Comparison of Preoperative MRI With Intraoperative Findings for Peroneal Tendon Pathologies.

Magnetic resonance imaging (MRI) is commonly used to evaluate soft tissue pathology of the foot and ankle. Prior investigations have reported limitations of this modality, however, in evaluation of pathologies related to the peroneal tendons. This article investigates the correlation of pre-operative MRI studies with intraoperative findings. Five board-certified radiologists interpreted MRIs of 80 ankles that subsequently underwent surgical procedures performed by one board-certified foot and ankle surgeon, after which comparison was made between their findings. Statistically significant disagreement was found between radiologist and surgeon findings of a normal peroneus brevis (PB), PB and peroneus longus (PL) tendinosis, PB and PL hypertrophy, PB and PL partial linear tears, PB and PL flattening, PB longitudinal split tears, and the PB attritional spectrum (combined analysis of flattening, partial linear tearing, and longitudinal split tears). These results suggest that given the disconcordance between MRI and intraoperative findings, surgeons should remain cautious in their reliance upon this imaging modality when evaluating this anatomic region.

Urban Traumatic Moving Injuries Before and During SARS-CoV-2: A Multilinear Regression Analysis.

Background The onset of the coronavirus pandemic (COVID-19/SARS-CoV-2) saw an overall decline in traffic. Fundamental shifts in the pattern of traffic-related traumas were observed across the United States and beyond.  Objectives This study aims to predict changes in the length of stay (LOS) for patients sustaining traumatic moving injuries before and during the coronavirus pandemic.  Methods All moving injuries (bicycle accidents, pedestrians struck, motor vehicle/motorcycle accidents) before and during the first SARS-CoV-2 wave in the US were extracted from our hospital's trauma registry. The study period was from March 1st to October 31st of 2019 and 2020, respectively. Ordinary least squares (OLS) multilinear regression models were estimated with a significance level of 0.05.  Results In both periods, the Glasgow coma scores (GCS), ICU LOS, injury severity scores (ISS), and admitting service had significant impacts on hospital duration. Higher GCS scores increased the hospital LOS by 0.811 days in 2019 and 0.587 days in 2020. A higher ISS resulted in an increase in LOS by 0.207 days in 2019 and 0.124 days in 2020. The ICU admissions increased LOS by 0.82 days in 2019 and 1.25 days in 2020. Admissions to trauma services increased in duration by 2.111 days in 2019 and 1.379 days in 2020. Average LOS dropped from 3.09 to 2.50 days between both periods.  Conclusion Our trauma center saw significant changes in the admission patterns of moving injuries during COVID-19. We must therefore be better prepared to handle increased volume during public health emergencies and potential reductions in trauma utilization. Local injury prevention efforts may help reduce the burden on trauma centers during such emergencies as they did during COVID-19, allowing for greater focus on non-trauma patients.

Systematic Review of Nonoperative Functional Protocols for Acute Achilles Ruptures Utilizing a Formal Rehabilitation Protocol Showing Lowest Rerupture Rates.

AIM: To lay out a comprehensive protocol for practitioners and physical therapists that has the lowest rerupture rates for nonoperative treatment of acute Achilles ruptures. METHOD: Relevant articles were searched in PubMed, CINAHL Plus, and Cochrane Library using keyword combinations: nonoperative AND/OR Achilles rupture AND functional AND/OR protocol or functional AND/OR rehabilitation. To be included in the full analysis, the studies had to have detailed functional protocols with physical therapy program details and outcome scores of rupture rates and/or Achilles Tendon Rupture Score (ATRS). We ultimately found 7 articles that fit our inclusion criteria for analysis. All of them had rerupture rates, and 4 had ATRS scores and functional protocols with mention of formal physical therapy programs. RESULTS: Lowest rerupture rates were found in strict functional rehabilitation protocols that were full weightbearing in boot immediately at full equinus or 30° plantar flexed. They started active range of motion at 5 to 8 weeks and started formal physical therapy at 10 weeks.Levels of Evidence: Level III: Evidence obtained from well-designed non-experimental descriptive studies.

Immigration Brings New Pathology with No Standardized Treatment Protocol Madura Foot Case Studies Phialemonium and Phaeoacremonium.

Madura foot is an uncommon invasive soft-tissue infection that foot and ankle specialists encounter. We present two rare cases of Phialemonium and Phaeoacremonium fungi infections of the foot diagnosed in northern California to inform physicians on the presentation and current treatment options for this unique pathology. The two cases presented outline the clinical presentations, diagnostic data, and surgical and antimicrobial interventions. There is a concentration on the antimicrobial options depending on which of the over 20 species is encountered. The pertinent literature and supporting data are reviewed to create an outline for discussion of treatment protocols when faced with these emerging opportunistic infections.

Initial Report on the Use of In-Office Cone Beam Computed Tomography for Early Diagnosis of Osteomyelitis in Diabetic Patients.

Osteomyelitis is one of the most feared sequelae of diabetic foot ulceration, which often leads to lower-extremity amputation and disability. Early diagnosis of osteomyelitis increases the likelihood of successful treatment and may limit the amount of bone resected, preserving ambulatory function. Although a variety of techniques exist for imaging the diabetic foot, standard radiography is still the only in-office imaging modality used today. However, radiographs lack sensitivity and specificity, making it difficult to diagnose bone infection at its early stages. In this report, we describe our initial experience with a cone beam computed tomography (CBCT)-based device, which may serve as an accurate and readily available tool for early diagnosis of osteomyelitis in a patient with diabetes. Two patients with infected diabetic foot ulcers were evaluated for osteomyelitis using radiography and CBCT. Positive imaging findings were confirmed by bone biopsy. In both patients, CBCT captured early osteolytic changes that were not apparent on radiographs, leading to early surgical intervention and successful treatment. The CBCT was helpful in facilitating detection and early clinical intervention for osteomyelitis in two diabetic patients with foot ulcers. These results are encouraging and warrant future evaluation.