Background: This study aims to evaluate and compare stiffness and the load to failure values of our novel medial malleolus compression plate (MP) and 3,5mm 1/3 tubular plate (TP) in the treatment of vertical shear fractures of medial malleolar fractures.
Methods: Fourteen identical synthetic third generation composite polyurethane bone models of right distal tibia were randomly separated into two groups. Fracture models were created with a custom-made osteotomy guide to provide the same fracture characteristics in every sample (AO OTA type 44A2). Fractures were reduced and novel medial malleolus compression plate was applied to bone models in MP group and tubular plate was applied to TP group. All samples were evaluated biomechanically, force/displacement and the load to failure values were recorded.
Results: The force required to create displacement in MP group was twice of that of the TP group. There was a significant difference between two groups in all amounts of displacement (p = .006, p = .005, p = .007 and .015 for 0.5, 1.0, 1.5, and 2.0 mm, respectively).
Conclusions: In the treatment of vertical shear fractures of the medial malleolus, the strength of fixation with the novel medial malleolar compression plate is biomechanically higher than the one-third semi-tubular plate.
Dislocations or subluxations of the metatarsophalangeal joints are rare, and open reduction is necessary in special cases. In this case report, we present the case of a 30-year-old man who had chronic dislocation of the V metatarsophalangeal joint after a motorcycle accident. Stiffening of the joint capsule prevented closed reduction therefore the patient underwent surgery, after performing a Gauthier-type osteotomy the joint was stabilized by k-wire. The patient had an excellent recovery with no new dislocation episodes.
Mucormycosis, also known as black fungus, is a rare but aggressive fungal disease with high morbidity and mortality rates that tends to affect patients who are severely immunocompromised. Early recognition of the infection and prompt intervention is critical for treatment success. In recent years the COVID-19 pandemic has resulted in a surge in the number of cases of mucormycosis. This study aims to report an unfortunate event involving an immunocompromised elderly male with mucormycosis of the foot who expired from sepsis due to COVID-19. It is important to have a high clinical suspicion for mucormycosis when a clinical lesion develops, and to appropriately biopsy the lesion in question, particularly in a context of COVID-19. Raising awareness of COVID-19-associated mucormycosis may allow for early detection of the disease, thus enabling the initiation of rapid treatment, ultimately saving lives.
Acquired hallux varus deformity secondary to postburn contracture is a rare condition. It causes cosmetic disfigurement, pain, and inability to wear a shoe. Soft-tissue procedures and tendon transfers have been described for correction; however, these may require multiple operations and the outcome may be poor. We report a 6-year-old neglected case of hallux varus deformity secondary to burn contracture successfully managed by contracture release with pivotless distraction technique using a biplanar distractor and skin grafting with Z-plasty in the same procedure. The deformity was corrected to a lesser extent and with good functional outcomes. The scar was excised and Z-plasty was performed. The medial joint capsule was released. We used gradual differential distraction with monitoring on sequential radiographs. Pain-free flexion of 45° and extension of 40° were achieved and the patient was able to wear shoes after 4 weeks postoperatively. Hallux varus is a multidimensional deformity. A severe and rigid deformity might not respond well to tendon transfers in a single stage. Our described technique can be used to correct rigid hallux varus deformity with preservation of joint function.
Background: Surgery is a common setting for opioid-naive patients to first be exposed to opioids. Understanding the multimodal analgesic-prescribing habits of podiatric surgeons in the United States may be helpful to refining prescribing protocols. The purpose of this benchmark study was to identify whether certain demographic characteristics of podiatric surgeons were associated with their postoperative multimodal analgesic-prescribing practices.
Methods: We administered a scenario-based, voluntary, anonymous, online questionnaire that consisted of patient scenarios with a unique podiatric surgery followed by a demographics section. We developed multiple logistic regression models to identify associations between prescriber characteristics and the odds of supplementing with a nonsteroidal anti-inflammatory drug, regional nerve block, and anticonvulsant agent for each scenario. We developed multiple linear regression models to identify the association of multimodal analgesic-prescribing habits and the opioid dosage units prescribed at the time of surgery.
Results: Eight hundred sixty podiatric surgeons completed the survey. Years in practice was a statistically significant variable in multiple scenarios. Compared with those in practice for more than 15 years, podiatric surgeons in practice 5 years or less had increased odds of reporting supplementation with an anticonvulsant agent in scenarios 1 (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.11–5.18; P = .03), 3 (OR, 2.97; 95% CI, 1.55–5.68; P = .001), 4 (OR, 2.54; 95% CI, 1.56–4.12; P < .001), and 5 (OR, 2.07; 95% CI, 1.29–3.32; P = .003).
Conclusions: Podiatric surgeons with fewer years in practice had increased odds of supplementing with an anticonvulsant. Approximately one-third of podiatric surgeons reported using some form of a nonopioid analgesic and an opioid in every scenario. The use of multimodal analgesics was associated with a reduction in the number of opioid dosage units prescribed at the time of surgery and may be a reasonable adjunct to current protocols.
There is a long-standing stigma associated with the use of epinephrine in digital nerve blocks (DNBs) over the concern of digital necrosis. We conducted a systematic review to assess the duration of anesthesia, onset of anesthesia, and complications of lidocaine with epinephrine compared with plain lidocaine for DNBs in adults. We searched Medline via Ovid, Cochrane Library, and ClinicalTrials.gov on January 28, 2020. We included randomized controlled trials that examined lidocaine with epinephrine 1:80,000 to 1:1,000,000 (1–12.5 µg/mL) and plain lidocaine for DNBs of fingers or toes in adults. We completed a blinded review of all unique articles, followed by full-text reviews, data extraction, and quality assessment of all eligible trials. Risk of bias was assessed to inform qualitative data analysis. We identified seven studies with a combined 363 adults and 442 DNBs that met the inclusion criteria. All five studies that reported duration of anesthesia established longer duration in the epinephrine-supplemented lidocaine group, with significant increases in three. Two of the three studies that reported the onset of anesthesia demonstrated significant differences. The two studies that reported complications did not have a single case of digital necrosis. In adults, the use of lidocaine with epinephrine 1:80,000 to 1:1,000,000 (1–12.5 µg/mL) for DNB yields a longer duration of anesthetic effect and seems to be as safe as plain lidocaine in healthy adults. Several studies had some concern for bias, and additional studies are warranted.
Background: Digital and ray amputations are common surgical treatments for infected bone and traumatic injuries in the foot. When disarticulated, the exposed articular cartilage can be addressed by either leaving the cartilage cap as a “protective barrier” to infection or by remodeling the exposed bone, removing the cartilage to bleeding bone to better fight infection.
Methods: Our objective is to provide the first study in the foot to determine whether leaving exposed articular cartilage after toe amputation results in more returns to surgery and delayed healing. We performed a review of the electronic database of patients who had undergone toe amputation and/or metatarsal head amputation with the inclusion criteria of Current Procedural Terminology codes 28825, 28820, and 28810. Excluded patients were those who had multiple osteomyelitic bones or more than one-digit amputations because of the difficulty of controlling the extent of infection. Sixty-three procedures were included in the study (group 1, n = 47; group, n = 216).
Results: The time to healing between group 1 (44.0 ± 40.6 days) and group 2 (51.7 ± 48.0 days) was not statistically significant (t test, 0.54392), with reinfection rate being low in both group 1 (8.51%) and group 2 (6.25%).
Conclusions: Our study showed a low reinfection rate in both groups (8.51% vs 6.25%). Age, A1C, and BMI were also similar between both groups. The PAD difference (55.3% vs 81.3%) could have contributed to the time to heal (44.0 vs 51.7 days) but not to infection rate between both groups. Tobacco use did not seem to affect time to heal or infection rate between both groups. From our results, there doesn’t seem to be a difference in infection rates between each group.
Heparin-induced thrombocytopenia (HIT) is a prothrombotic state caused by the buildup of platelet factor 4 antibodies with decreased platelet count caused by heparin therapeutic or prophylactic therapy. It is important to detect this complication, especially in critically ill patients and cardiac patients. Detection of HIT can be demonstrated by positive antibodies in a HIT panel. Based on clinical and laboratory findings, heparin use should be discontinued with immediate transition to alternative anticoagulation therapies. Thromboembolic events can be an adverse effect of HIT and can cause local tissue necrosis, especially in the lower extremity. This case is a retrospective medical record review of a 52-year-old man who was initially admitted as an outpatient for coronary artery bypass grafting and mitral valve replacement who developed digital gangrene from HIT. This case emphasizes the rare adverse effects of HIT and the need for timely consultation for surgical treatment of limb ischemia/gangrene.
Osteochondromas are the most common benign bone tumors, with an incidence of 36% to 41% among benign bone tumors. They can be caused by genetics, trauma, and growth defects. The incidence of all osteochondromas in the hands and feet is approximately 10%, and they are extremely rare in the calcaneus. They generally arise from the metaphysis and metaphyseal-diaphyseal region of the long bones. Osteochondromas, which are generally painless, are noted with signs of inflammation in the bursa, vascular and nerve compression, pain caused by joint deterioration, swelling in the subcutaneous tissue, or gait disturbance. The incidence of malignant transformation of solitary osteochondromas is 1%. We present two cases, an 11-year-old male patient and a 32-year-old male patient, diagnosed with osteochondroma in the calcaneus.
Background: Bibliometric studies in the field of orthopedics have increased because of the large volume of the available literature that prevents understanding the general status of the related field. This study aimed to identify and analyze the 100 most-cited articles related to flatfoot to reveal their characteristics and research trends.
Methods: Available literature on the Web of Science database until the end of 2020 were analyzed, and the 100 most-cited articles were determined. The characteristics of articles including publication year, authors, institutions, country, journal, number of pages, number of references, study design, level of evidence, main topic, age group, the specialty of the first author, and availability of funding were extracted and statistically analyzed for any association with the number of citations or citation density.
Results: The average citation number was 63.1 ± 43.8 (range, 30–278). The average citation density was 3.4 ± 1.8 (range, 0.8–12.6). The United States was the leading country with 65 articles, followed by Taiwan and the United Kingdom with five articles from each. Twenty-six papers had Level III evidence and 36 papers had Level IV evidence. Only three studies had Level I evidence and three had Level II evidence. The majority of articles (43 papers) were published in Foot & Ankle International. Citation density was positively correlated with publication year (P < .001) and the number of references (P = .004).
Conclusions: The available data provide general characteristics of the 100 most influential papers about flatfoot. The vast majority of papers had a low level of evidence, indicating the need for higher quality research.