Arthroscopy for Traumatic Ankle Injuries.

Using ankle arthroscopy in conjunction to open reduction internal fixation of traumatic ankle injuries can play an important role in the management of these injuries by way of treating intra-articular pathologies, leading to improved patient outcomes. While a majority of these injuries are not treated with concurrent arthroscopy, its addition may lead to more prognostic information to dictate the patient's course. This article has illustrated its use in managing malleolar fractures, syndesmotic injuries, pilon fractures and pediatric ankle fractures.

Double Versus Triple Arthrodesis Fusion Rates: A Systematic Review.

Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the need for hindfoot arthrodesis is generally accepted in severe deformities, there is a debate whether a double or triple arthrodesis should be performed. The aim of our systematic review is to review the fusion rates and mean time to fusion in double and triple arthrodesis.

Outcomes Following Open Reduction Internal Fixation of Ankle Fractures (ORIF) By Podiatric Surgeons.

Open reduction internal fixation of closed ankle fractures is a common procedure performed by podiatric surgeons. This is the first study to specifically evaluate complication rates of this procedure among podiatric surgeons using a large patient cohort. The rates of podiatric surgical complications were also compared to the complication rates reported in the orthopedic literature.

Sinus Tarsi Approach with Subcutaneously Delivered Plate Fixation for Displaced Intra-Articular Calcaneal Fractures.

Displaced intra-articular calcaneal fractures can be treated with open reduction and internal fixation through various methods, including the extensile lateral approach, sinus tarsi approach, percutaneous reduction and fixation, external fixation, and calcaneoplasty. Although the gold standard is the extensile lateral approach, this method has significant wound-healing complications associated with it. Literature shows that the reduction achieved through minimally invasive techniques is equal to that achieved with the extensile lateral approach, while reducing the amount of postoperative complications.

Lateral Column Lengthening for Revision Triple and Double Arthrodesis and Severe End-Stage Flatfoot Deformity.

Few options exist for the treatment of revision and severe cases of end-stage flatfoot deformity. Triple arthrodesis or medial-approach double arthrodesis have been the standard but often do not provide enough correction of the deformity. Lateral column lengthening is a powerful procedure performed either with an Evans calcaneal osteotomy or calcaneocuboid distraction arthrodesis that can be used as an adjunct in realigning the flatfoot.

Comparative Nonunion Rates in Triple Arthrodesis.

The contemporary literature is unclear regarding the joint that is most "at risk" to yield a nonunion in the performance of triple arthrodesis of the foot. There is also a debate regarding the best methods of joint preparation. A retrospective radiographic review was conducted of all primary triple arthrodeses performed within in a Northern California health maintenance organization between January 2007 and June 2013.

Comparison of Medial Malleolar Fracture Healing at 8 Weeks After Open Reduction Internal Fixation Versus Percutaneous Fixation: A Retrospective Cohort Study.

Unstable medial malleolar fractures are treated with either standard open reduction internal fixation (ORIF) or a percutaneous approach. The percutaneous approach avoids the potentially excessive soft tissue dissection associated with an open approach but can also result in inadequate anatomic reduction. No studies have compared the incidence of radiographic healing of medial malleolar fractures between an open approach and percutaneous fixation.

Arthroscopic Medial Approach for Modified Double Arthrodesis of the Foot.

The single medial incision subtalar joint and talonavicular joint arthrodesis has been shown to be a useful alternative for the correction of hindfoot valgus deformity. We describe an arthroscopic method of joint preparation using this approach. The present case report included 6 consecutive patients aged 35 to 72 (mean ± standard deviation 55.

A Multicenter, Retrospective Study of Early Weightbearing for Modified Lapidus Arthrodesis.

The modified Lapidus arthrodesis is a long-established surgical technique for management of hallux valgus that provides reproducible results and quality patient outcomes. The data from 367 consecutive patients undergoing unilateral modified Lapidus arthrodesis from January 1, 2007 to December 31, 2008 at participating centers were retrospectively evaluated. The included patients were categorized into early weightbearing (≤ 21 days) and delayed weightbearing (> 21 days) groups.

Early results with use of the midfoot fusion bolt in Charcot arthropathy.

Charcot neuroarthropathy is a complicated condition affecting up to 1 in 680 diabetic patients that can rapidly cause severe destruction of the bony architecture in the foot, with resultant gross instability and frank deformity. Conservative care is not always successful at maintaining an intact soft tissue envelope of the foot; therefore, surgical reconstruction is often attempted in an effort to salvage the limb. The goal is to create a stable, plantigrade foot that can be placed in a shoe or simple brace.

Soft tissue pathology of the ankle.

Derangements of the soft tissues within the ankle joint are associated with a wide variety of pathophysiology, and typically can be classified as secondary to traumatic injury, rheumatic disease, or congenital lesions. Patients often present with persistent pain, swelling, and limitations on function, usually focused on the anterior aspect of the joint. Evaluation should be guided by a detailed history and physical examination, followed by clinical, laboratory, and imaging studies as indicated.

Isolated medial incisional approach to subtalar and talonavicular arthrodesis.

Triple arthrodesis is commonly used to correct complex deformity with hindfoot valgus. The authors use an isolated medial incisional approach for subtalar and talonavicular joint arthrodesis to correct hindfoot deformity, including high degrees of hindfoot valgus. To assess outcomes achieved with this approach, we reviewed the records of 45 patients from the practices of 5 surgeons.

Revision surgery of the first ray.

When dealing with the first ray, and in particular when preparing for hallux abductovalgus surgery, numerous guidelines are available to help decide what procedure is most appropriate for the pathology based on radiographic findings. However, these guidelines are not as black and white as some physicians may think. Numerous factors affect the selection of a procedure, including physician preference, physician comfort with a procedure, experience with a procedure, and surgical skills.

Isolated talonavicular arthrodesis for adult onset flatfoot deformity/posterior tibial tendon dysfunction.

Surgical treatment of the adult onset flatfoot deformity can be a vexing problem. This article attempts to define the specific patient population that may benefit from isolated talonavicular arthrodesis. The authors provide an overview of critical biomechanical and anatomic considerations that must be implemented when performing this procedure.

Bioengineered alternative tissues and hyperbaric oxygen in lower extremity wound healing.

With the advent and clinical application of recombinant chemical and cellular mediators of wound healing and a better understanding of the importance of serial debridement, most foot wounds can be healed with little morbidity. Despite these advances, there remains the recalcitrant wound for which more heroic efforts seem warranted. For these patients, advanced wound healing technologies, orthobiologics, and bioengineered alternative tissues may tilt the scales in the direction of definitive wound closure.

Midfoot arthrodesis using a locking anterior cervical plate as adjunctive fixation: early experience with a new implant.

A retrospective review was performed on 14 patients (20 arthrodeses) who had undergone midfoot arthrodesis with a semi-constrained, locking anterior cervical plate as a form of adjunctive fixation. Fusion sites where the plate was used for the purpose of arthrodesis included the talonavicular joint, medial naviculocuneiform joints, first metatarsal cuneiform joint, and the calcaneal cuboid joint. All arthrodesis sites used one other type of fixation for the purpose of axial compression.

Orthobiologics: a survey of materials and techniques.

The modern study of the regenerative capabilities of skeletal tissues began in 1964, when Marshall Urist discovered that bone devoid of inorganic content and dried into a powder could be implanted into the muscle of a rabbit with resultant ectopic bone formation. Use of this technology is now commonplace, and a plethora of orthobiologic materials are available to the foot and ankle surgeon. The science has even become advanced to the point that custom bone replacements can be fabricated in vitro.

Vascular perfusion of the long dorsal arm versus chevron osteotomy: a cadaveric injection study.

Iatrogenic disruption of the first metatarsal head's blood supply after a distal osteotomy may lead to adverse events such as delayed union or avascular necrosis of the capital fragment. In this cadaveric study, 2 types of distal first metatarsal osteotomies were performed on 7 fresh-frozen specimens (long dorsal arm osteotomy, N = 4; chevron osteotomy, N = 3). For each specimen, the respective osteotomy was created.

Revision arthrodesis of the foot and ankle.

Previously failed procedures with less than optimal outcomes always are distressing to the patient and surgeon. The revisional arthrodesis may require a higher level of surgical technique and skill than the original procedure from which it was derived. Another level of difficulty is added when the original procedure was deemed to have failed secondary to poor patient compliance.

Efficacy of allogenic bone implants in a series of consecutive elective foot procedures.

To show the efficacy of an allogenic bone graft in elective foot surgery, the authors report on 39 consecutive procedures in which allograft was implanted in 26 patients during a 30-month period. These procedures were performed for a variety of conditions, including arthrodesis, segmental lengthening, and treatment of nonunion. Allograft material consisted of freeze-dried tricortical iliac crest or demineralized bone matrix used either alone or as a composite.

Adult flatfoot/posterior tibial tendon dysfunction: classification and treatment.

The authors provide a comprehensive classification and treatment algorithm for the adult flatfoot/posterior tibial tendon dysfunction. As well, the article provides a discussion as to the etiology, biomechanical implications, conservative treatment and surgical pearls of posterior tibial tendon dysfunction.