Avoiding Fifth Metatarsal Intramedullary Screw Head Cuboid Impingement: A Weightbearing Computed Tomography Anatomic Study.

Background: Multiple case reports of fifth metatarsal (MT) intramedullary fixation highlight symptomatic hardware with screw head impingement on the cuboid. We developed a fifth MT intramedullary screw trajectory model using weightbearing computed tomography data. The goal was to assess for cuboid impingement with simulated intramedullary screw position.

Patient-Reported Outcomes After Lateral Process Talus Fracture.

Objectives: To evaluate functional outcome after lateral process talus fracture using patient-reported instruments and identify injury characteristics that portend a worse prognosis.

Design: Retrospective case series.

Setting: Level 1 academic trauma center.

A hyperactivating proinflammatory RIPK2 allele associated with early-onset osteoarthritis.

Osteoarthritis (OA) is a common debilitating disease characterized by abnormal remodeling of the cartilage and bone of the articular joint. Ameliorating therapeutics are lacking due to limited understanding of the molecular pathways affecting disease initiation and progression. Notably, although a link between inflammation and overt OA is well established, the role of inflammation as a driver of disease occurrence is highly disputed.

Validation and Generalizability of Preoperative PROMIS Scores to Predict Postoperative Success in Foot and Ankle Patients.

Background: A recent publication reported preoperative Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) scores to be highly predictive in identifying patients who would and would not benefit from foot and ankle surgery. Their applicability to other patient populations is unknown. The aim of this study was to assess the validation and generalizability of previously published preoperative PROMIS physical function (PF) and pain interference (PI) threshold t scores as predictors of postoperative clinically meaningful improvement in foot and ankle patients from a geographically unique patient population.

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population.

Background: Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach.

Arthroscopic Talar Dome Access Using a Standard Versus Wire-Based Traction Method for Ankle Joint Distraction.

Purpose: To evaluate the accessibility of the talar dome through anterior and posterior portals for ankle arthroscopy with the standard noninvasive distraction versus wire-based longitudinal distraction using a tensioned wire placed transversely through the calcaneal tuberosity.

Methods: Seven matched pairs of thigh-to-foot specimens underwent ankle arthroscopy with 1 of 2 methods of distraction: a standard noninvasive strapping technique or a calcaneal tuberosity wire-based technique. The order of the arthroscopic approach and use of a distraction method was randomly determined.

Factors Affecting the Outcomes of Uncomplicated Primary Open Ankle Arthrodesis.

Background: The objective of this study was to identify factors influencing operative outcomes in straightforward, uncomplicated open ankle fusions.

Methods: We reviewed all primary open ankle fusions conducted at 1 institution over an 11-year period to identify straightforward, uncomplicated open ankle fusions. Inclusion required a minimum of 6 months follow-up.

New paradigm for patient-reported outcomes assessment in foot & ankle research: computerized adaptive testing.

Background: Accurately measuring, reporting and comparing outcomes is essential for improving health care delivery. Current challenges with available health status scales include patient fatigue, floor/ceiling effects and validity/reliability.

Methods: This study compared Patient Reported Outcomes Measurement Information System (PROMIS)-based Lower Extremity Physical Function Computerized Adaptive Test (LE CAT) and two legacy scales -the Foot and Function Index (FFI) and the sport module from the Foot and Ankle Ability Measure (spFAAM) -for 287 patients scheduled for elective foot and ankle surgery.

Posterior Ankle and Hindfoot Arthroscopy.

Introduction: Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and posterolateral portals with the patient in the prone position, has become an important diagnostic and therapeutic procedure for various intra-articular and extra-articular disorders.

Step 1 Position The Patient Prone: If you are planning to use fluoroscopy for surgery and wire distraction, position the patient prone, flex the contralateral knee, and wrap the contralateral leg to a padded holder.

Step 2 Apply Distraction If Necessary: Invasive distraction is used primarily to improve access to the ankle and subtalar joints.

Postoperative complications of posterior ankle and hindfoot arthroscopy.

Background: Posterior ankle and hindfoot arthroscopy, performed with use of posteromedial and posterolateral portals with the patient in the prone position, has been utilized for the treatment of various disorders. However, there is limited literature addressing the postoperative complications of this procedure. In this study, the postoperative complications in patients treated with posterior ankle and hindfoot arthroscopy were analyzed to determine the type, rate, and severity of complications.

Deltoid ligament abnormalities in chronic lateral ankle instability.

Background: Treatment of patients with repeated ankle sprains and chronic lateral ankle instability tends to focus on the lateral collateral ligaments. We reviewed records to ascertain the prevalence of abnormalities of the deltoid ligament in this population.

Methods: Retrospective review of MR images and surgical reports was performed for all patients during a 3-year period that underwent surgical treatment of chronic ankle instability at a single institution.

A biomechanical analysis of a tensioned suture device in the fixation of the ligamentous Lisfranc injury.

Background: We hypothesized that using a cadaveric Lisfranc ligamentous injury model, abduction stress would provoke greater post-injury motion than axial weightbearing between the medial cuneiform (MC1) and the base of the second metatarsal (MT2). Second, we hypothesized that both a tensioned suture-button device and a rigid screw fixation method could maintain a reduction and similarly restrain motion to intact (pre-injury) levels.

Materials And Methods: Motion was measured between MC1 and MT2 in five matched pairs of human cadaveric feet.

Micro-CT Density Analysis of the Medial Wall of the Human Medial Cuneiform.

The human medial cuneiform is incompletely characterized with regard to anatomical morphology, including mineral density and bone quality. Clinically, we have observed failures of fixation by pull-through of devices through relatively soft medial bone. Defining patterns of relative density may provide valuable information regarding implant placement as higher cortical density bone may offer better resistance to such failures.

Open posterior approach for tibiotalar arthrodesis.

Traumatic injury to the ankle and hindfoot often results in tibiotalar or subtalar arthritis. The associated joint pain, stiffness, and deformity may be difficult to treat with conservative measures. For such problems, arthrodesis of the ankle or hindfoot joints is the mainstay of treatment.

Complex Achilles reconstruction for massive soft tissue loss: allograft, autograft, and use of a temporary cement spacer.

A 36-year-old male sustained loss of the Achilles mechanism secondary to a crush injury. The patient was treated with early placement of a cement spacer in the superficial posterior compartment, which allowed for successful late reconstruction.

Lower Extremity Assessment Project (LEAP)--the best available evidence on limb-threatening lower extremity trauma.

Lower Extremity Assessment Project (LEAP) study set out to answer many of the questions surrounding the decision of whether to amputate or salvage limbs in the setting of severe lower extremity trauma. A National Institutes of Health-funded, multicenter, prospective observational study, the LEAP study represented a milestone in orthopedic trauma research, and perhaps in orthopedics. The LEAP study attempted to define the characteristics of the individuals who sustained these injuries, the characteristics of their environment, the variables of the physical aspects of their injury, the secondary medical and mental conditions that arose from their injury and treatment, their ultimate functional status, and their general health.

Minimally invasive distraction technique for prone posterior ankle and subtalar arthroscopy.

Background: Prone ankle and subtalar arthroscopy is challenging in part due to the limited working space in these joints.

Materials And Methods: Fourteen patients undergoing prone posterior arthroscopy with a novel skeletal traction method were reviewed and the technique detailed.

Results: No complications were observed in 14 patients treated with a minimally invasive skeletal traction technique for prone ankle and subtalar arthroscopy and 38 patients treated with the same traction device during supine ankle arthroscopy.

Continuous peripheral nerve blockade as postoperative analgesia for open treatment of calcaneal fractures.

Objective: To examine the cost and efficacy of methods of general and regional anesthetic for postoperative pain control after open repair of intra-articular calcaneal fractures. We compared single-injection popliteal fossa blocks and continuous infusion popliteal fossa blocks with drug delivered through a catheter from an infusion pump (CPNB) to general or spinal anesthetic alone in terms of hospital charges, length of hospital stay, and postoperative oral and intravenous narcotic use, antiemetic use, and safety.

Design: Retrospective review.

Charcot-Marie-Tooth disease and the cavovarus foot.

This article focuses on the cavovarus foot shape, with particular emphasis on those patients who have Charcot-Marie-Tooth disease. Recent greater understanding of this deformity has led to a better appreciation of how the underlying condition drives deformity progression and treatment of the problems associated with it. The basic science underpinning the development of Charcot-Marie-Tooth disease is reviewed and some elements of the importance of the genetic variability are emphasized.