Transfibular Total Ankle Arthroplasty: Clinical, Functional, and Radiographic Outcomes and Complications at a Minimum of 5-Year Follow-up.

Background: The Trabecular Metal Total Ankle Implant differs from other newer-generation implants in the transfibular approach, multiplanar external frame for alignment, tantalum trabecular metal interfaces, curved geometry, and shallow resection depths. The primary aim of this study was to report midterm clinical and radiographic results, as well as survivorship and adverse events at a minimum of 5-year follow-up.

Methods: A total of 83 ankles (81 patients, average age 60.

Suitability of Minced Cartilage From Osteochondral Lesions of the Talus for Immediate Autograft Reimplantation.

Background: Particulated autograft cartilage implantation is a surgical technique that has been previously described for the repair of osteochondral lesions of the talus (OLT). It uses cartilage fragments harvested from the OLT that are minced into 1-2-mm fragments and then immediately reimplanted back into the chondral defect and sealed with fibrin glue during a single-stage surgery. The purpose of this study was to characterize the suitability of these minced cartilage fragments as immediate autograft for the treatment of OLTs.

Minimally Invasive Cheilectomy for Hallux Rigidus.

Hallux metatarsophalangeal joint cheilectomy is a joint-sparing technique that involves resection of the dorsal metatarsal head osteophytes; this may be achieved through minimally invasive and arthroscopic techniques. General indications for minimally invasive surgery (MIS) cheilectomy are mild-to-moderate hallux rigidus (Grades I-II) with symptomatic dorsal osteophytes causing dorsal impingement and/or shoe wear irritation in those who have failed extensive nonoperative management. The literature confirms equivalent outcomes to open cheilectomy; however, it is somewhat inconsistent regarding superiority.

The Effect of Tibiotalar Joint Line Level Alterations on Tibiotalar Range of Motion Following Total Ankle Arthroplasty.

Background: The effect of tibiotalar joint line level (TTJL) on patient outcomes following total ankle arthroplasty (TAA) remains unclear. It was previously reported that patients with end-stage ankle arthritis have an elevated TTJL compared with nonarthritic ankles, and the TTJL post-TAA remains elevated compared with nonarthritic ankles. The objectives of this study were to (1) propose a reliable radiographic method to measure the TTJL absolute value and (2) determine the effect of TTJL alterations on tibiotalar range of motion (ROM) following TAA.

Effect of Achilles Tendon Lengthening and Gastrocnemius Recession on Radiographic Tibiotalar Motion Following Total Ankle Replacement.

Background: Surgeons frequently add an Achilles tendon lengthening or gastrocnemius recession to increase dorsiflexion following total ankle replacement. Previous studies have looked at the effects of these procedures on total tibiopedal motion. However, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement.

Effect of Training Modules on Hip Fracture Surgical Skills Simulation Performance: Early Validation of the AAOS/OTA Simulator.

Background: A preliminary validation study on a computer-based force-feedback simulation platform demonstrated the ability of the simulator to distinguish between novice and experienced users during a simulated hip-pinning procedure. The purpose of the present study was to further investigate whether the simulator and associated training modules are effective for improving user performance during simulated percutaneous hip-pinning procedures.

Methods: With institutional review board approval, 24 medical students at our institution were randomized to "Trained" and "Untrained" groups.

Factors influencing treatment recommendations for base of 5th metatarsal fractures in orthopaedic residency programs.

Background: Management of proximal 5th metatarsal fractures remains a controversial topic in orthopaedic surgery. Both operative and non-operative approaches have been described in the clinical setting. This confusion has led to non-standardized treatment recommendations for proximal 5th metatarsal fractures.

Prevention of Avascular Necrosis with Fractures of the Talar Neck.

Displaced talar neck fractures no longer constitute a surgical emergency; timing of definitive surgery has no bearing on the risk of osteonecrosis. Amount of initial fracture displacement is best predictor of osteonecrosis. Grossly displaced fractures or fracture-dislocations should be provisionally reduced, with or without temporary external fixation.

How to approach the pediatric flatfoot.

The most difficult aspect regarding treatment of the pediatric flatfoot is understanding who needs surgery, when it is necessary, and what procedure to be done. A thorough history, clinical examination, and imaging should be performed to guide the surgeon through an often complex treatment path. Surgical technique can be divided in three categories: Soft tissue, bony, and arthroereisis.

Accurate Measurement of First Metatarsophalangeal Range of Motion in Patients With Hallux Rigidus.

Background: The reliability of range of motion (ROM) measurements has not been established for the hallux metatarsophalangeal (MTP) joint in patients with hallux rigidus. The aim of the present study was to prospectively assess the clinical versus radiographic difference in ROM of the arthritic hallux MTP joint.

Method: One hundred consecutive patients who presented with any grade of hallux rigidus were included in this prospective study to determine the hallux MTP range of motion.

The Use of Osteotomy in the Management of Hallux Rigidus.

Metatarsus elevatus and gastrocnemius tightness contribute to the development of functional hallux rigidus. Although several osteotomies have been described for functional hallux rigidus, certain osteotomies are commonly used in practice for the correction of functional hallux rigidus, a long first metatarsal or an elevated metatarsal, or an unstable tarsometatarsal joint. Proximal plantarflexion osteotomy is used only in the presence of an elevated first metatarsal with a limit to dorsiflexion but without the presence of arthritis at the first metatarsophalangeal joint.

Revision Total Ankle Replacement.

Introduction: The technique for revision total ankle replacement described in this article addresses the subsidence and loosening that occur when an Agility total ankle replacement fails.

Step 1 Indications And Contraindications: The main indications for revision total ankle arthroplasty include loosening and subsidence of the talar component, with no limit to the extent of subsidence or loss of talar bone stock as neither precludes use of a revision system, particularly when a flat cut on the talus can be made.

Step 2 Anterior Incision And Joint Exposure: Make the incision employing the prior anterior midline incision, create full-thickness flaps of tissue to diminish the risk of wound dehiscence, and completely expose and debride the joint as this is critical to revising the total ankle replacement correctly.

Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study.

Controversy exists concerning the need for operative repair of the deltoid ligament during management of acute ankle fractures. The purpose of our report was to identify the indications for surgical intervention for deltoid ligament injury in the setting of ankle fractures. Furthermore, we aimed to elucidate the clinical outcomes after deltoid ligament repair in this setting.

The "joint-elevation" calcaneus fracture: a rare variant of the intra-articular calcaneus fracture-dislocation.

Unlabelled: Calcaneus fractures are the most commonly fractured tarsal bone with approximately 75% being intra-articular in nature. Böhler's angle has been found to be reliable and prognostic, and it has been used as a proxy for joint depression and articular involvement. It often guides the need for advanced imaging and/or operative intervention.

The management of infection following total ankle replacement: demographics and treatment.

Background: Little has been published on the management of infected total ankle replacements. This study reviewed our experience with this difficult clinical problem.

Methods: From 2002 to 2011 we retrospectively evaluated patients requiring prosthesis removal for infection following primary or revision total ankle replacement.

Resection of the Fifth Metatarsal Base in the Severe Rigid Cavovarus Foot.

Background: Cavovarus deformity associated with neuromuscular imbalance is a challenging pathology. Most of these deformities lead to pressure symptoms at the lateral border of the foot. This leads to pain, callosity, and commonly fracture of the fifth metatarsal base.

Radiographic analysis of an opening wedge osteotomy of the medial cuneiform.

Background: Forefoot varus deformity and medial column instability can develop or be present in association with ankle and hindfoot pathology. This study aimed to confirm the utility of medial cuneiform opening wedge osteotomy as part of hindfoot and ankle deformity correction.

Materials And Methods: Patients requiring operative management of flatfoot deformity between January 2002 and December 2007 were prospectively entered in a database.

Effectiveness of composite bone graft substitute plugs in the treatment of chondral and osteochondral lesions of the talus.

A review of outcomes in 13 patients with talar dome osteochondral or chondral lesions treated with a bone graft substitute plug was undertaken in an effort to evaluate its effectiveness in comparison with other reported surgical techniques. Mean patient age was 36.4 (range 16 to 57) years.

Posterior calf injury.

Acute injuries of the Achilles tendon are common among athletes and non-athletes alike. Injuries of other posterior calf muscles are far less common but should be considered in the differential, to ensure proper diagnosis and treatment of patients with calf injuries. This article focuses on these calf injuries, including injuries of the gastrocnemius, plantaris, soleus, and flexor hallucis longus, which may occasionally be mistaken for Achilles tendon disorders.

Surgical techniques for the reconstruction of malunited ankle fractures.

Ankle fractures are so common and most heal well so there is a certain lack of attention for the potential for adverse consequences and the potential to salvage these complications. There is a clear association between ankle fracture malunion and a poor outcome, whilst reconstruction can often be accomplished it can be very difficult. The key lies in accurate assessment, careful preoperative planning and proficiency in specialised reconstructive techniques.

Total ankle replacement: the Agility LP prosthesis.

The original design for the Agility ankle was developed and patented in the late 1970s. DePuy Orthopaedics began manufacturing the implant as the Agility Ankle System. Currently in the United States, the Agility is the most widely used ankle prosthesis.