Risks of injury in distal metatarsal minimally invasive osteotomy when comparing standard and modified techniques: A cadaveric study.

BACKGROUND: The objectives of the study were to evaluate the structures at risk in distal metatarsal mini-invasive osteotomy (DMMO) and to compare standard and intraosseous approaches. METHODS: DMMO was performed on the second and fourth metatarsals of 11 fresh-frozen cadaveric specimens. The standard technique was performed in 11 metatarsals. It was then compared to a modified intraosseous technique that entails starting inside the bone in 11 other metatarsals. The cadavers were dissected to identify unintentional injury to soft tissue structures. RESULTS: In the standard group the most injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group injured the EDL (27%), not the MJC (0%) and the EDB (0%). Distances between osteotomies and the dorsal metatarsal head articular surface (DMHAS) were 6.08 ± 3.99 mm in the standard and 9.92 ± 3.42 mm in the modified (p = 0.02). CONCLUSION: The DMMO techniques most frequently injured the EDL. Intra-articular positioning of the osteotomy was more observed in the standard. Overall, it appears the modified method could be an alternative to the standard DMMO. CLINICAL RELEVANCE: The modified minimally invasive DMMO has a comparable rate of potential iatrogenic injuries. This intraosseous procedure may present as an option when planning surgery to the lesser metatarsals. LEVEL OF EVIDENCE: Level III. Comparative Cadaveric Study.

Comparison between cotton test and tap test for the assessment of coronal syndesmotic instability: A cadaveric study.

INTRODUCTION: In surgically treated rotational malleolar fractures, residual syndesmotic instability is typically assessed following fixation with the widely used intraoperative Cotton test. However, due to its dynamic nature, there are inconsistencies of the magnitude and direction of the distraction force when attempting to pull the fibula away from the tibia using a bone hook. The novel Tap test advances a cortical tap through a drilled hole in the fibula with a stable, unidirectional distraction force applied to the tibia. The objective of this cadaveric study was to compare the Cotton and Tap tests as diagnostic tools for coronal plane syndesmotic instability. METHODS: Tibiofibular Clear Space (TFCS) of 10 cadaveric specimens was measured for: intact, non-stressed; intact, stressed; injured, non-stressed; and injured, stressed (Tap and Cotton tests). In injured conditions, the syndesmotic ligamentous complex was sectioned using an anterolateral longitudinal approach. Perfect fluoroscopic Mortise images were acquired for all conditions. Two independent and blinded Orthopaedic Foot and Ankle Surgeons measured TFCS 1 cm proximal to the ankle joint line. Intra and interobserver reliabilities were assessed by Intraclass Correlation Coefficient. Syndesmotic TFCS values for all conditions were compared by paired Wilcoxon. Diagnostic performance of the Cotton and Tap tests was assessed using a relative increase of TFCS > 2 mm when comparing intact stressed and injured stressed conditions. P-values <0.05 were considered significant. RESULTS: The intraclass correlation coefficient for intraobserver and interobserver reliability was respectively 0.96 and 0.79. TFCS measurements were similar in intact non-stressed, intact stressed (both Cotton and Tap tests) and injured non-stressed conditions, with mean values and 95% Confidence Intervals of: intact non-stressed, 3.5 mm; intact stressed, 3.6 mm (Cotton test) and 4.0 mm (Tap test); injured non-stressed, 3.8 mm. The Cotton test and Tap test had, respectively, 73.3% and 70% sensitivity, 100% and 90% specificity, 86.7% and 80% diagnostic accuracy. CONCLUSIONS: Our cadaveric study compared the Cotton and Tap tests for detection of coronal plane syndesmotic instability. Both tests demonstrated similar increases in the TFCS measurements in stressed injured conditions when compared to intact non-stressed and stressed conditions, as well as injured non-stressed conditions.

PROFILE OF PATIENTS WITH OSTEOPOROTIC FRACTURES AND FACTORS THAT DECREASE PREVENTION.

OBJECTIVE: To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention. METHODS: A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA. RESULTS: Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001). CONCLUSION: Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion. Level of Evidence III, Case-control.

OBJETIVO: Avaliar o perfil epidemiológico de pacientes com fraturas osteoporóticas, comparando com pacientes com osteoartrite (OA) e identificar fatores que diminuam aderência à prevenção secundária. MÉTODOS: 108 pacientes com FO foram comparados a 86 pacientes com OA. RESULTADOS: Grupo FO era mais velho (p< 0,001), com menor IMC (p<0,001), menos alfabetizado (p = 0,012), com maior frequência de brancos (p = 0,003), menor frequência de casados (p< 0,001). Apresentaram mais quedas, deficiência cognitiva, fraturas prévias, fratura antiga, queda no último ano, fraturas por queda. Necessitam de mais auxílio e tomam mais medicamento para osteoporose (p< 0,05); apresentaram menos patologia nos pés, fraqueza muscular. Tomam menos vitamina D e menor Katz & Lawton (p<0,001). Tem aumento da chance de não aderência: maior idade (p = 0,020), sedativo (p = 0,020), quedas (p = 0,035), deficiência cognitiva (p = 0,044) e presença de depressão/apatia/confusão (p< 0,001). CONCLUSÃO: Idade do paciente, etnia, estado civil, quedas prévias, patologias nos pés, fraqueza muscular, fraturas prévias, uso de vitamina D, uso de medicamentos para osteoporose e a escala Katz & Lawton definem o grupo FO. Aumentam a chance de não aderência: maior idade, sedativos, distúrbios cognitivos e sintomas de depressão/apatia/confusão. Nível de Evidência III, Estudo de caso controle.

Profile of patients with osteoporotic fractures and factors that decrease prevention / Perfil de pacientes com fraturas osteoporóticas e fatoresque diminuem aderência à prevenção

ABSTRACT Objective: To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention. Methods: A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA. Results: Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001). Conclusion: Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion. Level of Evidence III, Case-control.

RESUMO Objetivo: Avaliar o perfil epidemiológico de pacientes com fraturas osteoporóticas, comparando com pacientes com osteoartrite (OA) e identificar fatores que diminuam aderência à prevenção secundária. Métodos: 108 pacientes com FO foram comparados a 86 pacientes com OA. Resultados: Grupo FO era mais velho (p< 0,001), com menor IMC (p<0,001), menos alfabetizado (p = 0,012), com maior frequência de brancos (p = 0,003), menor frequência de casados (p< 0,001). Apresentaram mais quedas, deficiência cognitiva, fraturas prévias, fratura antiga, queda no último ano, fraturas por queda. Necessitam de mais auxílio e tomam mais medicamento para osteoporose (p< 0,05); apresentaram menos patologia nos pés, fraqueza muscular. Tomam menos vitamina D e menor Katz & Lawton (p<0,001). Tem aumento da chance de não aderência: maior idade (p = 0,020), sedativo (p = 0,020), quedas (p = 0,035), deficiência cognitiva (p = 0,044) e presença de depressão/apatia/confusão (p< 0,001). Conclusão: Idade do paciente, etnia, estado civil, quedas prévias, patologias nos pés, fraqueza muscular, fraturas prévias, uso de vitamina D, uso de medicamentos para osteoporose e a escala Katz & Lawton definem o grupo FO. Aumentam a chance de não aderência: maior idade, sedativos, distúrbios cognitivos e sintomas de depressão/apatia/confusão. Nível de Evidência III, Estudo de caso controle.