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Godoy-Santos AL, Pires EA, Fonseca FC, de Cesar-Netto C, Auch EC, Rammelt S. Staged reconstruction of the hallux for infected non-union using bulk autograft and a customized implant: Case report. Foot (Edinb) 2023; 56:102031. [PMID: 37075520 DOI: 10.1016/j.foot.2023.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 07/05/2021] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
This case report illustrates the outcome of a deep infection following internal fixation of a fracture of the big toe. Hallux amputation could be avoided through staged salvage procedure. This paper can assist readers on how to effectively and safely recognize and treat this type of injury.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil; Lab Prof Manlio Mario Marco Napoli, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Eduardo Araujo Pires
- Lab Prof Manlio Mario Marco Napoli, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | | | | | | | - Stefan Rammelt
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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2
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Robertson GAJ, Sinha A, Hodkinson T, Koç T. Return to sport following toe phalanx fractures: A systematic review. World J Orthop 2023; 14:471-484. [PMID: 37377988 PMCID: PMC10292062 DOI: 10.5312/wjo.v14.i6.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/19/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Evidence-based guidance on return to sport following toe phalanx fractures is limited.
AIM To systemically review all studies recording return to sport following toe phalanx fractures (both acute fractures and stress fractures), and to collate information on return rates to sport (RRS) and mean return times (RTS) to the sport.
METHODS A systematic search of PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, and Google Scholar was performed in December 2022 using the keywords ‘Toe’, ‘Phalanx’, ‘Fracture’, ‘injury’, ‘athletes’, ‘sports’, ‘non-operative’, ‘conservative’, ‘operative’, ‘return to sport’. All studies which recorded RRS and RTS following toe phalanx fractures were included.
RESULTS Thirteen studies were included: one retrospective cohort study and twelve case series. Seven studies reported on acute fractures. Six studies reported on stress fractures. For the acute fractures (n = 156), 63 were treated with primary conservative management (PCM), 6 with primary surgical management (PSM) (all displaced intra-articular (physeal) fractures of the great toe base of the proximal phalanx), 1 with secondary surgical management (SSM) and 87 did not specify treatment modality. For the stress fractures (n = 26), 23 were treated with PCM, 3 with PSM, and 6 with SSM. For acute fractures, RRS with PCM ranged from 0 to 100%, and RTS with PCM ranged from 1.2 to 24 wk. For acute fractures, RRS with PSM were all 100%, and RTS with PSM ranged from 12 to 24 wk. One case of an undisplaced intra-articular (physeal) fracture treated conservatively required conversion to SSM on refracture with a return to sport. For stress fractures, RRS with PCM ranged from 0% to 100%, and RTS with PCM ranged from 5 to 10 wk. For stress fractures, RRS with PSM were all 100%, and RTS with surgical management ranged from 10 to 16 wk. Six cases of conservatively-managed stress fractures required conversion to SSM. Two of these cases were associated with a prolonged delay to diagnosis (1 year, 2 years) and four cases with an underlying deformity [hallux valgus (n = 3), claw toe (n = 1)]. All six cases returned to the sport after SSM.
CONCLUSION The majority of sport-related toe phalanx fractures (acute and stress) are managed conservatively with overall satisfactory RRS and RTS. For acute fractures, surgical management is indicated for displaced, intra-articular (physeal) fractures, which offers satisfactory RRS and RTS. For stress fractures, surgical management is indicated for cases with delayed diagnosis and established non-union at presentation, or with significant underlying deformity: both can expect satisfactory RRS and RTS.
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Affiliation(s)
- Greg A J Robertson
- Department of Orthopaedic Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom
| | - Amit Sinha
- Department of Trauma and Orthopaedic Surgery, Wales Deanery, Cardiff CF15 7QQ, United Kingdom
| | - Thomas Hodkinson
- Department of Orthopaedic Surgery, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, United Kingdom
| | - Togay Koç
- Department of Trauma and Orthopaedic Surgery, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
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3
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Andrews NA, Ray J, Dib A, Harrelson WM, Khurana A, Singh MS, Shah A. Diagnosis and conservative management of great toe pathologies: a review. Postgrad Med 2021; 133:409-420. [PMID: 33622169 DOI: 10.1080/00325481.2021.1895587] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute great toe (Hallux) pain is a common complaint encountered by the primary care physician. Pathological conditions can vary from acute trauma to acute exacerbation of underlying chronic conditions. Delay in treatment or misdiagnosis can lead to debilitating loss of function and long-lasting pain. This review endeavors to discuss the pertinent history, physical exam findings, radiographic evidence, conservative treatment options, and surgical management for the musculoskeletal causes of acute and acute on chronic great toe pain in the adult population. The acute pathologies discussed in this review are hallux fractures and dislocations, turf toe, sand toe, and sesamoid disorders. The chronic pathologies discussed include hallux rigidus, hallux valgus, and chronic sesamoiditis.
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Affiliation(s)
- Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jessyca Ray
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aseel Dib
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ankit Khurana
- Department of Orthopaedic Surgery, Dr. BSA Medical College, Rohini, Delhi, India
| | - Maninder Shah Singh
- Department of Orthopaedic Surgery, Indian Spinal Injuries Centre, Rohini, Delhi, India
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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4
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GODOY-SANTOS ALEXANDRELEME, GIORDANO VINCENZO, CESAR NETTO CESARDE, SPOSETO RAFAELBARBAN, BITAR ROGÉRIOCARNEIRO, WAJNSZTEJN ANDRÉ, SAKAKI MARCOSHIDEYO, FERNANDES TÚLIODINIZ. HALLUX PROXIMAL PHALANX FRACTURE IN ADULTS: AN OVERLOOKED DIAGNOSIS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:318-322. [PMID: 33328790 PMCID: PMC7723381 DOI: 10.1590/1413-785220202806236612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives: To describe the surgical treatment of fractures that involves the hallux interphalangeal joint, current indications and management options. Methods: we performed a literature review of relevant clinical studies in multiple databases, including PubMed, MedLine and Scopus, from January 1989 to October 2020. Results: There is consensus for surgical treatment of intra-articular fractures with a deviation greater than 2 mm, metadiaphyseal fractures with malrotation and/or malangulation, open fractures and unstable fractures. Conclusion: The use of more rigid implants allow alignment maintenance during healing process and lower risk of reduction loss. Valgus deformity and interphalangeal joint osteoarthritis are possible complications that must be avoided. Level of Evidence III, Systematic review of Level III studies.
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5
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Bilateral Sesamoiditis as First Manifestation of Gout. Case Rep Orthop 2020; 2020:8890549. [PMID: 32963862 PMCID: PMC7499288 DOI: 10.1155/2020/8890549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022] Open
Abstract
Sesamoiditis secondary to gout is an extremely rare condition with few case reports in the literature. It is an important differential diagnosis because the treatment depends on targeted therapy, unlike the main causes of sesamoiditis that often involves immobilization with special orthoses and prescription of anti-inflammatory drugs. We report here a case of a 38-year-old male, athlete, with bipartite medial sesamoid, who had insidious pain in the base of the left hallux. Laboratory tests showed no alterations, and imaging examinations demonstrated sesamoiditis with suspicion of stress fracture. The patient was initially prescribed an immobilization boot and analgesic and anti-inflammatory drugs, but he did not respond to the measures taken. After the onset of the same condition in the contralateral foot and getting the same imaging findings, we began an investigation of systemic disease, focusing on gout, because of a positive family history, which was confirmed by dual-energy computed tomography.
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6
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Sposeto RB, Sakaki MH, Godoy-Santos AL, Ortiz RT, Macedo RS, Fernandes TD. Weightbearing Forefoot Axial Radiography - Technical Description and Reproducibility Evaluation. Rev Bras Ortop 2020; 55:367-373. [PMID: 32616984 PMCID: PMC7316550 DOI: 10.1055/s-0039-3402453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/05/2019] [Indexed: 11/28/2022] Open
Abstract
Objective
The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients.
Methods
The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients.
Results
We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1
st
, 2
nd
, 3
rd
, 4
th
, and 5
th
metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92.
Conclusion
Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.
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Affiliation(s)
- Rafael Barban Sposeto
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marcos Hideyo Sakaki
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Alexandre Leme Godoy-Santos
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rafael Trevisan Ortiz
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rodrigo Sousa Macedo
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Tulio Diniz Fernandes
- Grupo de Pé e Tornozelo, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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7
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Abstract
Metatarsal and toe fractures are the most frequent injuries of the foot skeleton. Nondislocated fractures can be conservatively treated with good success. Long-term relief and immobilization including the ankle joint are unnecessary. Metatarsal fractures close to the base are nearly always associated with Lisfranc luxation and treatment must also take the instability of the tarsometatarsal joints into consideratíon. Basal fractures of the 5th metatarsal bone require a differentiated consideration. The correct classification is necessary in order to initiate an adequate treatment. In general, intra-articular layer formation, inclination >10° and shortening between 3 mm and 5 mm, taking the position of the head of the metatarsal bone into consideration, are recommended as indications for surgery. Operative treatment of toe fractures is only rarely necessary.
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Affiliation(s)
- M Beck
- Klinik für Orthopädie und Unfallchirurgie, St. Bernward Krankenhaus, Treibestr. 9, 31134, Hildesheim, Deutschland.
| | - A Wichelhaus
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - R Rotter
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - P Gierer
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| | - T Mittlmeier
- Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
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8
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Amador LI, Giannini NP, Simmons NB, Abdala V. Morphology and Evolution of Sesamoid Elements in Bats (Mammalia: Chiroptera). AMERICAN MUSEUM NOVITATES 2018. [DOI: 10.1206/3905.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lucila Inés Amador
- Unidad Ejecutora Lillo: Fundación Miguel Lillo – CONICET, Tucumán, Argentina
| | - Norberto Pedro Giannini
- Unidad Ejecutora Lillo: Fundación Miguel Lillo – CONICET, Tucumán, Argentina
- Facultad de Ciencias Naturales e Instituto Miguel Lillo, Universidad Nacional de Tucumán, Tucumán, Argentina
- Division of Vertebrate Zoology (Mammalogy), American Museum of Natural History
| | - Nancy B. Simmons
- Facultad de Ciencias Naturales e Instituto Miguel Lillo, Universidad Nacional de Tucumán, Tucumán, Argentina
| | - Virginia Abdala
- Instituto de Biodiversidad Neotropical: Universidad Nacional de Tucumán – CONICET, Tucumán, Argentina
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9
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Nishikawa DRC, Duarte FA, de Cesar Netto C, Monteiro AC, Albino RB, Fonseca FCP. Internal Fixation of Displaced Intra-articular Fractures of the Hallux Through a Dorsomedial Approach: A Technical Tip. Foot Ankle Spec 2018; 11:77-81. [PMID: 29076759 DOI: 10.1177/1938640017735889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED Phalangeal fractures of the toes represent common injuries of the forefoot. In the hallux, most fractures occur at the distal phalanx and frequently result from a direct crushing type of injury. Intra-articular fractures of the hallux are usually treated nonoperatively, except when the fragments are displaced and the joint is incongruent. Displaced fractures treated nonoperatively can result in degenerative arthritis of the interphalangeal joint, causing pain and range of motion limitation, hindering gait and weightbearing. The aim of this study was to present an option of operative approach in the treatment of displaced interphalangeal joint fractures of the hallux, along the medial border of the extensor hallucis longus tendon. It is our understanding that this approach minimizes injury to the soft tissue envelope, allowing a rigid fixation and early weightbearing and range of motion. LEVELS OF EVIDENCE Level V: Expert opinion.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Fernando Aires Duarte
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Cesar de Cesar Netto
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Augusto César Monteiro
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Rômulo Ballarin Albino
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
| | - Fabio Corrêa Paiva Fonseca
- Foot and Ankle Clinic, Department of Orthopedic Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN, FAD, ACM, FCPF).,Orthopaedic Surgery, General Surgery Department, University of Alabama at Birmingham, Birmingham, Alabama (CdCN).,Foot and Ankle Clinic, Department of Orthopedic Surgery, Universidade Estadual Paulista-Campus de Botucatu (UNESP), São Paulo, SP, Brazil (RBA)
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10
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Kiener AJ, Hanna TN, Shuaib W, Datir A, Khosa F. Osseous injuries of the foot: an imaging review. Part 1: the forefoot. Arch Emerg Med 2017; 34:112-118. [DOI: 10.1136/emermed-2015-204807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 12/16/2015] [Accepted: 01/17/2016] [Indexed: 11/03/2022]
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11
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Outcomes of Nonoperative Treatment of Forefoot Fractures: Casting Versus Off-Loading Shoes. Trauma Mon 2016. [DOI: 10.5812/traumamon.27533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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13
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Abstract
A turf toe injury encompasses a wide spectrum of traumatic problems that occur to the first metatarsophalangeal joint. Most of these injuries are mild and respond well to nonoperative management. However, more severe injuries may require surgical management, including presence of diastasis or retraction of sesamoids, vertical instability, traumatic hallux valgus deformity, chondral injury, loose body, and failed conservative treatment.
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Affiliation(s)
- Lyndon W Mason
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
| | - Andrew P Molloy
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
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14
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Abstract
Most toe phalangeal fractures can be successfully treated nonoperatively without any residual deformity and are usually clinically asymptomatic. Toe phalangeal fractures are nevertheless common fracture clinic referrals. Our aim was to evaluate the injury characteristics of patients with toe fractures attending a fracture clinic and to understand how current management affects the fracture clinic workload. We retrospectively evaluated all new referrals to a subspecialized foot and ankle fracture clinic during a 12-month period at our institution under the care of 1 consultant. Data were collected regarding patient demographics, fracture type, patient outcome, and the number of clinic appointments attended, cancelled, or not attended. A total of 707 new patients (mean age 39 ± 19 years; 345 males, 362 females) were seen in 47 foot and ankle fracture clinics within the study period. Seventy-four phalangeal fractures were identified in 65 patients. A total of 135 outpatient appointments were scheduled for these patients (initial and follow-up), with 93 (69%) attended, 25 (19%) not attended, and 15 (11%) cancelled and rescheduled at the patient's request. Seventeen patients (13%) failed to attend their first clinic appointment. The results of the present study highlight that 9% of all new patient referrals to a fracture clinic were for toe phalangeal fractures. Only 2 patients required surgery for significant loss of articular congruency or deformity. No patient subsequently developed a symptomatic malunion or required toe surgery during the following 2 years. We believe that undisplaced and stable toe phalangeal fractures do not need to be referred to the fracture clinic. This would result in a reduction of outpatient appointments for toe fractures by 52%.
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Affiliation(s)
- Timothy B Eves
- Registrar, Trauma and Orthopaedics, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom
| | - Michael J Oddy
- Consultant Surgeon, Trauma and Orthopaedics, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.
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15
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Wedmore I, Young S, Franklin J. Emergency Department Evaluation and Management of Foot and Ankle Pain. Emerg Med Clin North Am 2015; 33:363-96. [DOI: 10.1016/j.emc.2014.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Kim JY, Park JH, Cho J. Acute Comminuted Pathologic Fracture of a Hallucal Sesamoid with Tophaceous Gout: A Case Report. JBJS Case Connect 2014; 4:e85. [PMID: 29252444 DOI: 10.2106/jbjs.cc.m.00285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jae Young Kim
- Department of Orthopaedic Surgery, Research Institute for Foot and Ankle Diseases, Inje University, Seoul Paik Hospital, No. 85 2-Ga, Jeo-Dong, Jung-Gu, Seoul, 100-032, Republic of Korea. . .
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17
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[Anatomical reconstruction of fresh, malunion and nonunion of fractures of the sesamoid bones of the hallux]. Unfallchirurg 2014; 117:808-12. [PMID: 25182237 DOI: 10.1007/s00113-014-2604-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multifragmentary sesamoid bones of the hallux have established the concept of sesamoidea multipartita which is explained as a congenital characteristic of these bones. Sesamoid bones although fragmented are often asymptomatic as are, for example fragmented patellae. Evidence shows, however, that fragmentation of sesamoid bones is significantly more frequent in young people active in sports (soccer). The diagnosis of traumatic fractures and subsequent pain and disability is a challenge. Patients often present to physicians relatively late and are, therefore, treated in the acute phase long after onset of pain. METHOD Inquisitive interview of the patient and precise examination together with a detailed radiological investigation (computed tomography) are essential to be able to determine a causal relation to the fragmentation of sesamoid bones. Treatment consists of an anatomical reconstruction of vital bone fragments possibly augmented with an autologous cancellous bone graft after debridement. Surgical approaches are longitudinal medial for the medial sesamoid bone and longitudinal plantar for the lateral sesamoid bone. The means of fixation mostly involves two 1.5 mm screws for optimal mechanical stability.
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18
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Forefoot: a basic integrated imaging perspective for radiologists. Clin Imaging 2014; 38:397-409. [PMID: 24746447 DOI: 10.1016/j.clinimag.2014.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/29/2014] [Accepted: 02/20/2014] [Indexed: 02/07/2023]
Abstract
Imaging of the forefoot is increasingly requested for patients with metatarsalgia. Awareness with specific anatomic arrangements exclusive for the forefoot and widely variable pathologic entities associated with metatarsalgia helps the radiologist to tailor a cost-effective imaging approach. This will enable reaching a specific diagnosis as much as possible with subsequent proper patient management. This pictorial review aims to provide basic understanding for the different imaging modalities used in studying the forefoot. After that, certain anatomic arrangements exclusive for the forefoot are discussed. The final section of this review describes the imaging findings of some common forefoot problems.
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19
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Martin EA, Barske HL, DiGiovanni BF. Open surgical treatment of an acute, unstable bony mallet injury of the hallux. Foot Ankle Int 2013; 34:295-8. [PMID: 23413073 DOI: 10.1177/1071100712465850] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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20
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Abstract
Fractures of the forefoot are common and comprise approximately two thirds of all foot fractures. Forefoot fractures are caused by direct impact or the effect of indirect force. The forces exerted can range from repetitive minor load (stress fractures) to massive destructive forces (complex trauma). The clinical course in forefoot fractures is typically more favourable than in fractures of the mid- and hindfoot. The incidence of complications like infection or pseudarthrosis is low. Exceptions are rare fractures of the proximal shaft of the fifth metatarsal and the sesamoids with higher pseudarthrosis rates. Malunited metatarsal fractures can cause painful conditions that should even be treated operatively. Differences in structure and function of the different forefoot areas and specific fracture types require an adapted management of these special injuries.
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Affiliation(s)
- M Richter
- Klinik für Unfallchirurgie, Orthopädie und Fußchirurgie Coburg und Hildburghausen, Standort Klinikum Coburg, Ketschendorfer Straße 33, 96450, Coburg, Deutschland.
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21
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Van Vliet-Koppert ST, Cakir H, Van Lieshout EMM, De Vries MR, Van Der Elst M, Schepers T. Demographics and functional outcome of toe fractures. J Foot Ankle Surg 2011; 50:307-10. [PMID: 21440463 DOI: 10.1053/j.jfas.2011.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Indexed: 02/03/2023]
Abstract
Toe fractures are common; however, there are few data on demographics and functional outcome. We studied outcomes in 339 consecutive patients with toe fractures treated between January 2006 and September 2008. Two hundred and sixty-four patients, aged 16 to 75, were mailed an outcome questionnaire, and overall subjective satisfaction with the outcome of treatment was measured using a visual analog scale (VAS). Most frequently affected were the first (38%) and fifth (30%) toes, and most (75.6%) of the fractures were caused by stubbing or crush injury. More than 95% of the fractures were displaced less than 2 mm, and all of the fractures were treated conservatively. The questionnaire was returned by 141 (53%) patients with a median follow-up of 27 months. Respondents were female in 57.4% of cases and had a median age of 45 years. The median AOFAS score was 100 (P(25), P(75) = 93,100) points; the median VAS was 10 (P(25), P(75) = 8, 10) points. Univariate regression analysis revealed no statistically significant associations between outcome and the particular toe or phalanx involved, number of fractured toes, fracture type and location, articular involvement, gender, age, body mass index, smoking habits, and the presence of diabetes mellitus. Satisfaction VAS was dependent on age (P = .047) and gender (P = .049) in the multivariate analysis. The AOFAS midfoot score was not influenced by any of the covariates. This is the first epidemiological investigation using 2 outcome-scoring systems to determine function and satisfaction following treatment of toe fractures.
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Affiliation(s)
- Sabine T Van Vliet-Koppert
- Orthopedics Resident, Department of General Surgery and Traumatology, Reinier de Graaf Groep, Delft, The Netherlands
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22
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Lee DK, Mulder GD, Schwartz AK. Hallux, sesamoid, and first metatarsal injuries. Clin Podiatr Med Surg 2011; 28:43-56. [PMID: 21276517 DOI: 10.1016/j.cpm.2010.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hallux, sesamoid, and first metatarsal injuries are common foot injuries and have implications in the biomechanical functionality of the first ray and foot. They are essential for propulsion in normal gait. As part of the first ray, it is an important contributor to normal locomotion. Any structure disruption or injury can create angular changes or arthritis, which can have biomechanical implications, including pain, disability, compensation, swelling, and reduced range of motion.
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Affiliation(s)
- Daniel K Lee
- Department of Orthopaedic Surgery, School of Medicine, University of California-San Diego, 350 Dickinson Street, San Diego, CA 92103-8894, USA.
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23
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Sanders TG, Rathur SK. Imaging of painful conditions of the hallucal sesamoid complex and plantar capsular structures of the first metatarsophalangeal joint. Radiol Clin North Am 2009; 46:1079-92, vii. [PMID: 19038614 DOI: 10.1016/j.rcl.2008.09.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Numerous injuries and pathologic conditions can involve the hallucal sesamoidal complex and plantar capsular structures of the first metatarsophalangeal joint. Although clinical history and presentation are important in developing a reasonable differential diagnosis, there is often considerable overlap in the clinical presentation and physical findings between various pathologic entities. Imaging plays an important role in narrowing the differential diagnosis and in directing appropriate therapy. This article reviews the normal anatomy of the hallucal sesamoidal complex and the plantar capsular structures of the first metatarsophalangeal joint. Typical clinical presentations are discussed for various pathologic entities that involve this area of the hallux, followed by a summary of the various imaging findings that occur when using conventional radiography, nuclear medicine bone scan, CT and MR imaging. Finally, general treatment guidelines are discussed for each entity.
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Affiliation(s)
- Timothy G Sanders
- National Musculoskeletal Imaging, 1930 N. Commerce Parkway, Suite #5, Weston, FL 33326, USA.
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24
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Tosun B, Akansel G, Sarlak AY. Traumatic dislocation of the first metatarsophalangeal joint with entrapment of the flexor hallucis longus tendon. J Foot Ankle Surg 2008; 47:357-61. [PMID: 18590902 DOI: 10.1053/j.jfas.2008.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Indexed: 02/03/2023]
Abstract
A case of traumatic dislocation of the first metatarsophalangeal joint with concomitant fibular sesamoid fracture and thoracic vertebral fracture is presented. The first metatarsophalangeal joint was repaired by means of open reduction with collateral ligament repair. At 12 months following the operation, the patient displayed nonpainful and unrestricted first metatarsophalangeal joint motion.
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Affiliation(s)
- Bilgehan Tosun
- Kocaeli University, School of Medicine, Department of Orthopaedics and Traumatology, Izmit, Turkey.
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25
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26
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Mandracchia VJ, Mandi DM, Toney PA, Halligan JB, Nickles WA. Fractures of the forefoot. Clin Podiatr Med Surg 2006; 23:283-301, vi. [PMID: 16903154 DOI: 10.1016/j.cpm.2006.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fractures of the forefoot are common injuries of various causes. Although not crippling, forefoot fractures can be debilitating if they go undiagnosed or are mistreated. Whenever patients complain of foot pain with ambulation or difficulty ambulating, radiographs should be taken as part of a standard routine to assess for bony pathology. This article discusses the classification and treatment of metatarsal fractures, digital and sesamoid fractures, and open fractures about the forefoot.
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Affiliation(s)
- Vincent J Mandracchia
- Division of Podiatric Surgery, Department of Surgery, Broadlawns Medical Center, 1801 Hickman Road, Des Moines, IA 50314, USA.
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