Behandlung von plantaren, neuropathischen und metatarsalen Ulzera mittels distaler minimalinvasiver metatarsaler Osteotomie

Mehlhorn, Alexander T.; Harrasser, Norbert; Walther, Markus

doi:10.1007/s00132-019-03848-w

Cited by 13 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further, the different patients' outcomes scores used by the authors may have contributed to the observed significant heterogeneity among studies, impairing comparability and assessment of the merits of each technique. Further, only studies published in English were included; however, our review did not lose much data from studies published in other languages, as only one was in German [55]. Finally, another limit of this review is the large time frame taken into consideration.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Minimally Invasive Metatarsal Osteotomies (MIMOs) for the Treatment of Plantar Diabetic Forefoot Ulcers (PDFUs): A Systematic Review and Meta-Analysis with Meta-Regressions

et al. 2021

View full text Add to dashboard Cite

Plantar Diabetic Foot Ulcers (PDFUs) are frequent injuries affecting and heavily limiting the quality of life in diabetic patients. PDFUs can be treated both conservatively (with a high recurrence rate) or surgically (with a high rate of complication). Recently, minimally invasive surgery (MIS), performed by small incisions, has been increasingly applied on diabetic feet due to their encouraging outcomes and low complication rate. This systematic review with meta-analysis and meta-regression aims to evaluate for the first time the effectiveness of minimally invasive metatarsal osteotomies (MIMOs) in treating PDFUs and reducing their recurrence rate. A literature search of PubMed/MEDLINE, ISI/Web of Science and Scopus databases was carried out with the keywords “(metatarsal osteotom*) OR (metatarsal AND osteotom*) AND diabet* AND (feet OR foot OR forefoot) AND ulcer”, covering the period from 1980 until June 2021 following PRISMA guidelines. The JBI critical appraisal tool was used for Quality Assessment. Healing rate/time, infection rate, recurrence rate, non-union rate and complication rate were evaluated. When possible, these values were pooled and expressed in effect size (ES), and their 95% confidence interval (CI) was computed. Meta-regression analysis (both uni- and multivariate) was conducted. Eight studies were included in the review, including 189 patients. The healing rate of these studies ranged between 55.1 and 100%, infection rate from 3.3% to 31.8%, recurrence rate from 0.0% and 13.6% and non-union rate from 4.5–30.0%. Overall complication rate was reported in three studies and ranged from 44.9 to 68.2%. Meta-analysis of the various rates revealed an overall healing rate of 91.9% (range from 74.9 to 97.8%), infection rate of 10.9% (4.2–25.2%), recurrence rate 7.2% (3.6–14.2), non-union rate 16.9% (10.2–26.7) and finally, the complication rate was computed at 53.2%. Satisfactory short- to medium-term clinical and radiographic results were reported by the studies included in this review, supporting that MIMOs represent an effective surgical approach to treat PDFUs. However, poor quality in the methodology of some studies and the lack of long-term data were reported. Therefore, randomized controlled trials, prospective studies and long-term follow-up studies are needed

show abstract

Section: Strengths and Limitationsmentioning

confidence: 99%

Minimally Invasive Metatarsal Osteotomies (MIMOs) for the Treatment of Plantar Diabetic Forefoot Ulcers (PDFUs): A Systematic Review and Meta-Analysis with Meta-Regressions

et al. 2021

View full text Add to dashboard Cite

show abstract

“…One other controlled study, 92 and 5 non‐controlled studies 130–134 reporting similar time‐to‐healing to the controlled study, found improved time‐to‐healing for metatarsal osteotomy versus ‘conservative’ care as a surrogate to ulcers healed outcome (RR NA; 51.3 vs. 159.3 days; p = 0.004; N = 1; n = 76; Low CoE) that may imply small increases in proportions of ulcers healed.…”

Section: Resultsmentioning

confidence: 93%

“…Overall, 5 RCTs 36,80–83 and 7 other controlled studies 34,91–96 reported outcomes for this comparison, while 24 non‐controlled studies 50,51,114–145 added relevant evidence. See the Comparison 7 SoF tables and forest plots in Supplementary File .…”

Section: Resultsmentioning

confidence: 99%

“…See the Comparison 7 SoF tables and forest plots in Supplementary File . Note as there was controlled study evidence for six different surgical offloading interventions, we reviewed each separately and produced six SoF tables for this comparison, including Achilles tendon lengthening 81,82, 114–118 (Comparison 7A), metatarsal head resections 34,83,91,93,94,119–125 (Comparison 7B), joint arthroplasties 95,96,126–129 (Comparison 7C), joint arthrodeses 80 (Comparison 7D), metatarsal osteotomies 92, 130–134 (Comparison 7E), and digital flexor tenotomies 36,50,51,135–145 (Comparison 7F). All other surgical offloading interventions with no controlled studies are listed at the end of this section.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

Lazzarini

Armstrong

Crews

et al. 2023

Diabetes Metabolism Res

View full text Add to dashboard Cite

BackgroundOffloading treatment is crucial to heal diabetes‐related foot ulcers (DFU). This systematic review aimed to assess the effectiveness of offloading interventions for people with DFU.MethodsWe searched PubMed, EMBASE, Cochrane databases, and trials registries for all studies relating to offloading interventions in people with DFU to address 14 clinical question comparisons. Outcomes included ulcers healed, plantar pressure, weight‐bearing activity, adherence, new lesions, falls, infections, amputations, quality of life, costs, cost‐effectiveness, balance, and sustained healing. Included controlled studies were independently assessed for risk of bias and had key data extracted. Meta‐analyses were performed when outcome data from studies could be pooled. Evidence statements were developed using the GRADE approach when outcome data existed.ResultsFrom 19,923 studies screened, 194 eligible studies were identified (47 controlled, 147 non‐controlled), 35 meta‐analyses performed, and 128 evidence statements developed. We found non‐removable offloading devices likely increase ulcers healed compared to removable offloading devices (risk ratio [RR] 1.24, 95% CI 1.09–1.41; N = 14, n = 1083), and may increase adherence, cost‐effectiveness and decrease infections, but may increase new lesions. Removable knee‐high offloading devices may make little difference to ulcers healed compared to removable ankle‐high offloading devices (RR 1.00, 0.86–1.16; N = 6, n = 439), but may decrease plantar pressure and adherence. Any offloading device may increase ulcers healed (RR 1.39, 0.89–2.18; N = 5, n = 235) and cost‐effectiveness compared to therapeutic footwear and may decrease plantar pressure and infections. Digital flexor tenotomies with offloading devices likely increase ulcers healed (RR 2.43, 1.05–5.59; N = 1, n = 16) and sustained healing compared to devices alone, and may decrease plantar pressure and infections, but may increase new transfer lesions. Achilles tendon lengthening with offloading devices likely increase ulcers healed (RR 1.10, 0.97–1.27; N = 1, n = 64) and sustained healing compared to devices alone, but likely increase new heel ulcers.ConclusionsNon‐removable offloading devices are likely superior to all other offloading interventions to heal most plantar DFU. Digital flexor tenotomies and Achilles tendon lengthening in combination with offloading devices are likely superior for some specific plantar DFU locations. Otherwise, any offloading device is probably superior to therapeutic footwear and other non‐surgical offloading interventions to heal most plantar DFU. However, all these interventions have low‐to‐moderate certainty of evidence supporting their outcomes and more high‐quality trials are needed to improve our certainty for the effectiveness of most offloading interventions.

show abstract

“…Recently, foot minimally invasive surgery has gained popularity in DM patients ( 40 , 41 ). The scarcity of scarring or tissue damage, the low number of complications ( 33 , 42 ) as well as the absence of osteosynthesis reduce the number of infections while could favor the recovery time ( 13 , 43 ).…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of bone consolidation chronology in claw toes operated through minimal invasive osteotomies in diabetic vs. non-diabetic patients

et al. 2022

View full text Add to dashboard Cite

ObjectiveTo compare bone healing time in osteotomies performed in claw toes correction through minimal invasive surgery in diabetic vs. non-diabetic patients. The relation between the patient's ages and the American Orthopedic Foot and Ankle Surgery Society (AOFAS) functional scores before and after surgery was also analyze in the two types of patients.MethodA series of 45 women, 23 of them suffering from Diabetes Mellitus, were operated to correct claw toes. The surgery was always performed through minimal invasive digital osteotomies. After the intervention, bone healing was controlled by a fluoroscopic weekly follow-up until a complete bone consolidation was reached. Bone healing time was compared in in two groups of patients, diabetic and non-diabetic. All patients were evaluated with AOFAS scale 48 h before and 90 days after the intervention.ResultsThe time of bone healing ranged from 24 to 40 days after the surgery and took shorter time of consolidation in non-diabetic patients although the Mann Withney U test did not show statistically significant differences (p = 0,409, effect size (ES) = 0,14 [-0.20 to 0.45]) between both groups. A statistically significant association (r = 0.71, R2 = 50%, p < 0.001) was found between the healing days and the day of medical discharge, also between the ages of the patients and the medial discharge (r = 0.36, R2 = 13%, p < 0.001). However, no statistically significant associations were found between pre-intervention glycemia and days of bone consolidation, neither in medical discharge (r = 0.07, p = 0.646 y r = 0.07, p = 0.648, respectively). AOFAS test scores and the diabetes status showed statistically significant differences, both in the main effect of Diabetes (F[1,41] = 9.41, p = 0.004) as in the interaction between diabetes and age (F[1,41] = 9.17, p = 0.004).ConclusionsThe bone healing time in claw toes operated through minimal invasive osteotomy surgery is not influenced by the presence of diabetes. The consolidation speed and the improvement in AOFAS functional scale score post-surgery in diabetic and elder patients was related to duration of the medical discharge.

show abstract

Behandlung von plantaren, neuropathischen und metatarsalen Ulzera mittels distaler minimalinvasiver metatarsaler Osteotomie

Cited by 13 publications

References 15 publications

Minimally Invasive Metatarsal Osteotomies (MIMOs) for the Treatment of Plantar Diabetic Forefoot Ulcers (PDFUs): A Systematic Review and Meta-Analysis with Meta-Regressions

Minimally Invasive Metatarsal Osteotomies (MIMOs) for the Treatment of Plantar Diabetic Forefoot Ulcers (PDFUs): A Systematic Review and Meta-Analysis with Meta-Regressions

Effectiveness of offloading interventions for people with diabetes‐related foot ulcers: A systematic review and meta‐analysis

Comparative analysis of bone consolidation chronology in claw toes operated through minimal invasive osteotomies in diabetic vs. non-diabetic patients

Contact Info

Product

Resources

About