Outcomes Following the Use of Subtalar Arthroereisis in the Correction of Adult Acquired Flatfoot: A Systematic Review.

BACKGROUND: Adult acquired flatfoot deformity (AAFD) is a condition affecting approximately 3% of the adult population. It can lead to severe morbidity, and therefore, prompt treatment is of the upmost importance in maintaining and restoring function. Recently, the use of subtalar arthroereisis has become more widespread in the treatment of AAFD. The purpose of this systematic review is to examine the clinical and radiological outcomes of AAFD when treated with subtalar arthroereisis. METHODS: Studies involving the use of subtalar arthroereisis for the management of AAFD were reviewed, and appropriate studies selected based on inclusion and exclusion criteria. Studies were reviewed for both clinical and radiological outcomes following the use of subtalar arthroereisis as well as reported complications. RESULTS: Nine studies met our inclusion criteria, with most of these involving stage II AAFD. A total of 190 subtalar arthroereisis procedures were performed with all studies demonstrating improvement in both clinical and radiological scores with a low rate of complications. CONCLUSION: Subtalar arthroereisis may have benefits when used as an adjunct to treat stage II AAFD. However, more high-quality studies are needed to establish its best use. LEVELS OF EVIDENCE: Level IV: Systematic review.

Radiographic and Computed Tomography Correlation of Kienböck's Disease: Is There a Need to Revisit Staging with Improved Imaging?

Carpal height ratio and ulnar variance on plain X-ray were measured and compared to the width/height ratio of the lunate as measured on a computed tomography (CT) scan in 50 patients with Kienböck's disease. Width/height ratio of the lunate was also measured in a series of 50 controls. No correlation between ulnar variance and fractures was found. Conversely, the correlation between carpal height ratio on X-ray and width/height ratio on a CT scan was statistically significant. Similarly, the correlation between ulnar variance and width/height ratio was statistically significant. We have concluded that width/height ratio while correlating with carpal height is a better measure of lunate collapse. It also appeared that lunate collapse precedes carpal collapse, specifically most if not all lunates have collapsed prior to reduction in carpal height ratio. Finally, while we are unable to conclude the level at which the width/height ratio of lunate becomes unreconstructable, it does appear that in all Litchman stage 3b and most if not all of 3a the shape of the lunate has altered significantly.

Adolescent hallux valgus: a systematic review of outcomes following surgery.

PURPOSE: The management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV. METHODS: A comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed. RESULTS: The published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5-22). The mean follow-up was 41.6 months (range 12-134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p < 0.0001) and distal metatarsal articular angle (DMAA, p = 0.019). CONCLUSION: Based on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).

Patient functional outcomes with trapeziectomy alone versus trapeziectomy with TightRope(®).

PURPOSE OF THE STUDY: We assess whether patient functional outcomes with the use of a tightrope in conjunction with trapeziectomy are better than traditional trapeziectomy alone. METHODS: Retrospective study of 56 trapeziectomies in 53 patients; 26 trapeziectomies alone without additional procedures, and 30 trapeziectomies performed in conjunction with tightrope suspensionplasty. All patients were scored using Quick DASH, Patient-Rated Wrist Evaluation and Nelson base of thumb arthritis scores pre- and post-operatively. RESULTS: Significant improvements were seen with both operations using all three scoring systems. However, there was no statistically significant difference in post-operative scores between the two operations. STUDY DESIGN: Retrospective comparative study. LEVEL OF EVIDENCE: III.

The Southampton Dupuytren's Scoring Scheme.

The aim of this study was to construct and validate a simple patient-related outcome score to quantify the disability caused by Dupuytren's disease (DD), thus enabling prioritisation of treatment, to allow reliable audit of surgical outcome and to support future research. The Southampton Dupuytren's Scoring System (SDSS) was developed in a staged fashion according to the recommendations of The Derby Outcomes Conference. (1) Item generation; (2) Item reduction; (3) Internal consistency; (4) Test-re-test; (5) Field management; (6) Sensitivity to change standardised response mean; and (7) Criterion validity: ability of the SDSS to measure what it is supposed to measure. Internal consistency measured with Cronbach's alpha indicated acceptable reliability. The test-re-test correlation coefficient showed high reliability with SDSS. Field-testing showed SDSS ratings to be higher than the QuickDASH (Disability of the arm, shoulder and hand) ratings evaluated by the patients who answered both questionnaires. Standardised response mean was more sensitive for SDSS compared with QuickDASH showing sensitivity to change. Criterion validity was used to assess if the SDSS was measuring what it is supposed to measure comparing the SDSS with QuickDASH. A highly significant correlation was found between the two scoring systems. SDSS is a disease-specific patient-related outcome measure with a good internal consistency and performs better than QuickDASH in terms of test-re-test reliability and sensitivity to change. SDSS shows better field-testing attributes suggesting that it is a relatively more patient and practitioner friendly scoring system. This study proposes to the SDSS is a useful patient-related outcome measure for DD.