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Kachesov AV, Nosov OB, Bobrov DS, Artemov KD, Lekic G. Clinical and biomechanics effects of modified Helal osteotomy with screw fixation in forefoot reconstruction. Int Orthop 2023; 47:2579-2583. [PMID: 37389651 DOI: 10.1007/s00264-023-05874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The object of this study was to assess the efficacy of Helal metatarsal osteotomy with screw fixation in patients with hammertoe deformities. METHODS Thirty-five patients (66 feet, 66 metatarsals) with hammertoe deformity underwent Helal osteotomy with screw fixation after first ray reconstruction. Pre- and postoperative AOFAS scale results, podobarometry (in-shoe plantar pressure), and X-ray (angular) parameters were analyzed. The patients were examined before the operation and two, six, and 24 months postoperatively. RESULTS The average AOFAS score was 59 (± 2.4) preoperatively and 96 (± 1.2) in 12 months after the operations. Pressure under the second and third metatarsal heads was decreased from 396 (± 52.3) kPa preoperatively to 240 (± 22.3) kPa 12 months postoperatively. Lateral subluxation of the second and third toes before the operation was observed in 62 (94%) feet, average metatarsophalangeal angle was 28.1 (± 3.3) degrees. While it was not found in any case 12 months after operation, in four (6.1%) feet, it became recurrent 24 months postoperatively; the average metatarsophalangeal angle was 5° (± 0.6). CONCLUSION Helal osteotomy with screw fixation demonstrated good-to-excellent results in 24 months postoperatively. It allows for a three-dimension lesser rays reconstruction: shortening, elevating, and lateral or medial displacement of the metatarsal head.
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Affiliation(s)
- Anton V Kachesov
- Microsurgical Department of University Clinic, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Oleg B Nosov
- Microsurgical Department of University Clinic, Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - Dmitry S Bobrov
- Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Moscow, Russia
| | - Kirill D Artemov
- Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Moscow, Russia.
| | - Goran Lekic
- Department of Traumatology, Military Medical Academy, Belgrade, Serbia
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Döhner C, Beyerle H, Graw JA, Soost C, Burchard R. Biomechanical comparison of different implants for PIP arthrodesis. Foot Ankle Surg 2023; 29:518-524. [PMID: 36842926 DOI: 10.1016/j.fas.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Surgical correction of hammertoe deformities with arthrodesis of the proximal interphalangeal joint (PIP) is one of the most frequent forefoot procedures. Recently, new intramedullary fixation devices for PIP arthrodesis have been introduced. The aim of this study was to compare a newly developed absorbable intramedullary implant made of magnesium (mm.PIP), an already available intramedullary implant made of titanium (PipTree), and the classical Kirschner-wire (K-wire). METHODS The three intramedullary devices (mm.PIP, PipTree, and K-wire) for PIP arthrodesis were compared. A classical arthrodesis of the PIP joint was performed on fifty-four composite synthetic bone pairs. After arthrodesis, torsional load, weight-bearing and cyclic load tests were performed, and stability of the synthetic bone pairs was analyzed. RESULTS The mm.PIP was the most torsion resistant (mm.PIP vs. PipTree and K-wire, p < 0.001). The PipTree showed the best overall stability during cyclic weight-bearing simulation (PipTree vs. mm.PIP and K-wire, p < 0.001). K-wire demonstrated the highest breaking loads during bending tests (K-wire vs. mm-PIP and PipTree, p < 0.001). CONCLUSION Biomechanical properties of two new intramedullar implants, the bioresorbable mm.PIP made of magnesium and the PipTree made of titanium, were found to be comparable to the biomechanical properties of a K-wire which is commonly used for this procedure. Future work should be directed towards a clinical assessment of the bioabsorbable fixation devices for hammertoe procedures.
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Affiliation(s)
- Claudia Döhner
- University of Giessen and Marburg, Department of Orthopaedics and Traumatology, Marburg, Germany; Department of Orthopaedics and Trauma Surgery, Lahn-Dill-Kliniken, Wetzlar, Dillenburg, Germany
| | - Hanna Beyerle
- University of Giessen and Marburg, Department of Orthopaedics and Traumatology, Marburg, Germany
| | - Jan A Graw
- Department of Anesthesiology and Intensive Care Medicine, Ulm University Hospital, Ulm, Germany
| | | | - Rene Burchard
- University of Giessen and Marburg, Department of Orthopaedics and Traumatology, Marburg, Germany; Department of Orthopaedics and Trauma Surgery, Lahn-Dill-Kliniken, Wetzlar, Dillenburg, Germany.
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Štalc J, Cicchinelli LD, Miller S, Sofka CM, Richter M. Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows advanced implant bio-integration at 2-year follow-up. Foot Ankle Surg 2022; 28:1293-9. [PMID: 35773179 DOI: 10.1016/j.fas.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND A bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) for proximal interphalangeal joint (PIPJ) correction-arthrodesis showed partial bio-integration at 1-year follow-up (1FU) in a previous study. The study was prolonged to assess the bio-integration at 2-year-follow-up (2FU). METHODS Twenty-four patients with proximal interphalangeal joint (PIPJ) correction-arthrodesis using the fiber-reinforced implant and analysed at 1FU, completed 2FU. Follow-up included clinical examination, patient reported outcomes, radiographs, MRI and bio-integration scoring. Results were compared between the 1FU and 2FU (paired t-test). RESULTS Radiographs confirmed fusion in 96 % (n = 23) at 2FU (1FU, 92 % (n = 22)). Implant was no longer visible in 21 % (n = 5), partially visible in 33 % (n = 8), and fully visible in 46 % (n = 11)(1FU, fully visible 100 % (n = 24)). The border between implant and surrounding bone was scored not visible in 88 % (n = 21) and partially visible in 12 % (n = 3) (1FU, border partially visible 100 % (n = 24)). There were no cyst formation or fluid accumulation findings 1FU/2FU. Mild bone edema was detected in 4 % (n = 1) (1FU, 29 % (n = 7)). None of the edema findings were considered as adverse implant related. The mean bio-integration score was 9.71 ± 0.69 at 2FU (1FU, 7.71 ± 0.46). The parameters of border between implant and bone and bone edema further improved at the 2FU compared to the 1FU, total bio-integration score was also higher at 2FU than 1FU (each p < 0.05). CONCLUSIONS This study demonstrates 96 % PIPJ fusion rate and increased bio-integration from 1FU to 2FU, reaching advanced bio-integration of the fiber-reinforced implant at 2FU.
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Mayolo PC, Tran A, Kress K, Jaffe DE. Hammertoe correction with wire fixation of varying length. Foot Ankle Surg 2022; 28:1345-1349. [PMID: 35810126 DOI: 10.1016/j.fas.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Proximal interphalangeal (PIP) joint fusion with Kirschner (K) -wire fixation remains a popular strategy for hammertoe correction. This study was performed to evaluate the effect of length of wire fixation on clinical outcomes. METHODS A retrospective review of all hammertoe reconstructions by a single surgeon was performed. Wire length was chosen at the surgeon's discretion. Outcomes were assessed with metatarsophalangeal (MTP) congruency, pin complications, and PIP union. RESULTS 157 toes underwent reconstruction. Seventy had wires that spanned the MTP and 87 that did not. Wire breaks were significantly more common with longer wire fixation (P = .024). MTP incongruency was significantly more common in the MTP group (P = .014). CONCLUSION Pin breakage was rare and only occurred in the MTP group. MTP incongruence was significantly more common in the MTP group but may not reflect surgical technique. PIP union was more common with longer wire fixation but is not clinically significant. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Patrick C Mayolo
- University of Arizona College of Medicine, 475 N 5th St, Phoenix, AZ 85004, USA
| | - Aaron Tran
- University of Arizona College of Medicine, 475 N 5th St, Phoenix, AZ 85004, USA
| | - Kristen Kress
- Advocate Aurora Health, 855 N. Westhaven Dr., Oshkosh, WI 54904, USA
| | - David E Jaffe
- OrthoArizona, 8405 N Pima Center Pkwy, Scottsdale, AZ 85258, USA.
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5
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Rajan L, Kim J, An T, Fuller R, Zhu J, Pinney SJ, Ellis SJ. The influence of concomitant hammertoe correction on postoperative outcomes in patients undergoing hallux valgus correction. Foot Ankle Surg 2022; 28:1100-1105. [PMID: 35346594 DOI: 10.1016/j.fas.2022.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/13/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with hallux valgus often develop secondary hammertoe deformities of the lesser toes. Operative management of bunions with hammertoe can be more extensive; however, it is unclear whether this affects patient-reported outcomes. The aim of this study was to compare postoperative patient-reported outcome measures and radiographic outcomes between patients who underwent isolated bunion correction and patients who underwent simultaneous bunion and hammertoe correction. METHODS Preoperative, postoperative, and change in Patient-Reported Outcomes Measurement Information System (PROMIS) scores were compared between patients who underwent isolated hallux valgus correction and those who underwent concomitant hammertoe correction. Radiographic measures including hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal-articular angle (DMAA), and Meary's angle were also compared. Targeted minimum-loss estimation (TMLE) was used for statistical analysis to control for confounders. RESULTS A total of 221 feet (134 isolated bunion correction, 87 concomitant hammertoe correction) with a minimum of 12 months follow-up were included in this study. Both cohorts demonstrated significant improvements in the physical function, pain interference, pain intensity, and global physical health PROMIS domains (all p < 0.001). However, patients in the concomitant hammertoe cohort had significantly less improvements in pain interference and pain intensity (p < 0.01, p < 0.05 respectively). The concomitant hammertoe cohort also had significantly higher postoperative pain interference scores than the isolated bunion cohort (p < 0.01). Radiographic outcomes did not differ between the two groups. CONCLUSION While both isolated bunion correction and concomitant hammertoe correction yielded clinically significant improvements in patient reported outcomes and normalized radiographic parameters, patients undergoing simultaneous bunion and hammertoe correction experienced substantially less improvement in postoperative pain-related outcomes than those who underwent isolated bunion correction.
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Affiliation(s)
- Lavan Rajan
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jaeyoung Kim
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Tonya An
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Robert Fuller
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Jiaqi Zhu
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Stephen J Pinney
- Hospital for Special Surgery, 532 East 72nd Street, 5th Floor, New York, NY 10021, United States.
| | - Scott J Ellis
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
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Malani K, Ravine M, Schneider HP. Nonoperative Treatment of Plantar Plate Tears. Clin Podiatr Med Surg 2022; 39:451-459. [PMID: 35717062 DOI: 10.1016/j.cpm.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The plantar plate is a critical structure involved in stabilizing the metatarsophalangeal joint. Its disruption can not only be painful for the patient but also may lead to subsequent structural deformities. There are several conservative treatment modalities available to help mitigate symptoms including splinting, offloading, and intraarticular injections. That being said, once the pathology progresses to advanced stages, these treatments are not efficacious. Reported success with conservative treatment modalities is limited to case studies and series with a low level of clinical evidence. As such, this represents an area where further investigation is needed to evaluate the true efficacy of conservative treatment and to allow for development of a more standardized approach.
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Affiliation(s)
- Karan Malani
- Cambridge Health Alliance, 1493 Cambridge Street, Department of Surgery, Cambridge, MA 02139, USA
| | - Madison Ravine
- Cambridge Health Alliance, 1493 Cambridge Street, Department of Surgery, Cambridge, MA 02139, USA
| | - Harry P Schneider
- Cambridge Health Alliance, 1493 Cambridge Street, Department of Surgery, Cambridge, MA 02139, USA.
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Manz WJ, Bariteau JT. Complications of Lesser Toe Surgery: How To Avoid Them before Surgery and How To Assess and Treat Them When They Have Occurred. Foot Ankle Clin 2022; 27:233-51. [PMID: 35680286 DOI: 10.1016/j.fcl.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Complications following lesser toe surgery are challenging to manage. The keys to treatment of any of these conditions are, first, to try to avoid them through identification of patient- and surgeon-related variables that contribute to their development and, second, following the occurance of a complication, to understand what can and cannot be corrected with surgical and nonsurgical management. This review provides a comprehensive assessment of current literature, demonstrates best practices and approaches to lesser toe complications, and provides an illustration of clinical examples.
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8
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Štalc J, Cicchinelli LD, Miller S, Richter M. Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows implant bio-integration at 1-year follow-up. Foot Ankle Surg 2022; 28:418-423. [PMID: 34247921 DOI: 10.1016/j.fas.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND A new bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) was developed for proximal interphalangeal joint (PIPJ) correction-arthrodesis. The main purpose of this clinical study was to assess implant bio-integration at 1-year follow-up. METHODS Twenty-four patients, previously treated for a Hammertoe deformity using the bio-integrative, fiber-reinforced implant, were enrolled in this follow-up study. One-year follow-up included clinical examination, patient reported outcomes, radiographs, Magnetic Resonance Imaging (MRI) and bio-integration scoring. RESULTS Proximal interphalangeal joint (PIPJ) radiographic fusion rate was 92% (n = 22). MRI was analyzed for 24 (100%) patients. In 100% of patients (n = 24), the border between implant and surrounding tissue was scored as partially visible. There were no cyst formation or fluid accumulation findings. Mild bone edema was detected in 29% (n = 7) and is attributed to the chronic distribution of forces due to chronic abnormal gait and pasture. None of the edema findings were considered as adverse implant-related finding. The mean bio-integration score was 7.71 ± 0.46. CONCLUSIONS This study demonstrates safe bio-integration of the newly developed fiber-reinforced implant at 1-year follow-up without negative side effects.
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Affiliation(s)
- Jurij Štalc
- Valdoltra Orthopedic Hospital, Ankaran, Slovenia.
| | | | - Stuart Miller
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Martinus Richter
- Department for Foot and Ankle Surgery, Rummelsberg and Nuremberg, Germany
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de Cesar Netto C, Schmidt EL, Lalevee M, Mansur NSB. Flexor tenodesis procedure in the treatment of lesser toe deformities. Arch Orthop Trauma Surg 2022; 142:3125-37. [PMID: 33974142 DOI: 10.1007/s00402-021-03942-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022]
Abstract
In this technical report study, we describe the use of a flexor tenodesis procedure in the treatment of lesser toe deformities (LTD). Using a specific implant, both the flexor digitorum longus and brevis tendons are attached to the plantar aspect of the proximal phalanx, allowing dynamic correction of flexible deformities of metatarsophalangeal and interphalangeal joints. Good clinical results and absence of complications were observed in a series of 3 patients, with considerable correction of the LTD, and absence of substantial residual floating toe or metatarsophalangeal joint stiffness. LEVEL OF EVIDENCE: V - Technical Report/Case Report/Expert Opinion.
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Ingall EM, Michalski MP, Joo P, DiGiovanni CW, Thordarson DB, Kwon JY. The Ischemic toe following forefoot surgery: A review of current practices and a proposed approach for management. Foot Ankle Surg 2021; 27:723-729. [PMID: 33087305 DOI: 10.1016/j.fas.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/19/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
Toe hypoperfusion is a commonly encountered concern following forefoot surgery, yet there is limited clinical guidance available to surgeons to aid in management of this scenario. This work aims to review the etiology, pathophysiology and current strategies to address a perioperative ischemic toe. The authors review various interventions to approach this problem based on available evidence and clinical experience. Interventions to restore perfusion can be loosely based on the ischemic causality they intend to address. Described maneuvers to restore perfusion have, in turn, been designed to either chemically (through topical/local medication) or mechanically (bending/removing K-wires, adjusting repair tension) aid in mitigation of the offending cause. Depending upon the type of surgery performed, which may or may not include instrumentation, a surgeon can implement a series of steps to maximize restoration of toe perfusion. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Eitan M Ingall
- Harvard Combined Orthopaedic Residency Program, 55 Fruit St., Boston, MA 02114, USA.
| | - Max P Michalski
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA
| | - Peter Joo
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115, USA
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - David B Thordarson
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 S San Vicente Blvd #603 #901, Los Angeles, CA 90048, USA
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02115, USA
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Cosín-Matamoros J, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Casado-Hernández I, Benito-de-Pedro M, Calvo-Lobo C, Pérez-Boal E, Rodríguez-Sanz D, López-López D. Intramedular transfer of the flexor digitorum brevis tendon for the correction of clawtoe/ hammertoe deformity: A cross-sectional study. Ann Anat 2021; 234:151646. [PMID: 33248234 DOI: 10.1016/j.aanat.2020.151646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND A literature review did not reveal any studies concerning the intramedullary transfer of the flexor digitorum brevis tendons (FDB) technique with a single longitudinal incision through the proximal phalanx of the toes. The main goal of this investigation was to demonstrate whether the FDB tendons of the toes are long enough to enable intramedullary transfer to the dorsal area of the proximal phalanx. METHODS We examined whether the technique would allow the surgeon to transfer the FDB tendons through the proximal phalanx of the toes. The technique transfers the FDB tendons through the proximal phalanx dorsal area of the toes using an intramedullary transfer of the FDB tendons. The intramedullary transfer of the FDB tendons was performed through a single dorsal incision. RESULTS The FDB tendons for the second, third, and fourth toes were performed in 100% of the feet. No ruptures in any toe in which the surgical technique was performed was noted, and no proximal phalanges of the second, third, and fourth toes were fractured. CONCLUSIONS Transfer of FDB tendons via the intramedullary approach of the proximal phalanx of the second, third, and fourth toes is possible. The FDB tendons have sufficient length for transfer via an intramedullary transfer and were carried out in 100% of the second toes. For a successful transfer, it is essential to perform a thorough resection of the extensor digitorum longus aponeurosis since it has expansions intimately attached to the plantar base of the proximal phalanx of the toe.
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12
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Grambart ST, Jones NEH. The Role of Lesser Metatarsophalangeal Joint Arthrodesis for Revision Surgery. Clin Podiatr Med Surg 2020; 37:433-445. [PMID: 32471610 DOI: 10.1016/j.cpm.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Revision hammertoe surgery can be extremely challenging for the foot and ankle surgeon given the scar tissue and available osseous and soft tissue. Although not a common procedure, lesser metatarsophalangeal joint arthrodesis is an option for the patient especially in lieu of an amputation. This article describes the current literature and the surgical technique for a lesser metatarsophalangeal joint arthrodesis.
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Affiliation(s)
- Sean T Grambart
- Des Moines University, College of Podiatric Medicine and Surgery, 3200 Grand Avenue, Des Moines, IA 50312, USA; Unitypoint Health - Iowa Methodist Medical Center, 1200 Pleasant Street, Des Moines, IA 50309, USA.
| | - Nephi E H Jones
- Unitypoint Health - Iowa Methodist Medical Center, 1200 Pleasant Street, Des Moines, IA 50309, USA
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Payo-Ollero J, Casajús-Ortega A, Llombart-Blanco R, Villas C, Alfonso M. The efficacy of an intramedullary nitinol implant in the correction of claw toe or hammertoe deformities. Arch Orthop Trauma Surg 2019; 139:1681-1690. [PMID: 31098688 DOI: 10.1007/s00402-019-03203-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION A multitude of procedures has been described in the literature for the treatment of lesser toe deformities and there is currently no general consensus on the optimal method of fixation. The aim of this study is to assess the clinical and radiological outcomes of an intramedullary nitinol implant for the correction of lesser toe deformities, and to determine if the distal interphalangeal (DIP) joint and metatarsophalangeal (MTP) joint are modified during patient follow-up after correction of the PIP joint. MATERIALS AND METHODS A prospective analysis of 36 patients with claw toe or hammertoe who were treated with an intramedullary nitinol implant. Clinical manifestations and angulation of the metatarsophalangeal, proximal and distal interphalangeal (MTP, PIP, DIP) joints were evaluated in radiographic studies preoperatively, at first medical revision post-surgery, and after a minimum of 1 year of follow-up. Complications such as non-union rate, implant rupture, and implant infection were also evaluated during follow-up. RESULTS All patients were women with an average age of 65.5 (range 47-82) years. The average follow-up time was 2.4 (range 1-5.7) years. Fifty intramedullary nitinol implants were used. The MTP joint extension and PIP joint flexion decreased by 15.9° (95% CI - 19.11 to - 12.63) and 49.4° (95% CI - 55.29 to - 43.52), respectively, at the end of follow-up. Moreover, the DIP joint flexion increased progressively during follow-up (13.7° pre-surgery versus 35.6 in last medical check-up, 95% CI 13.24-30.57). There were four (8%) asymptomatic implant ruptures. The rate of fusion was 98%. CONCLUSION The reduction of the PIP joint using an intramedullary nitinol implant is a good option in lesser toe deformities, with few complications and a high rate of arthrodesis. Moreover, the PIP joint reduction affects both the MTP and DIP joints.
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Affiliation(s)
- Jesús Payo-Ollero
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain.
| | | | - Rafael Llombart-Blanco
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain
| | - Carlos Villas
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain
| | - Matías Alfonso
- Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain
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Abstract
Lesser digit deformities that require surgical intervention may be corrected by interphalangeal arthrodesis. The traditional fixation device used to stabilize an interphalangeal arthrodesis is a smooth Kirschner wire (K-wire). Its use, however, has been associated with risks. The K-wires are known to migrate and break, and there are increased risks of pin tract infection. Choices for digital implants include nonresorbable, resorbable, and allograft. There are more than 60 newer intramedullary fixation devices available for use in digital surgery. Intramedullary implants also have their own inherent risks. Further research into patient outcomes and cost-effectiveness of these new devices is still needed.
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Affiliation(s)
- Roya Mirmiran
- Sutter Medical Group, 2725 Capitol Avenue, Sacramento, CA 95628, USA.
| | - Melissa Younger
- Independence Foot and Ankle Associates, LLC, 1401 North 5th Street, Perkasie, PA 18944, USA
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Thomas M, Jordan M. [Minimally invasive correction of lesser toe deformities and treatment of metatarsalgia]. Oper Orthop Traumatol 2018; 30:171-83. [PMID: 29737368 DOI: 10.1007/s00064-018-0548-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/05/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Atraumatic and joint-sparing procedure for the correction of lesser toe deformities by using a linear or perpendicular osteotomy of the proximal and/or middle phalanx of the lesser toes with additional capsulotomies or tendon dissection for soft tissue realignment. Metatarsalgia is addressed via an extracapsular distal metaphyseal crescentic-like metatarsal osteotomy. INDICATIONS Symptomatic lesser toe deformities, painful pseudoexostosis, metatarsalgia, symptomatic metatarsal malalignment, metatarsus adductus. CONTRAINDICATIONS Infection or malperfusion of the forefoot, dislocation at metatarsophalangeal joint level, noncompliance. SURGICAL TECHNIQUE Correction of lesser toe deformities via fluoroscopy-guided minimally invasive surgical technique. Osteotomy of the proximal and middle phalanx is combined with a plantar capsulotomy of the proximal interphalangeal joint. Condylectomy of the head of the proximal phalanx, tenotomy of the extensor digitorum longus tendon proximal to the joint line in combination with tenotomy of the short flexor tendons at the level of proximal interphalangeal joint can be necessary. Distal metatarsal osteotomies are performed with a micro-burr starting from plantar-medial parallel to the metatarsal shaft axis ending dorsally perpendicular to the metatarsal shaft axis. POSTOPERATIVE MANAGEMENT Taping for external stabilization of the lesser toes as well as self-adhesive bandage to stabilize the metatarsals for 6 weeks; early weight-bearing is possible. RESULTS A prospective study of minimally invasive distal metaphyseal metatarsal osteotomies (DMMO; 30 patients, n = 73 osteotomies) and Weil osteotomies (30 patients, n = 45 osteotomies) showed similar results after a mean follow-up of 13 months. The surgery time was significantly shorter for the minimally invasive technique, but radiation exposure for the surgeon and patient were higher.
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Meyr AJ, Sansosti L, Ali S. A pictorial review of reconstructive foot and ankle surgery: elective lesser forefoot procedures. J Radiol Case Rep 2017; 10:8-22. [PMID: 28580056 DOI: 10.3941/jrcr.v10i11.2458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This pictorial review focuses on basic procedures performed within the field of podiatric surgery, specifically for elective procedures of the lesser forefoot including the correction of hammertoes and lesser metatarsal deformities. Our goal is to demonstrate objective radiographic parameters that surgeons utilize to initially define the deformity, lead to procedure selection and judge post-operative outcomes. We hope that radiologists will employ this information to improve their assessment of post-operative radiographs following reconstructive foot surgeries. First, relevant radiographic measurements are defined and their role in procedure selection explained. Second, the specific surgical procedures of the digital arthroplasty, digital arthrodesis, lesser metatarsal osteotomy, and correction of metatarsus adductus are described in detail. Finally, specific plain film radiographic findings that judge post-operative outcomes for each procedure are detailed.
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Affiliation(s)
- Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - Laura Sansosti
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania, USA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Abstract
The traditional open surgical options for the treatment of metatarsalgia and lesser toe deformities are limited and often result in unintentional stiffness. The use of percutaneous techniques for the treatment of metatarsalgia and lesser toe deformities allows a more versatile and tailor-made approach to the individual deformities. As with all percutaneous techniques, it is vital the surgeon engage in cadaveric training from surgeons experienced in these techniques before introducing them into his/her clinical practice.
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Abstract
Managing digital and metatarsophalangeal joint (MTPJ) deformities can range from simple to complex and uniplanar to triplanar. Because of the complexity and variability of digital and MTPJ deformities, there are many procedures, and no 1 procedure has become the gold standard. Tendon transfers for digital and MTPJ deformities are just 1 treatment option, and usually they are not stand-alone procedures. Typically, a combination of procedures needs to be performed. This article describes the surgical technique and provides a review of the literature, including clinical results for tendon transfers of the central rays.
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Guelfi M, Pantalone A, Cambiaso Daniel J, Vanni D, Guelfi MGB, Salini V. Arthrodesis of proximal inter-phalangeal joint for hammertoe: intramedullary device options. J Orthop Traumatol 2015; 16:269-73. [PMID: 26115745 PMCID: PMC4633419 DOI: 10.1007/s10195-015-0360-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 06/11/2015] [Indexed: 11/29/2022] Open
Abstract
Background Proximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary devices for the fixation of this arthrodesis have been introduced. The purpose of this work is to look at the currently available devices and to perform a review of the present literature.
Materials and methods A literature search of PubMed/Medline and Google Scholar databases, considering works published up until September 2014 and using the keywords: hammertoe, arthrodesis, PIP joint, fusion, intramedullary devices, and K-wire, was performed. The published papers were included in the present study only if they met the following inclusion criteria: English articles, arthrodesis of PIP joints for hammertoes with new generation intramedullary devices, series with n > 10. Studies using absorbable pins or screws that are considered as another kind of fixation that involved more than one articulation, as well as comments, letters to the editor, or newsletters were excluded.
Results Nine publications were included. Of the patients’ reports, 93–100 % were good or excellent concerning satisfaction. Radiological arthrodesis was achieved in 60.5–100 % of cases. Three of the publications compared the new devices with the K-wire. Of these three articles, two employed the traditional technique and one the buried technique. The AOFAS score, evaluated in three publications, showed a delta of 19, 45 and 58 points. Major complications, which required a secondary surgical revision, were between 0 and 8.6 %. The complications of the K-wire and the new devices were similar; also the reoperation rate was close to equal (maximal difference 2 %). On the other hand, these kinds of devices definitely have a higher price, compared to the K-wire. Conclusion The use of these new devices provides good results; however, their high price is currently a problem. For this reason, cost-benefit studies seem to be necessary to justify their use as standard treatment. Level of evidence Level III systematic review.
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Affiliation(s)
- Matteo Guelfi
- Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy. .,, Via Caprera 7/3, 16146, Genoa, Italy.
| | - Andrea Pantalone
- Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy
| | - Janos Cambiaso Daniel
- Department of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Augenbruggerplatz 29, 8036, Graz, Austria
| | - Daniele Vanni
- Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy
| | - Marco G B Guelfi
- Orthopaedic Division, Clinica Montallegro, Via M.Te Zovetto 27, 16145, Genoa, Italy
| | - Vincenzo Salini
- Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy
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Gilheany M, Baarini O, Samaras D. Minimally invasive surgery for pedal digital deformity: an audit of complications using national benchmark indicators. J Foot Ankle Res 2015; 8:17. [PMID: 25908945 PMCID: PMC4407429 DOI: 10.1186/s13047-015-0073-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background There is increasing global interest and performance of minimally invasive foot surgery (MIS) however, limited evidence is available in relation to complications associated with MIS for digital deformity correction. The aim of this prospective audit is to report the surgical and medical complications following MIS for digital deformity against standardised clinical indicators. Methods A prospective clinical audit of 179 patients who underwent MIS to reduce simple and complex digital deformities was conducted between June 2011 and June 2013. All patients were followed up to a minimum of 12 months post operatively. Data was collected according to a modified version of the Australian Council of Healthcare standards (ACHS) clinical indicator program. The audit was conducted in accordance with the National Research Ethics Service (NRES) guidelines on clinical audit. Results The surgical complications included 1 superficial infection (0.53%) and 2 under-corrected digits (0.67%), which required revision surgery. Two patients who underwent isolated complex digital corrections had pain due to delayed union (0.7%), which resolved by 6 months post-op. No neurovascular compromise and no medical complications were encountered. The results compare favourably to rates reported in the literature for open reduction of digital deformity. Conclusion This audit has illustrated that performing MIS to address simple and complex digital deformity results in low complication rates compared to published standards. MIS procedures were safely performed in a range of clinical settings, on varying degrees of digital deformity and on a wide range of ages and health profiles. Further studies investigating the effectiveness of these techniques are warranted and should evaluate long term patient reported outcome measures, as well as developing treatment algorithms to guide clinical decision making.
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Affiliation(s)
- Mark Gilheany
- East Melbourne Podiatry, Suite 4, Level 2, 182 Victoria Parade, Melbourne, VIC 3002 Australia ; Australasian College of Podiatric Surgeons, PO BOX 248, Collins Street West, Melbourne, VIC 8007 Australia
| | - Omar Baarini
- Australasian College of Podiatric Surgeons, PO BOX 248, Collins Street West, Melbourne, VIC 8007 Australia
| | - Dean Samaras
- Australasian College of Podiatric Surgeons, PO BOX 248, Collins Street West, Melbourne, VIC 8007 Australia
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Abstract
Forefoot pain in the adult often alters mobility and has a negative impact on quality of life. Metatarsalgia describes pain localized to the forefoot. Forefoot pain may be caused by conditions of the lesser toes themselves (eg, hammertoes, mallet toes, claw toes). The pathophysiology of lesser toe deformities is complex and is affected by the function of intrinsic and extrinsic muscle units. In addition to lesser toe and metatarsal abnormality, forefoot pain can be attributed to interdigital neuritis, disorders of the plantar skin, and gastrocsoleus contracture. Treatment of these conditions may include shoe modifications, appliances, therapeutic exercises, and surgical repair.
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Affiliation(s)
- John A DiPreta
- Division of Orthopaedic Surgery, Albany Medical Center, Albany Medical College, Capital Region Orthopaedics, 1367 Washington Avenue, Suite 200, Albany, NY 12206, USA.
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Abstract
Hammertoe digital deformity correction is a very controversial topic among foot and ankle surgeons. Hammertoes are characterized by an extension deformity at the metatarsophalangeal joint (MTPJ) and flexion deformity at the proximal interphalangeal joint (PIPJ). Current treatment options are often guided by the patient's discomfort as well as the reducibility of the affected digit. Kirschner wires (K-wires) have long been considered the gold standard for hammertoe digital repair. Although K-wires are simplistic to use as fixation, they carry inherit risks such as pin tract infections, migration, and breakage. This has lead to multiple intramedullary hammertoe devices including the PROTOE intramedullary device. This paper will discuss the usage and benefits the PROTOE has to offer over the conventional K - wire.
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