No abstract

Level IV, case series.

Use of structural allografts is appropriate for reconstructive procedures in the foot and ankle. The grafts may be used successfully, with a relatively low complication rate, in patients with risk factors for less satisfactory bone-healing.

Background: Minimally invasive surgery (MIS) is increasingly being used for bunion correction, but limited patient outcome data have been reported for third-generation minimally invasive chevron/Akin (MICA) techniques. The aim of this study was to report on radiographic outcomes, pain control, satisfaction, learning curve, and complication rates in a consecutive series of 94 patients undergoing MICA procedures for hallux valgus. It also describes strategies for avoiding perioperative complications that may arise with MIS bunionectomies. Methods: The treating surgeon’s first 94 MICA procedures were included in the study. Radiographs were reviewed to measure pre- and postoperative intermetatarsal angles (IMAs), hallux valgus angles (HVAs), and soft tissue/bony foot width. Outcome measures, including visual analog scale (VAS) scores and Coughlin satisfaction scores, were obtained. Complication rates were retrospectively assessed though chart review. Statistical analysis was performed using Student t test for continuous variables and χ2 test for categorical variables. Average patient follow-up was 11.2 months. Results: VAS scores dropped 1 week postoperatively, from 5.2 preoperatively to 2.4 ( P < .001). IMA improved from 12.6 degrees to 5.7 degrees at final follow-up ( P < .001), while HVA improved from 26.8 degrees to 10.3 degrees ( P < .001). Bony foot width improved from 92.4 mm to 87.2 mm ( P < .001), and soft tissue foot width improved from 104.1 mm to 100.1 mm ( P < .001). The reoperation rate was 5%, including 3 hardware removals, 1 irrigation and debridement, and 1 neurolysis. Ninety-four percent of patients reported good or excellent satisfaction with the procedure. Complication rates and patient satisfaction scores were similar between the first and second half of patients ( P > .05), suggesting the learning curve was not a factor. Conclusion: In our experience, the MICA osteotomy was a safe and reproducible technique, associated with rapid improvement in pain scores, early weightbearing, significant deformity correction, high patient satisfaction, and low frequency of complications. In addition, the learning curve for the procedure was not as steep as previously reported. Level of Evidence: Level III, retrospective comparative series.

Arthrodesis of the first metatarsophalangeal joint of 21 matched pairs of cadaver toes was performed in order to compare the strength of three methods of internal fixation: 1. two crossed cannulated screws, 2. a dorsal plate with an oblique 0.062 K-wire, and 3. two compression staples with an oblique 0.062 K-wire. Biomechanical testing with plantar force was carried out, and gapping across the fusion site was measured. Stiffness, load to 1-mm displacement, and force to failure was determined for each specimen. Both the plate and screw constructs were statistically stronger in force to failure and initial stiffness than the compression construct. Compression staples have an advantage in their ease of insertion and theoretical continuous compressive force across an arthrodesis site, but should be supplemented with a cast or other external immobilization until union is achieved.

Level IV, retrospective case series.

No abstract

Category: Ankle, Bunion, Hindfoot, Lesser Toes, Midfoot/Forefoot Introduction/Purpose: Orthopaedic surgeons frequently prescribe pain medications during the postoperative period. The efficacy of these medications at alleviating pain after foot/ankle surgery and the quantity of medication required (and conversely, the quantity of medication leftover) are unknown. Methods: All patients that underwent foot/ankle surgery during a three month period and met inclusion criteria were surveyed at their first postoperative visit (4-10 days after surgery). Information collected from the patients included gender, number of narcotic tablets remaining in the bottle, satisfaction with pain control, and willingness to surrender leftover narcotics to a Drug Enforcement Administration (DEA) disposal center. These data were collected prospectively. Additional data, including utilization of a perioperative nerve block, type of procedure (bony vs non-bony), and anatomic region of procedure, were collected by review of the medical record. All data were analyzed in a retrospective fashion. Results: A total of 47 surveys were filled out over the course of 4 weeks. Eighty-five percent of patients were either extremely satisfied or satisfied with their pain control. Ninety-six percent of patients had short acting opioids leftover, and 94% of patients had long acting opioids leftover. On average, there were 27 short acting and 11 long acting narcotic pills leftover at the first postoperative visit (4-10 days after surgery). Of those with leftover narcotic medications, 72% were willing to surrender them to a DEA disposal center. Conclusion: Most patients undergoing foot/ankle surgery had both short and long acting narcotic pain pills leftover at the first postoperative visit (4-10 days after surgery). While it is unknown how many patients continue to require narcotics after the first week from surgery, most patients said they would be willing to surrender any leftover opioid medications to a DEA disposal center. In the future, perhaps patients should be given information on the location of the nearest disposal center when given prescriptions for narcotics.