Search

Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain.

High mortality rates have been reported after major amputations of a lower limb secondary to diabetes and peripheral vascular disease. However, the mortality rates have varied across studies. A systematic review of the 5-year mortality after nontraumatic major amputations of the lower extremity was conducted. A data search was performed of Medline using OVID, CINHAL, and Cochrane, 365 abstracts were screened, and 79 full text articles were assessed for eligibility. After review, 31 studies met the inclusion and exclusion criteria. Overall, the 5-year mortality rate was very high among patients with any amputation (major and minor combined), ranging from 53% to 100%, and in patients with major amputations, ranging from 52% to 80%. Mortality after below-the-knee amputation ranged from 40% to 82% and after above-the-knee amputation from 40% to 90%. The risk factors for increased mortality included age, renal disease, proximal amputation, and peripheral vascular disease. Although our previous systematic review of the 5-year mortality after ulceration had much lower rates of death, additional studies are warranted to determine whether amputation hastens death or is a marker for underlying disease severity.

International audience

The purpose of this study was to compare complication rates after total ankle replacement in 2 groups of patients based on polyethylene insert size. The total cohort was divided into 2 groups based on insert size. Group 1 included patients with polyethylene insert size less than 10 mm in thickness. Group 2 included patients with polyethylene insert sizes 10 mm and larger. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by one surgeon. Patient demographics, polyethylene insert size, implant used, concomitant procedures, postoperative complications, and patient-reported outcome scores were recorded. One hundred patients were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. The average follow-up was 31.3 months (range = 10-60 months). Forty-eight females and 52 males were included in this study. There were a total of 63 patients in group 1 and 47 patients in group 2. The total complication rate for patients in group 1 was 11.1% (7/63), and in group 2 it was 16.2% (6/32). There was no statistical significance in complication rates when comparing the 2 groups (P = 0.5427). All patients underwent at least one concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement complication rates are equal when comparing large polyethylene inserts commonly utilized to correct deformities, versus small polyethylene inserts commonly utilized in primary resurfacing. Levels of Evidence: Level IV, Retrospective comparative study

The 2011 Arab Spring swept across the Middle East creating profound instability in Egypt, a country already challenged with poverty and internal pressures. To respond to this crisis, Catholic Relief Services led a community-based program called “Egypt Works” that included community improvement projects and psychosocial support. Following implementation, program outcomes were analyzed using the middle-range theory of adaptation to situational life events, based on the Roy adaptation model. The comprehensive, community-based approach facilitated adaptation, serving as a model for applying theory in post-crisis environments.

Presence of underlying metatarsus deformity is known to negatively affect the outcome of hallux valgus corrective surgery. Yet there are many other factors that also affect final outcomes. In order to address the potential relationships between variables, we attempted to evaluate the association of metatarsus adductus with surgical outcomes, independent of other common factors used in evaluation of hallux valgus deformity. We enrolled 154 patients who had undergone hallux valgus corrective surgery and recorded their pre- and postoperative intermetatarsal (IM12) and hallux valgus (HVA) angles, preoperative Engel’s angle, and type of hallux valgus procedure. Using linear and logistic regression models, we identified variables that were independently (1) associated with the final IM12 and HVA and those (2) independently associated with dichotomized postoperative IM12 and HVA. We found that the only factors that were independently associated were preoperative IM12 with postoperative IM12, and preoperative HVA with postoperative HVA. In the linear model, a discretized Engel’s angle of 21 to 25 was marginally negatively associated with the final IM12. There was no detectable relationship between underlying metatarsus adductus deformity and the final outcome of hallux valgus correction after adjusting for other covariates.Levels of Evidence: Level III: Retrospective, cohort study

Chronic lateral ankle instability is a common condition treated by most foot and ankle surgeons. Once conservative treatment has failed, patients often undergo surgical reconstruction, either anatomic or nonanatomic. The present retrospective cohort study compared the clinical outcomes of 2 different arthroscopic Brostrom procedures. A total of 110 patients (83 females [75.5%] and 27 males [24.5%]) were treated with 1 of the 2 lateral ankle stabilization techniques from October 1, 2014 to December 31, 2015. Of the 110 patients, 75 were included in the arthroscopic lateral ankle stabilization group with an additional suture anchor used proximally and 35 were included in the arthroscopic lateral ankle stabilization group using the knotless design. The age of the cohort was 46.05 ± 17.89 (range 12 to 83) years. The body mass index was 30.03 ± 7.42 (range 18.3 to 52.5) kg/m 2 . Of the 110 patients, 25 (22.7%) had undergone concomitant procedures during lateral ankle stabilization. Overall, postoperative complications occurred in 14 patients (12.7%). No statistically significant differences were found between the 2 groups regarding the complication rates, use of concomitant procedures, and the presence of diabetes and workers compensation claims. No statistically significant differences were found in the mean age, body mass index, or gender distribution between the 2 groups. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores were 50.85 ± 13.56 (range 18 to 76) and 51.26 ± 13.32 (range 18 to 69) in groups 1 and 2, respectively. The postoperative AOFAS Ankle-Hindfoot scores were 88.19 ± 10.72 (range 54 to 100) and 84 ± 15.41 (range 16 to 100) in groups 1 and 2, respectively. No statistically significant difference was found between these 2 groups. The preoperative visual analog scale score was 7.45 ± 1.39 (range 3 to 10) and 6.97 ± 1.25 (range 5 to 10), which had improved to 1.12 ± 1.38 (range 0 to 5) and 1.8 ± 1.98 (range 1 to 9) postoperatively for groups 1 and 2, respectively. The difference in the postoperative visual analog scale score between the 2 groups was statistically significant. The preoperative and postoperative AOFAS scale, Foot Function Index, and Karlsson-Peterson scores showed no statistically significant differences between the 2 groups. From our experience, either procedure is an acceptable treatment option for chronic lateral ankle instability, with the knotless technique showing a trend toward more complications.