Percutaneous fixation of forefoot, midfoot, hindfoot, and ankle fracture dislocations.

Open reduction with rigid internal fixation is the basic principle for surgical management in foot and ankle trauma. High-risk patients present a surgical dilemma for the foot and ankle surgeon because the possible complications are magnified in this patient population. Percutaneous fixation is a unique alternative for achieving anatomic stabilization without increased physical strain to the patient. The significant advantages of percutaneous fixation include minimizing damage to the vascular supply, maintaining and preserving a stable soft tissue envelope, and decreasing the potential risk for infection. This article provides an overview of percutaneous surgical fixation methods and their role in foot and ankle trauma for the high-risk patient.

Scarfette osteotomy for surgical treatment of bunionette deformity.

Numerous procedures have been described for a bunionette deformity. Choosing a specific osteotomy depends largely on the degree of the deformity and surgeon preference. The Scarfette osteotomy is a versatile procedure that addresses specific etiologic factors associated with bunionette deformities. The primary aim of this study is to show the versatility of the Scarfette osteotomy in varying degrees of bunionette deformities. A retrospective review of 50 cases was performed with a follow-up of 12 months. Objective information was obtained by measuring specific radiographic variables on preoperative and postoperative weight-bearing radiographs. Mean radiographic results are presented for the intermetatarsal 4-5 angle, lateral deviation angle, and fifth metatarsophalangeal angles postoperatively. The authors report short-term results of the Scarfette osteotomy in the correction of bunionette deformities. The Scarfette is a predictable and versatile osteotomy to correct varying degrees of bunionette deformities. The Scarfette is not technically demanding and allows early postoperative ambulation.

A new minimally invasive technique for treating plantar fasciosis using bipolar radiofrequency: a prospective analysis.

The purpose of this study was to evaluate the effectiveness of a new minimally invasive technique using bipolar radiofrequency in the treatment of plantar fasciosis. A prospective study was performed on 10 patients with recalcitrant plantar fasciosis that failed conservative care. A percutaneous microtenotomy was performed unilaterally with a Topaz microdebrider. Outcome measures included visual analog scale, American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot and Midfoot Scale, and patient satisfaction assessment. All patients had statistical improvement in outcome measures at 6 months and 1 year. One patient developed recurrent heel pain at the 1-year mark. There were no postoperative complications. This minimally invasive technique is a viable surgical treatment option in patients with plantar fasciosis that failed conservative care.

A retrospective review of immediate weightbearing after first metatarsophalangeal joint arthrodesis.

First metatarsophalangeal (MTP) joint arthrodesis is a proven technique as a salvage procedure for many foot pathologies. Many studies have looked at joint preparation techniques, position of the fusion, and construct stability. In this retrospective study, the authors report the overall fusion rate after first MTP joint fusion with full immediate postoperative weightbearing. Forty-five first MTP arthrodeses were performed during the study period. Eight fusions were excluded, leaving 37 fusions for review. The overall fusion rate was 91.1%. The mean time to fusion was 69.0 +/- 37.6 days. Complications included 2 delayed unions (1 screw, 1 plate), 3 nonunions (1 screw, 2 plates), and 2 hardware removals (1 screw, 1 plate). Fixation stability is important to allow immediate postoperative weightbearing. A fusion rate of 91.1% was seen in a diversity of patients after first MTP fusion with immediate weightbearing.

A comparison of the crescentic and Mau osteotomies for correction of hallux valgus.

UNLABELLED: We retrospectively compared crescentic and Mau osteotomies used to treat a total of 39 cases of hallux abductovalgus. Follow-up was possible in 10 of the crescentic cases (mean 228 days) and 24 of the Mau cases (mean 245 days). Preoperatively, the mean first intermetatarsal and hallux abductus angles were 17.5 degrees and 35.4 degrees , respectively, in the crescentic group; and 16.6 degrees and 31.3 degrees , respectively, in the Mau group. Postoperatively, these same radiographic angles were 11.7 degrees and 18.9 degrees , respectively, in the crescentic group; and 9.8 degrees and 12.9 degrees , respectively, in the Mau group, and these differences were not statistically significant. Complications included metatarsus primus elevatus (crescentic 7, Mau 2), lesser metatarsal transfer lesion (crescentic 1, Mau 0), nonunion (crescentic 5, Mau 1), revisional surgery (crescentic 0, Mau 1), and transarticular hardware (crescentic 3, Mau 0). The incidence of complications in the crescentic group was 60%, whereas that in the Mau group was 37.5%; this difference was not statistically significant (P = .276). Analysis by the type of complication revealed statistically significant differences between the crescentic and Mau groups in regard to metatarsus primus elevatus (70% versus 8.3%, P = .001), transarticular hardware (30% versus 0%, P = .02), and nonunion (50% versus 4.2%, P = .006). In conclusion, crescentic and Mau osteotomies satisfactorily corrected the first intermetatarsal and hallux abductus angles in patients that fit our inclusion criteria, although the incidence of postoperative metatarsus primus elevatus, delayed union, and transarticular hardware placement, was higher in the crescentic osteotomy group. LEVEL OF CLINICAL EVIDENCE: 2.

Cost comparison of crossed screws versus dorsal plate construct for first metatarsophalangeal joint arthrodesis.

UNLABELLED: Expensive surgical implants can significantly add to the cost of a procedure. We performed a crude cost analysis to evaluate and compare the crossed screw technique versus dorsal plating for first metatarsophalangeal arthrodesis. First metatarsophalangeal arthrodeses performed over a 20-month period were selected. Exclusion criteria included diabetes, neuroarthropathy, revision surgery, or alternate fixation. Hospital records were reviewed for each case to determine implant charges. Patient charts and radiographs were also reviewed to determine time to fusion, delayed union/nonunion, revision surgery, or hardware removal. Fifty-five first metatarsophalangeal arthrodeses were performed during the study period. Ten fusions were excluded, leaving 45 fusions for review. The overall fusion rate was 91.1%. The average time to fusion in crossed screw versus plating technique was 73.2 +/- 32.5 days (range, 43 to 162) and 69.3 +/- 37.3 days (range, 44 to 238), respectively, and not statistically significant. The mean implant cost in the crossed screw versus dorsal plating technique was $374.05 +/- 76.3 (range, 278.72 to 530.00) and $603.57 +/- 234.7 (range, 543.40 to 1677.00) respectively and was strongly significant (P = .0002). Complications included 2 delayed unions (1 screw, 1 plate), 4 nonunions (1 screw, 3 plate), 2 revisions (1 screw, 1 plate), and 2 hardware removals (1 screw, 1 plate). SUMMARY: A cost comparison of crossed screws versus dorsal plate construct for first metatarsophalangeal arthrodesis is performed. No statistical difference was found in the time to fusion between the 2 constructs but there was strong statistical difference in hardware cost. This information may aid in the cost management of this procedure without compromising clinical results. ACFAS Level of Clinical Evidence: 2c.

Early results of the Mau osteotomy for correction of moderate to severe hallux valgus: a review of 24 cases.

UNLABELLED: In our retrospective study, we report the objective results of the Mau osteotomy in the treatment of hallux valgus. We reviewed the results of 24 cases of moderate to severe hallux valgus deformities corrected with the Mau osteotomy of the first metatarsal combined with a distal soft-tissue procedure. Follow-up was possible in 24 cases. Preoperatively the mean hallux valgus and first intermetatarsal angles were 31.3 degrees and 16.6 degrees respectively, and were corrected postoperatively to an average of 13.00 degrees+/-7.15 degrees and 9.80 degrees+/-2.43 degrees respectively (P< .001). In the sagittal plane, the first metatarsal was shortened by an average of 2.00 mm. Two (8.3%) cases had dorsal elevation of the osteotomy fragment. Complications included 3 recurrences of the deformity, 1 frank nonunion, 8 dorsal cortical nonunions, 5 cases of undercorrection, and 1 case of broken hardware that was present in the nonunion that went on to revision. There were no superficial or deep infections, and no cases of transfer metatarsalgia were noted. In this series, the use of an oblique first metatarsal osteotomy with a dorsal shelf resulted in reliable and powerful correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. Particular attention should be paid to severe IM angles and the possibility of undercorrections. Despite ambulation postoperatively, the Mau osteotomy minimized dorsal malunion and the incidence of transfer metatarsalgia. LEVEL OF CLINICAL EVIDENCE: 4.