Clinical efficacy of the Ankle Spacer for the treatment of multiple secondary osteochondral lesions of the talus.

Background: The Ankle Spacer was developed as a joint-sparing alternative to invasive end-stage surgeries. Currently, there are no clinical studies on the Ankle Spacer.

Aim: To describe the operative technique and the clinical efficacy of the Ankle Spacer for the treatment of multiple, cystic osteochondral lesions of the talus in patients with failed prior operative treatment.

[Percutaneous needle flexor tendon tenotomy to prevent diabetic foot ulcers].

People with diabetes and polyneuropathy often develop foot deformities, resulting in ulcers or pre-ulcerative lesions on the apex of the toes. The Dutch guideline on diabetic foot disease recommends considering a flexor tendon tenotomy to treat a distal toe ulcer, if conservative treatment fails, and to prevent a toe ulcer if a pre-ulcerative lesion is present. To our knowledge, this technique is rarely performed in the Netherlands and if used, performed with a scalpel.

Deltoid Rupture in Ankle Fractures: To Repair or Not to Repair?

The most common injury mechanism for ankle fractures with concomitant deltoid ligament injury is a supination external rotation type 4 trauma. In the acute setting, malalignment, ecchymosis, and profound edema of the affected ankle can be found. Clinical examination is a poor indicator for deltoid ligament injury.

[Update on total ankle arthroplasty].

Update on total ankle arthroplasty Ankle arthritis is a major cause of impaired quality of life and affects approximately 1 % of the world population. Treatment options in end stage arthritis include ankle arthrodesis and total ankle replacement. As ankle arthroplasty preserves motion at the ankle joint it has become a popular alternative to fusion.

The Peroneus Quartus Muscle in a Locking Phenomenon of the Ankle: A Case Report.

We present the case of a 64-year-old female who was referred to us with an unexplained clicking and locking phenomenon of the right ankle. The magnetic resonance imaging findings suggested a longitudinal tear of the peroneus brevis tendon. During tendoscopy, not only was a Raikin type B intrasheath tendon subluxation visible, but also a peroneus quartus muscle.

Articular Gap and Step-off Revisited: 3D Quantification of Operative Reduction for Posterior Malleolar Fragments.

Objectives: Despite advanced imaging techniques, classic measurements of fracture reduction have not been revisited to date. The purpose of this study was to evaluate the reliability of innovative measurement techniques to quantify operative fragment reduction of posterior malleolar fractures by quantification of three-dimensional computed tomography (Q3DCT).

Methods: Twenty-eight ankle fractures including a posterior malleolar fragment (AO/OTA type 44) were evaluated using 2DCT and Q3DCT to postoperatively quantify fragment reduction.

Diagnostic Accuracy of 2-Dimensional Computed Tomography for Articular Involvement and Fracture Pattern of Posterior Malleolar Fractures.

Background: Up to 44% of ankle fractures have involvement of the posterior tibial margin. Fracture size and morphology are important factors to guide treatment of these fragments, but reliability of plain radiography in estimating size is low. The aim of the current study was to evaluate the accuracy of 2-dimensional computed tomography (2DCT) in the assessment of posterior malleolar fractures.

Posterior Malleolar Fracture Patterns.

Objective: To characterize posterior malleolar fracture morphology using Cole fracture mapping and to study reliability of quantification of 3-dimensional computed tomography (CT)-modeling for posterior malleolar fractures with respect to quantification of fragment size (in cubic millimeter) and true articular involvement (in square millimeter).

Methods: CT scans of a consecutive series of 45 patients with an ankle fracture involving the posterior malleolus were reconstructed to calculate (1) fracture maps, (2) fragment volume, (3) articular surface of the posterior malleolar fragment, (4) articular surface of intact tibia, and (5) articular surface of the medial malleolus by 3 independent observers. Three-dimensional animation of this technique is shown on www.

Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only.

Background: There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis.

Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature.

The objective of the present study was to review the current data on the long-term outcomes of calcaneal fractures, with special emphasis on the role of the type of treatment, surgical approach, and reduction and internal fixation. The search was limited to skeletally mature patients. Major databases were searched from 1978 to 2011 to identify studies relating to functional outcome, subjective outcome, and radiographic evaluation at least 2 years after either surgical or conservative treatment of calcaneal fractures.

The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review.

The supination-external rotation or Weber B type fracture exists as a stable and an unstable type. The unstable type has a medial malleolus fracture or deltoid ligament lesion in addition to a fibular fracture. The consensus is the unstable type and best treated by open reduction and internal fixation.

Classification and treatment of supramalleolar deformities.

Background: Supramalleolar osteotomies are increasingly popular for addressing asymmetric arthritis of the ankle joint. Still, recommendations for the indication and the use of additional procedures remain arbitrary. We preoperatively grouped different types of asymmetric arthritis into several classes and assessed the usefulness of an algorithm based on these classifications for determining the choice of supramalleolar operative procedure and the risk factors for treatment failure.

Medium- to long-term outcome of ankle arthrodesis.

Background: Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address these topics.

Effect of supramalleolar varus and valgus deformities on the tibiotalar joint: a cadaveric study.

Background: Distal tibia coronal plane malalignment predisposes the ankle joint to asymmetric load. The purpose of this cadaveric study was to quantify changes in pressure and force transfer in an ankle with a supramalleolar deformity.

Materials And Methods: Seventeen cadaveric lower legs were loaded with 700 N after creating supramalleolar varus and valgus deformities.

Measurement of the medial distal tibial angle.

Background: The aim of this study was to describe the difference between the medial distal tibial angle (MDTA) when measured on whole lower limb radiographs and mortise radiographs of the ankle.

Materials And Methods: A total of 48 legs were included of 24 healthy volunteers. Standard radiographs were obtained of the whole lower leg.

Triple arthrodesis.

Triple arthrodesis is largely used to restore painful hindfoot deformity. However, the procedure has been connected to several postoperative complications. Therefore, an isolated fusion of the talonavicular and the subtalar joint through a single medial approach has gained popularity.

Evidence-based treatment of maisonneuve fractures.

The objective of the current study was to review the published clinical evidence available for the treatment of Maisonneuve fractures. Medline via PubMed, Orthopaedic Trauma Association (OTA) annual meetings' abstracts archives Web site, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Clinical Trial register were searched for the period extending from January 1970 to May 2009 in order to identify studies relating to the treatment of Maisonneuve ankle fractures. Six level 4 (case series, N ≥ 5) studies, describing a total of 83 patients with a Maisonneuve fracture, were included in the review.

Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study.

Background: The role of the location and severity of the initial cartilage lesions associated with an ankle fracture in the development of posttraumatic osteoarthritis has not been established, to our knowledge.

Methods: We performed a long-term follow-up study of a consecutive, prospectively included cohort of 288 ankle fractures that were treated operatively between June 1993 and November 1997. Arthroscopy had been performed in all cases in order to classify the extent and location of cartilage damage.

Lambrinudi arthrodesis with posterior tibialis transfer in adult drop-foot.

Background: The adult drop-foot is one of the most disabling disorders that affects gait and quality of life. Despite orthoses and orthopaedic shoes, the disability often progresses. We have used the Lambrinudi arthrodesis to correct the bony component of drop-foot in association with a posterior tibial tendon transfer to provide lateral ankle stability and active dorsiflexion.

Measuring hindfoot alignment radiographically: the long axial view is more reliable than the hindfoot alignment view.

Background: Hindfoot malalignment is a recognized cause of foot and ankle disability. For preoperative planning and clinical follow-up, reliable radiographic assessment of hindfoot alignment is important. The long axial radiographic view and the hindfoot alignment view are commonly used for this purpose.

Anteroinferior plating of midshaft clavicle nonunions and fractures.

Objective: Anatomic reconstruction of clavicle with limited dissection and biomechanically optimal osteosynthesis. Anteroinferior plate placement to minimize patient's discomfort and need for implant removal.

Indications: Midshaft clavicle nonunions.

Treatment of midshaft clavicular delayed and non-unions with anteroinferior locking compression plating.

Introduction: Pain and impaired shoulder function are the predominant symptoms of midshaft clavicle non-unions. Obtaining consolidation and improvement of shoulder function is often successfully achieved with osteosynthesis and bone grafting. Most data in the literature pertain to plate osteosynthesis, placing the plate on the subcutaneous superior aspect of the clavicle.