-region method of analysis, we investigated trabecular structure throughout the skeleton of humans and chimpanzees. Trabecular bone volume fraction (BV/TV), degree of anisotropy (DA) and trabecular thickness (Tb.Th) were quantified from high resolution micro-computed tomographic scans of the humeral and femoral head, third metacarpal and third metatarsal head, distal tibia, talus and first thoracic vertebra. We found that BV/TV is, in most anatomical sites, significantly higher in chimpanzees than in humans, suggesting a systemic difference in trabecular structure unrelated to local loading regime. Differences in BV/TV between the forelimb and hindlimb did not clearly reflect differences in locomotor loading in the study taxa. There were no clear systemic differences between the taxa in DA and, as such, this parameter might reflect function and relate to differences in joint loading. This systemic approach reveals both the pattern of variability across the skeleton and between taxa, and helps identify those features of trabecular structure that may relate to joint function.
Topics: Anatomic Variation; Animals; Anisotropy; Body Patterning; Cancellous Bone; Female; Femur Head; Humans; Humeral Head; Locomotion; Male; Metacarpal Bones; Metatarsal Bones; Pan troglodytes; Statistics, Nonparametric; Talus; Thoracic Vertebrae; Tibia; Tomography, X-Ray Computed
PubMed: 29344941
DOI: 10.1111/joa.12776 -
Orthopaedic Surgery Dec 2023Rotational Scarf osteotomy has its unique advantages in treating hallux valgus, but it also has certain drawbacks. The biomechanical differences between rotational Scarf...
OBJECTIVE
Rotational Scarf osteotomy has its unique advantages in treating hallux valgus, but it also has certain drawbacks. The biomechanical differences between rotational Scarf and translational Scarf osteotomy are not clear evaluates the correction ability and biomechanical difference of two surgical methods for hallux valgus by finite element analysis.
METHODS
The computerized tomography data of a hallux valgus patient were selected to establish a finite element model. The standard Scarf osteotomy was simulated based on the model, and the rotation and translation were performed, respectively. The size of the intermetatarsal angle, contact area, distal metatarsal articular angle and the absolute length of the first metatarsal was compared between the two groups. We completed the cartilage, ligament and other tissues on the bone model to establish a full foot model. We analyzed the troughing, plantar aponeurosis tension, plantar soft tissue, and ground stress and also observed the stability of the fracture site by a three-point bending test.
RESULTS
Both surgical methods may effectively correct the intermetatarsal angle. After rotational osteotomy, the contact area increased, and the length of the first metatarsal bone initially increased and then decreased compared to that in the translational group. Furthermore, rotational Scarf significantly increased the distal metatarsal articular angle. Mechanical analysis showed that the cancellous bone in the contact part of the fracture site in the translation group had greater stress, which was the reason for the occurrence of the troughing. Stress distribution of plantar aponeurosis, plantar soft tissue, and the ground showed no significant difference. The three-point bending test showed that the separation of the broken ends of the rotational Scarf osteotomy model (0.133 mm) was slightly smaller than the translational group (0.147 mm).
CONCLUSION
Both surgical methods can successfully correct intermetatarsal angle (IMA). Compared to traditional translational Scarf osteotomy, rotational Scarf osteotomy is more conducive to postoperative stability and healing, but it also has certain drawbacks. In clinical practice, individualized surgical methods still need to be selected for different types of patients with hallux valgus.
Topics: Humans; Hallux Valgus; Finite Element Analysis; Metatarsal Bones; Osteotomy; Metatarsophalangeal Joint; Treatment Outcome
PubMed: 37731316
DOI: 10.1111/os.13903 -
Asian Journal of Surgery Oct 2022
Topics: Amputation, Surgical; Humans; Metatarsal Bones; Osteomyelitis
PubMed: 35431128
DOI: 10.1016/j.asjsur.2022.03.120 -
Journal of the American Veterinary... Aug 2021A 5-year-old 4.0-kg (8.8-lb) castrated male domestic shorthair cat was referred because of grade 4/5 left hind limb lameness and swelling in the region of the second...
CASE DESCRIPTION
A 5-year-old 4.0-kg (8.8-lb) castrated male domestic shorthair cat was referred because of grade 4/5 left hind limb lameness and swelling in the region of the second metatarsal bone of that limb.
CLINICAL FINDINGS
Computed tomography revealed an expansile osteolytic lesion of the second metatarsal bone associated with a periosteal reaction on the third metatarsal bone. There was no evidence of metastases.
TREATMENT AND OUTCOME
Amputation of the second and third metatarsal bones was performed but resulted in medial instability of the remaining metatarsal bones. The instability was treated by placing a loop of 2-0 monofilament, nonabsorbable suture from a screw placed in the distal row of the tarsal bones to a tunnel in the proximal metaphysis of the fourth metatarsal bone. Clinical reevaluation of the cat 7, 15, 30, 60, 90, and 210 days after surgery and radiographic reevaluation 90 and 210 days after surgery showed complete recovery of the cat. The implants were removed at the time of the 7-month reevaluation. Clinical evaluation 18 months after implant removal showed the treated joint to be stable.
CLINICAL RELEVANCE
The surgical stabilization technique described here provided medial stability of the tarsometatarsal joint after amputation of the second and third metatarsal bones. This method may be an alternative to arthrodesis while maintaining articular function in cats.
Topics: Amputation, Surgical; Animals; Bone Cysts, Aneurysmal; Bone Screws; Male; Metatarsal Bones; Tarsal Bones
PubMed: 34242073
DOI: 10.2460/javma.259.3.294 -
Clinical Orthopaedics and Related... Jul 2022Fractures of the proximal fifth metatarsal are common, and often they are classified using a three-part scale first proposed by Lawrence and Botte. A clear consensus on...
BACKGROUND
Fractures of the proximal fifth metatarsal are common, and often they are classified using a three-part scale first proposed by Lawrence and Botte. A clear consensus on prognosis and treatment for these fractures is lacking, particularly for fractures in the middle classification, Zone 2; the reliability of the classification scheme itself may be partly at fault for this. The intra- and interrater reliability of the classification itself has never been established, and it remains unclear whether the three-part classification of fifth metatarsal fractures can be applied consistently enough to guide treatment.
QUESTIONS/PURPOSES
When used by experienced orthopaedic surgeons, (1) What is the overall interrater reliability of the three-part Lawrence and Botte classification of fifth metatarsal base fractures? (2) What is the overall intrarater reliability of the three-part Lawrence and Botte classification of fifth metatarsal base fractures? (3) What are these same metrics for the individual transitions within the classification (Zone 1-2 and Zone 2-3)?
METHODS
Thirty sets of initial presentation radiographs representing an equal number of fractures originally diagnosed by treating clinicians as Zone 1, Zone 2, and Zone 3 were evaluated and classified by three orthopaedic surgeons specializing in foot and ankle surgery and eight foot and ankle fellows to determine interrater reliability. Two weeks later, the same set of radiographs were reevaluated in random order to determine intrarater reliability. Kappa values for interrater and intrarater reliability were calculated. Additionally, the individual transitions between zones were separately analyzed by calculating kappa values for a hypothetical two-part classification based on each transition.
RESULTS
The three-part Lawrence and Botte classification of fifth metatarsal fractures demonstrated an overall interrater agreement of κ = 0.66 (observed agreement 77% versus chance agreement 33%). Intrarater reliability for the 11 surgeons ranged from κ = 0.60 to κ = 0.90. A two-part scheme divided by the transition between Zone 1 and Zone 2 demonstrated an interrater agreement of κ = 0.83, and a two-part scheme divided by the transition between Zone 2 and Zone 3 demonstrated a much lower interrater reliability of κ = 0.66.
CONCLUSION
The three-part Lawrence and Botte classification system demonstrated a concerningly low level of interrater reliability with an observed agreement of 77% compared with a chance agreement of 33%. The primary source of concern is the assessment of the interface between Zone 2 and Zone 3, which proved much less reliable than that between Zone 1 and Zone 2. This suggests that previous studies of isolated Zone 1 fractures likely contain a homogeneous fracture cohort, whereas studies of Zone 2 or Zone 3 fractures are likely to include a mixture of fracture types. In practice, the consensus treatment of fifth metatarsal fractures differs based on whether they represent a more proximal, avulsive injury or a more distal injury from indirect trauma. Our data suggest that the Lawrence and Botte classification should be abandoned. Further work should focus on developing a new classification scheme that demonstrates improved interobserver reliability and more directly corresponds to this treatment paradigm.
LEVEL OF EVIDENCE
Level III, diagnostic study.
Topics: Ankle Injuries; Foot Injuries; Fractures, Bone; Humans; Knee Injuries; Metatarsal Bones; Observer Variation; Radiography; Reproducibility of Results
PubMed: 35081080
DOI: 10.1097/CORR.0000000000002131 -
La Tunisie MedicaleHallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with... (Review)
Review
BACKGROUND
Hallux valgus is a deformity of the forefoot involving a phalangeal valgus and a metatarsal adductus. In most cases its correction requires surgical treatment with different types of osteotomies. The best known is Scarf osteotomy.
AIM
To study the effet of Scarf osteotomy on distal metatarsal articular angle (DMAA) as well as the validitiy of this angle and the value of its correction after review of the literature.
METHODS
It was a retrospective study including patients operated on for severe hallux valgus by a Scarf osteotomy. The clinical assessment was based on the the American-Orthopedic-Foot-and-Ankle-society (AOFAS) score. Radiologically, we calculated the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA. This assessment was performed preoperatively and one year postoperatively.
RESULTS
We collected 37 cases of evolved hallux valgus. The average AOFAS score went from 60.7 to 85.8 / 100 postoperatively with a gain of 25 points. We've noted a significant correction of the 3 angular measurements at one year postoperatively (the metatarsophalangeal angle, the inter-metatarsal angle and the DMAA) which went from 38.8° to 20.5°, from 17° at 10° and 13.5° to 8.5° respectively (p<0.05).
CONCLUSION
The literature has shown that there is no consensus regarding the effect of HV surgery on the DMAA. As for the accuracy, reproducibility and interest of correcting this angle we deduce that the DMAA is an interesting measure in the pathology of HV. Its correction seems not to be necessary in order not to hamper the correction of metatarsus varus. But in cases where the preoperative DMAA is high (> 15 °), efforts should be made to correct it to avoid recurrence.
Topics: Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Reproducibility of Results; Retrospective Studies
PubMed: 35822335
DOI: No ID Found -
Joint Diseases and Related Surgery 2020This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
OBJECTIVES
This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
PATIENTS AND METHODS
Twenty-six feet of 22 patients (4 males, 18 females; mean age 46.2±18 years; range, 16 to 70 years) who were diagnosed as hallux valgus between March 2013 and April 2016 and who underwent distal oblique metatarsal osteotomy were included in this retrospective study. American Orthopedic Foot and Ankle Society/Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS/HMIS) was used for clinical and functional evaluation. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, first metatarsal length and forefoot bone and soft tissue width were measured for radiological evaluation.
RESULTS
The mean follow-up time was 33.1±9.8 months. The AOFAS/HMIS score increased significantly postoperatively (p=0.001). In the footwear section of the AOFAS/HMIS, the median preoperative score of 5 (range, 0-5) increased to 10 (range, 5-10) at the postoperative period (p=0.001). Hallux valgus angle, IMA, DMAA, and first metatarsal length significantly decreased when compared to preoperative measurements. Forefoot bone width also decreased significantly from 9.3 cm (range, 7.5-11.5 cm) to 8.8 cm (6.8-10.3 cm) (p=0.001).
CONCLUSION
Distal oblique metatarsal osteotomy is a safe method for hallux valgus deformity. Forefoot width reduction, decrease of soft tissue tension, sesamoid reduction, and plantar fascia relaxation are the crucial benefits of this method.
Topics: Adolescent; Adult; Aged; Female; Hallux Valgus; Humans; Metatarsal Bones; Middle Aged; Osteotomy; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32160500
DOI: 10.5606/ehc.2020.71298 -
BMC Veterinary Research Aug 2022Treatment options for metacarpal/metatarsal fractures include conservative and surgical management. The aim of this study is to determine whether there is any...
BACKFROUND
Treatment options for metacarpal/metatarsal fractures include conservative and surgical management. The aim of this study is to determine whether there is any significant difference in healing and complication rates, between open and closed treatment. Medical records of dogs and cats with metacarpal/metatarsal fractures with complete follow-up were retrospectively reviewed. Patients were allocated in two groups: open or closed stabilization. Minor and major complications were recorded and compared. Fracture healing was classified as good, delayed and non-union, and it was statistically compared.
RESULTS
Sixty-three patients (35 dogs and 28 cats) were included. Thirty-one were treated with an open approach and 32 by a closed stabilization. Regarding fracture healing a significantly higher proportion of delayed healing/non-union was found in the closed group (12/32 vs 2/31). Regarding postoperative complications, a significantly higher number of animals in the open group did not develop any complications (12/31 vs 3/32). A significantly higher proportion of minor complications were reported in the closed group (27/32 vs 12/31). However, a higher number of major complications was reported in the open group (7/31 vs 2/32) although this was not statistically significant. Fracture malalignment was significantly more prevalent in patients undergoing closed stabilization (11/32 vs 2/31).
CONCLUSION
According to the results, better healing, fracture alignment and a lower complication rate are found when fractures are stabilised with an open technique. However, other factors such as configuration of the fracture, soft tissue involvement, patient´s character and client´s situation would also need to be taken into account in the decision of stabilization technique.
Topics: Animals; Ankle Injuries; Cat Diseases; Cats; Dog Diseases; Dogs; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Metacarpal Bones; Metatarsal Bones; Retrospective Studies; Treatment Outcome
PubMed: 35927668
DOI: 10.1186/s12917-022-03404-3 -
Orthopaedics & Traumatology, Surgery &... Sep 2021We present a new arthroplasty concept for the first metatarsophalangeal joint (MTP1) involving the HAPY® pyrocarbon interposition implant. This is a spherical implant...
We present a new arthroplasty concept for the first metatarsophalangeal joint (MTP1) involving the HAPY® pyrocarbon interposition implant. This is a spherical implant that does not integrate into bone. Instead, the goal is to achieve gliding of the implant on the bone/cartilage to maintain the function and mobility of the MTP1 joint. We describe the surgical technique used for its implantation. Since the implant is not anchored into bone, it is stabilized in a spherical cavity hollowed out in the metatarsal head. In a preliminary study of 22 cases with a mean follow-up of 36 (20-79) months, the mean AOFAS score improved from 64 (35-72) preoperatively to 91 (47-100) postoperatively (p<0.05). At the final assessment, no subchondral cyst or osteolysis was visible.
Topics: Carbon; Follow-Up Studies; Hallux Rigidus; Humans; Metatarsal Bones; Metatarsophalangeal Joint
PubMed: 33845174
DOI: 10.1016/j.otsr.2021.102926