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Gowda P, Kohli A, Chhabra A. Two-Dimensional and 3-Dimensional MRI Assessment of Progressive Collapsing Foot Deformity-Adult Acquired Flat Foot Deformity. Clin Podiatr Med Surg 2024; 41:707-722. [PMID: 39237180 DOI: 10.1016/j.cpm.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.
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Affiliation(s)
- Prajwal Gowda
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ajit Kohli
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
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Gowda P, Kohli A, Chhabra A. Two-Dimensional and 3-Dimensional MRI Assessment of Progressive Collapsing Foot Deformity-Adult Acquired Flat Foot Deformity. Foot Ankle Clin 2023; 28:551-566. [PMID: 37536818 DOI: 10.1016/j.fcl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
This article is meant to serve as a reference for radiologists, orthopedic surgeons, and other physicians to enhance their understanding of progressive collapsing foot deformity, also known as adult acquired flat foot deformity. Pathophysiology, imaging findings, especially on MRI and 3-dimensional MRI are discussed with relevant illustrations so that the readers can apply these principles in their practice for better patient managements.
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Affiliation(s)
- Prajwal Gowda
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ajit Kohli
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA; Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
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Abstract
The tarsal navicular is an essential component of the Chopart joint and crucial for most of hindfoot motion. Most fractures are low-energy dorsal avulsions that may be treated nonoperatively. Displaced comminuted fractures require open reduction and internal fixation, sometimes with external fixation, bridge plating, and bone grafting. Diagnosis of stress fractures is commonly delayed. Conservative treatment is associated with good results, but surgery allows for quicker return-to-play in athletes. Nonunion in acute and stress fractures needs open debridement, grafting, and stable fixation. Müller-Weiss disease may present with a fragmented navicular and mimic an acute or a stress fracture.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Calle Diego de Velazquez 1, 28223 Pozuelo de Alarcón, Madrid, Spain.
| | - Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Calle Diego de Velazquez 1, 28223 Pozuelo de Alarcón, Madrid, Spain
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York TJ, Jenkins PJ, Ireland AJ. Reporting Discrepancy Resolved by Findings and Time in 2947 Emergency Department Ankle X-rays. Skeletal Radiol 2020; 49:601-611. [PMID: 31754742 PMCID: PMC7021739 DOI: 10.1007/s00256-019-03317-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 02/02/2023]
Abstract
AIMS To identify common errors in ankle X-ray reporting between initial interpretation and final assessment at the virtual fracture clinic. Also, to assess time of initial reporting as a causative factor for discrepancy. METHODS Two thousand nine hundred forty-seven final reports were reviewed by standard of agreement to the initial interpretation. Where discrepancy was found, it was classified and collated by specific finding. Comparison was made between reports with discrepancy and the complete dataset, allowing rates of error by finding to be established. The reports containing discrepancy were further classified by time period, this was compared against an expected value to establish if initial reporting outside of routine working hours was as accurate as that conducted within routine working hours. RESULTS 94.4% of reports were in agreement with the initial interpretation, 2.9% contained minor discrepancy, and 2.7% major discrepancy. In 45.6% of reports there was no radiologically observable injury. 16.4% of reports contained a lateral malleolar fracture, most commonly Weber type B. 40.0% of all navicular fractures, and 33.3% of all cuboidal fractures were not commented upon in the initial reporting. Lower rates of more frequently observed findings were missed with 2.5% of Weber type B fractures not commented upon. An increased proportion of major discrepancy reports were generated from 00:00 to 07:59 (expected = 15.0%, observed = 22.2%; p = 0.07908). Similarly, a greater than expected number of minor discrepancy reports were found between 20:00 and 23:59 (expected = 18.0%, observed = 34.1%, p = 0.00025). CONCLUSIONS The initial reporting of ankle X-rays in the emergency department is performed to a high standard, however serious missed findings emphasise the need for timely senior review. Reporters should increase their awareness of navicular, cuboid, talar, and Weber A fractures which were missed at disproportionate rates. This study also finds evidence to support increased rates of error in initial reporting of ankle X-rays outside of normal working hours (17:00-07:59), particularly with a significantly increased rate of minor discrepancy seen from 20:00 to 23:59.
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Affiliation(s)
| | - P J Jenkins
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - A J Ireland
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
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Abstract
Fractures of the tarsal navicular are commonly the result of trauma or chronic overload. Because of its complex anatomy and blood supply, the tarsal navicular is susceptible to osteonecrosis, and injury to this bone can lead to posttraumatic arthrosis of the surrounding joints. Diagnosis of the injury, especially in patients with stress fractures, can require a high index of suspicion and the use of advanced imaging. The treatment of stress fracture is controversial and ranges from immobilization in a non-weight-bearing cast or boot to internal fixation with or without bone grafting. Traumatic fractures are treated with open reduction and internal fixation with or without external fixation for medial and lateral column stabilization. To avoid a poor outcome, concomitant injuries must be recognized and treated. Despite appropriate treatment, patients may ultimately require fusion procedures to address ongoing pain and disability.
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Abstract
Treatment of malunion and nonunion at the Chopart joint aims at axial realignment of the midfoot to the hindfoot and restoration of the normal relationship of the lateral and medial columns of the foot. In carefully selected patients with intact cartilage, joint-preserving osteotomies are feasible at all 4 bony components of the Chopart joint to restore near-normal function. Priority should be given to the anatomic reconstruction of the talonavicular joint because it is essential for global foot function. Patients must be counseled about the risk of progressive arthritis or osteonecrosis necessitating late fusion.
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Affiliation(s)
- Wolfgang Schneiders
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany
| | - Stefan Rammelt
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany.
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Coulibaly MO, Jones CB, Sietsema DL, Schildhauer TA. Results and complications of operative and non-operative navicular fracture treatment. Injury 2015; 46:1669-77. [PMID: 26058352 DOI: 10.1016/j.injury.2015.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/28/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Navicular fractures (NF) are uncommon. The purpose of this study was to compare results of operative (ORIF) and non-operative (NOT) treatment in NF. METHODS A retrospective analysis was undertaken on patients diagnosed with NF between March 2002 and June 2007 at a Level I teaching trauma centre. Clinical outcome consisted of functional ability and complications. RESULTS Eighty-eight patients with 90 fractures were identified including 56 males and 32 females with a mean age of 38 (range 17-72) and body mass index of 28.2 (range 18.7-48.9). Twenty-one of 90 (23.3%) injuries were isolated. Ten of 90 (11.1%) injuries were open. Treatment was 49/90 (55%) NOT and 41/90 (45.6%) ORIF. 11/41 (30%) ORIF required bone grafting. Complications included one ipsilateral deep vein thrombosis, one avascular necrosis, one nonunion, seven infections (two deep and five superficial), and 56 cases of secondary osteoarthrosis (SOA). ORIF had significantly more SOA (χ(2)=0.000). Secondary surgery was 25 hardware removals (16 for irritation, five for prominent or broken plates), nine arthrodeses/-plasties, two debridements for infection, and one tarsal tunnel release. Pain was present at final follow up in 39/90 (43.3%) feet. Work status was 64 without restrictions, 17 with restrictions, and 5 did not return to work. Sixty-two of 88 (69%) patients were able to wear normal shoes, which were related to return to work without restrictions (ρ=-0.508, p=0.000). Inability to return to previous work was related to pain (ρ=-0.394), SOA (ρ=-0.280), and poor reduction quality (ρ=-0.384) with significance at p<0.01. Increased BMI (>35) related to pain (ρ=0.250) and poor reduction quality (ρ=0.326) at a σ<0.05. CONCLUSIONS Despite modern surgical techniques, operative treatment of displaced fractures is at high risk for complications. Obesity, pain, and secondary osteoarthrosis determine shoe wear, return to function, and employment status. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Marlon O Coulibaly
- Orthopaedic Research Fellowship, Grand Rapids Medical Education and Research Center, Grand Rapids, MI, United States; Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany.
| | - Clifford B Jones
- Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States
| | - Debra L Sietsema
- Orthopaedic Associates of Michigan, Grand Rapids, MI, United States; Michigan State University, College of Human Medicine, Department of Surgery, Grand Rapids, MI, United States
| | - Thomas A Schildhauer
- Ruhr-University Bochum, University Hospital Bergmannsheil GmbH, Department of Traumatology, Bochum, Germany
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Cheng Y, Yang H, Sun Z, Ni L, Zhang H. A Rare Midfoot Injury Pattern: Navicular—Cuneiform and Calcaneal—Cuboid Fracture—Dislocation. J Int Med Res 2012; 40:824-31. [PMID: 22613449 DOI: 10.1177/147323001204000250] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A rare midfoot injury pattern of navicular—cuneiform and calcaneal—cuboid fracture—dislocation is presented with two typical cases and a systematic review of the literature. This injury usually occurs as a result of high-energy crushing trauma and most often causes plantarly directed dislocation of the midfoot. Initial diagnosis includes a thorough physical examination and adequate radiological imaging, comprising anteroposterior, oblique and lateral X-radiography and computed tomography with three-dimensional reconstruction. Care should be taken to determine any injury to adjacent midfoot joints, in particular the Lisfranc joint. Intrasurgical protection of soft tissue is essential. Open reduction using two parallel incisions with minifragment plate fixation is recommended in more comminuted injuries. The navicular—cuneiform and calcaneal—cuboid joints play important roles in maintaining the arch of the foot and in weight-bearing during locomotion. Without proper therapy in the immediate post-traumatic phase, the long-term results are generally unsatisfactory.
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Affiliation(s)
- Y Cheng
- Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou, China
| | - H Yang
- Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Z Sun
- Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou, China
| | - L Ni
- Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou, China
| | - H Zhang
- Department of Orthopaedics, First Affiliated Hospital of Soochow University, Suzhou, China
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Abstract
Because of the effect on hindfoot kinematics, missed or delayed diagnosis of peritalar injuries often results in impairment. The seemingly innocuous nature of these injuries, subtle radiographic findings, and low incidence limit familiarity, thereby increasing the likelihood of misdiagnosis. Because of delay in diagnosis, salvage arthrodesis may be necessary to restore function to the extremity. Talar head fracture, talar process fracture, subtalar fracture-dislocation, transverse tarsal joint fracture, and transverse tarsal ligamentous disruption with instability are recurrently misdiagnosed. The keys to proper diagnosis of these potentially devastating injuries are the recognition of their existence, their injury patterns, and their radiographic appearance. The threshold for additional imaging studies should be lowered when a patient has pain and physical examination findings are out of proportion to a provisional diagnosis, or when symptoms fail to improve.
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Abstract
A 62-year-old woman with severe seizure disorder presented with right ankle and foot pain after being found down, presumably following a seizure recurrence. Imaging showed an acute comminuted fracture of the anterolateral aspect of the right calcaneus, as well as an acute avulsion fracture of the right navicular tuberosity at the site of insertion of the tibialis posterior tendon. This fracture pattern suggests forced abduction of the midfoot or forefoot with severe compression of the lateral column and failure of the medial column under tension, an entity that has previously been described as the nutcracker fracture. This mechanism of injury should prompt particularly careful evaluation of the navicular, cuboid, and calcaneus for any signs of injury. Subtle fractures of the navicular and calcaneus may be overlooked in the emergency setting, leading to a delay in surgical treatment and ultimately chronic foot deformities that can result in significant functional disability.
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