Hallux valgus is a common condition that results from a complex positional deformity of the first ray. The bunion or medial prominence that results from the lateral deviation and pronation of the hallux is only one component of the 3-dimensional deformity. Hallux valgus can lead to considerable pain and altered joint mechanics. The precise biomechanical etiology remains under debate. Predisposing factors include female sex, age, constricting footwear, and family history. Metatarsus adductus, equinus contracture, hammertoe deformity, and pes planus often coexist with hallux valgus. Nonoperative treatment involves patient education, shoe modifications, toe pads and positioning devices, and activity modifications. Surgery is considered in patients who fail nonoperative treatment with the goal of pain relief, correction of the deformity, improved first ray stability, and improved quality of life. More than 100 different procedures have been described to treat hallux valgus; they include combinations of soft tissue balancing, metatarsal osteotomies, and fusion of either the metatarsophalangeal (MTP) or tarsometatarsal (TMT) joint. The choice of procedures depends on the severity and location of the deformity as well as surgeon preference. Recent advances in operative techniques include minimally invasive surgery and correction of rotational deformity.

Introduction Optimal management of lower extremity fractures includes early antibiotics administration, thorough irrigation and debridement, consideration of soft tissue injury, and definitive skeletal management. The purpose of this study was to evaluate the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures. Methods This was a retrospective case control study in which open lower extremity fractures at our institution were reviewed for development of infection (including species and sensitivity if present) and the development of unanticipated wound complications requiring intervention. Patients from 2010-2015 were treated with standard of care consistent with evidence-based literature (IV antibiotics with external fixator, intramedullary nail, etc.). Patients from 2016–18 were additionally treated with vancomycin powder applied directly to the wound before closure. All patients were monitored per the treating surgeon’s standard follow-up protocol and had follow-up of at least two months. Results This retrospective case control study comprised 434 patients. The historical control group (n = 388 patients) and treatment group (n = 46 patients) were similar for age, sex, BMI (body mass index), diabetes, smoking status, and Injury Severity Score (ISS). There were 36 infections (9.28%) in the control group compared to four infections (8.70%) in the vancomycin powder group (p = 0.901). No significant difference was seen after adjusting for age, sex, BMI, diabetes, smoking status, and ISS. The vancomycin powder group experienced significantly more wound complications (15.2%) compared to the control group (6.4%; p = 0.039), which remained significant when adjusting for multiple covariates. Conclusions Topical vancomycin powder did not reduce the infection rate when applied in the surgical site of open lower extremity fractures. Instead, the addition of topical vancomycin powder resulted in significantly more wound complications in patients with open lower extremity fractures.

Infection and delayed wound healing are two major serious complications related to traumatic injuries and cause a significant burden to patients and society. Most currently available drug delivery materials typically carry a single drug, lack protection from drug loading, and face challenges in on-demand and precisely controlled drug release. Here, we report a flower (Cirsium arvense)inspired capsule-integrated multilayer nanofilm (FICIF), synthesized using a layer-by-layer self-assembly, for programmed multiple drug co-delivery for trauma (open fracture as an example) treatments. Our approach allows polypeptide multilayer nanofilms and innovative impregnated capsules to assemble hierarchical reservoirs with specific drug binding sites, shielding protection capability, and ordered packing structures. The resultant FICIF nanocarriers enable sustained and on-demand co-delivery of a unique immune-tuning cytokine (interleukin 12p70) and a growth factor (bone morphogenetic protein 2) in clinical use, resulting in extraordinary anti-infection (3 orders of magnitude improved bacterial killing) and bone regeneration (5 times enhanced bone healing) in treating infected rat femur fractures. The successful synthesis of these biomimetic high-performance delivery nanocoatings is expected to serve as a source of inspiration for the development of biomaterials for various clinical applications.

Background: Foot width reduction is a desirable cosmetic and functional outcome for patients with hallux valgus. Triplanar first tarsometatarsal (TMT) arthrodesis could achieve this goal by 3-dimensional correction of the deformity. The aim of this study was to evaluate changes in bony and soft tissue width in patients undergoing triplanar first TMT arthrodesis. Methods: After receiving Institutional Review Board approval, charts were retrospectively reviewed for patients undergoing triplanar first TMT arthrodesis for hallux valgus at 4 institutions between 2016 and 2019. Patients who underwent concomitant first metatarsal head osteotomies (eg, Silver or Chevron) or fifth metatarsal osteotomies were excluded. Preoperative and postoperative anteroposterior weightbearing radiographs were compared to evaluate for changes in bony and soft tissue width. One hundred forty-eight feet from 144 patients (48.1 ± 15.7 years, 92.5% female) met inclusion criteria. Results: Preoperative osseous foot width was 96.2 mm, compared to 85.8 mm postoperatively ( P < .001). Preoperative soft tissue width was 106.6 mm, compared to 99.3 mm postoperatively ( P < .001). Postoperatively, patients had an average 10.4 ± 4.0 mm reduction (10.8% reduction) in osseous width and average 7.3 ± 4.0 mm reduction (6.8% reduction) in soft tissue width. Conclusions: Triplanar first TMT arthrodesis reduced both osseous and soft tissue foot width, providing a desirable cosmetic and functional outcome for patients with hallux valgus. Future studies are needed to determine if patient satisfaction and outcome measures correlate with reductions in foot width. Level of evidence: Level III, retrospective comparative study

A stem cell-based tissue-engineering approach is a promising strategy for treatment of cartilage defects. However, there are conflicting data in the feasibility of using this approach in young recipients. A young rabbit model with an average age of 7.7 months old was used to evaluate the effect of a tissue-engineering approach on the treatment of osteochondral defects. Following in vitro evaluation of proliferation and chondrogenic capacity of infrapatellar fat pad-derived stem cells (IPFSCs) after expansion on either tissue culture plastic (TCP) or decellularized extracellular matrix (dECM), a premature tissue construct engineered from pretreated IPFSCs was used to repair osteochondral defects in young rabbits. We found that dECM expanded IPFSCs exhibited higher proliferation and chondrogenic differentiation compared to TCP expanded cells in both pellet and tissue construct culture systems. Six weeks after creation of bilateral osteochondral defects in the femoral trochlear groove of rabbits, the Empty group (left untreated) had the best cartilage resurfacing with the highest score in Modified O'Driscoll Scale (MODS) than the other groups; however, this score had no significant difference compared to that of 15-week samples, indicating that young rabbits stop growing cartilage once they reach 9 months old. Interestingly, implantation of premature tissue constructs from both dECM and TCP groups exhibited significantly improved cartilage repair at 15 weeks compared to those at six weeks (about 9 months old), indicating that a tissue-engineering approach is able to repair adult cartilage defects. We also found that implanted pre-labeled cells in premature tissue constructs were undetectable in resurfaced cartilage at both time points. This study suggests that young rabbits (less than 9 months old) might respond differently to the classical tissue-engineering approach that is considered as a potential treatment for cartilage defects in adult rabbits.