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Correlating pre-operative MRI measurements of metatarsal Osteomyelitis with surgical clean margins reveals the need for a one centimeter resection margin

Overview of attention for article published in Journal of Foot and Ankle Research, August 2017
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  • Good Attention Score compared to outputs of the same age (66th percentile)

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Title
Correlating pre-operative MRI measurements of metatarsal Osteomyelitis with surgical clean margins reveals the need for a one centimeter resection margin
Published in
Journal of Foot and Ankle Research, August 2017
DOI 10.1186/s13047-017-0222-5
Pubmed ID
Authors

Brent Bernstein, Melody Stouder, Eric Bronfenbrenner, Steven Chen, David Anderson

Abstract

Due to the high incidence of forefoot ulcerations with associated osteomyelitis, there has been an increased demand for partial ray amputations. In order to ensure complete removal of infected metatarsal bone, a clean margin amount is chosen based on the surgeon's intraoperative visual subjective evaluation. The margin is resected and sent to pathology. Currently the literature shows positive proximal margin rates of 35-40%. The purpose of this study was to reduce the rate of positive proximal margins by effectively resecting all infected bone using pre-operative MRI measurements with an added resection margin. Twenty-four osteomyelitis positive metatarsals were included in this exploratory study. The distance of proximal osteomyelitic extension within the metatarsal was measured on MRI in centimeters. Intra-operatively, the partial ray amputation cut was determined by adding an extra 0.5 cm resection margin to the MRI measurement. At the study's mid-point, bone histopathology revealed an increase in positive proximal margin rates-so the resection margin was increased to 1 cm. Descriptive outcomes included the mean distance of osteomyelitis propagation, proximal margin rates, as well as diagnostic statistics. After removing the specimens with false positive MRI results, the study sample included 21 metatarsals positive for osteomyelitis. A 0.5 cm resection margin proximal to the osteomyelitis resulted in a 50% positive proximal margin rate. After increasing the resection margin to 1 cm, there was found to be an improved positive proximal margin rate of 9%. Based on MRI findings, the mean distance + standard deviation of osteomyelitis propagation along the metatarsal proximally was 1.81 cm + 0.74 cm. The metatarsal specimen was processed by pathology into multiple pieces and compared to MRI, resulting in MRI sensitivity of 67%, specificity of 74%, positive predictive value of 79%, and negative predictive value of 60%. By performing a 1 cm resection margin proximal to the metatarsal osteomyelitis the proximal margin rate was reduced to clinically meaningful levels. These preliminary findings support using a 1 cm resection margin when performing any form of metatarsal amputation, to reduce the risk of residual osteomyelitis post-operatively. St. Luke's Hospital, IRB National Protocol ID SLHN2015-112. Date:1-13-16.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 10 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 10 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 4 40%
Student > Bachelor 2 20%
Student > Doctoral Student 1 10%
Researcher 1 10%
Professor > Associate Professor 1 10%
Other 0 0%
Unknown 1 10%
Readers by discipline Count As %
Medicine and Dentistry 4 40%
Nursing and Health Professions 2 20%
Sports and Recreations 1 10%
Agricultural and Biological Sciences 1 10%
Unknown 2 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 January 2018.
All research outputs
#3,339,049
of 12,358,097 outputs
Outputs from Journal of Foot and Ankle Research
#291
of 494 outputs
Outputs of similar age
#87,538
of 267,915 outputs
Outputs of similar age from Journal of Foot and Ankle Research
#15
of 16 outputs
Altmetric has tracked 12,358,097 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 494 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.2. This one is in the 40th percentile – i.e., 40% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 267,915 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 66% of its contemporaries.
We're also able to compare this research output to 16 others from the same source and published within six weeks on either side of this one. This one is in the 6th percentile – i.e., 6% of its contemporaries scored the same or lower than it.