Extra-articular Lateral Talar Dome Osteochondral Fracture: A Case Report and a Review of Literature

The lateral talar dome osteochondral fracture has been described as shallow or wafer-shaped and is more likely to have an associated flake fracture than medial injuries. Displacement into the extracurricular space, however, is a rare occurrence. We present a case of ankle trauma with persistent pain and edema. A CT scan revealed a displaced osteochondral fracture of the lateral dome of the talus and an avulsion fracture of the tip of the medial malleolus. After appropriate dissection and exposure, the fragment was found below the skin, outside the ankle joint capsule. The fragment was fixed to the neck of the talus, and the deltoid ligament and anterior inferior tibiofibular ligament were repaired. After a one-year follow-up, full recovery was achieved without pain, stiffness, or osteonecrosis of the displaced fragment. Although the extra-articular displacement of lateral talar dome osteochondral fractures is rare, it should be considered when assessing ankle trauma.

Patient reported outcomes following revision neurectomy through a dorsal approach for recurrent interdigital neuroma

Interdigital neuroma is one of the commonest causes of metatarsalgia. The reported success rate after excision of a primary neuroma is 74%. Recurrent symptoms after neurectomy can be due to a recurrent interdigital neuroma. Recurrent interdigital neuromas can be diagnosed using sound clinical examination and ultrasonography. Surgical excision is the best treatment modality with varying success reported in the literature. We report on the clinical outcome following surgical excision of recurrent interdigital neuromas through a dorsal approach. All patients who had undergone excision of a recurrent interdigital neuroma by a single surgeon between 01/2010 and 12/2019 were identified. Inclusion criteria included patients having a preoperative ultrasound and postoperative histology report. The exclusion criteria were preexisting neuropathy or tarsal tunnel syndrome. Demographic data was collected, and a self-reported foot and ankle score questionnaire (SEFAS) was completed by the patient at their most recent follow-up. Twenty-three patients (25 feet) were included in the study. Mean time of follow-up was 75 (range 14-189) months. The mean age was 49 (range 15-71) years. Eleven (44%) recurrent neuromas were excised from the second webspace and 14 (56%) were excised from the third webspace. All excised masses were confirmed as recurrent neuromas histologically. Regarding the SEFAS score, 17 (73.93%) patients scored as excellent, one (4.34%) as good, three (13.04%) as fair, and two (8.69%) as poor. This long term follow-up study on outcomes after surgery for recurrent interdigital neuroma suggests that excision through a dorsal approach is an effective treatment option with a high patient satisfaction.

Knee scooter related injuries and satisfaction in patients following foot and ankle surgery

BACKGROUND

Knee scooters have become popular amongst foot and ankle surgeons for patients who are required to be non-weight bearing. Information is limited regarding falls and injuries sustained while using a knee scooter and potential contraindications to their use are ill-defined. No study has assessed patient reported injuries and satisfaction. This study aims to evaluates the patient's perspective with regards to the use of a knee scooter. As a secondary aim we assessed for risk factors associated with knee scooter related injuries to try make recommendations for the safe use of a knee scooter.

METHODS

Patients who used a knee scooter during 2018-2020 were emailed a questionnaire assessing (1) demographic data, (2) medical history, (3) falls and injuries sustained, including the management of these injuries, and (4) patient satisfaction. This study is a descriptive, cross-sectional survey analysis.

RESULTS

101/196 (51,5%) responses were received, which included 32 males and 69 females. The cohort had a mean age of 56.4 years, and BMI of 28.5. Mean time spent using the scooter was 6.7 weeks. Twenty-five respondents had fallen off the scooter, with 5 reporting injuries. One patient required medical attention for a shoulder injury. Cause of falls included hitting an obstacle, making a sharp turn, moving too fast, and moving downhill. There was no correlation between falls and patient comorbidities. Ninety-six percent of respondents reported a high satisfaction and preferred the scooter to crutches.

CONCLUSION

The knee scooter is a safe, and well-tolerated, mobility aid for patients requiring non-weight bearing during their recovery, with a high satisfaction rate. Educating patients on correct use and common causes for falling is important as a preventative measure.

LEVEL OF EVIDENCE

IV, retrospective case series.

A Rare Case of Flexor Digitorum Accessorius Longus Muscle Presenting as Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is a relatively uncommon nerve entrapment neuropathy. Many pathologies are reported as possible causes for TTS. The diagnosis of TTS can be difficult and often missed. We present a rare case of TTS due to an accessory flexor digitorum longus muscle. Together with a high index of suspicion, MRI is the investigation of choice in making the diagnosis. These patients are best managed with excision or transposition of the flexor digitorum accessorius longus (FDAL) and neurolysis of the posterior tibial nerve and its branches.

Outcome of arthroscopic single-bundle anterior cruciate ligament reconstruction: anteromedial portal technique versus transtibial drilling technique

PURPOSE

Controversies exist about the femoral tunnel preparation technique in anterior cruciate ligament (ACL) reconstruction surgeries. The aim of this study was to evaluate mid-term outcomes of transtibial (TT) technique in comparison with anteromedial portal (AMP) one.

METHODS

Demographic data, height, weight, period of time from injury to surgery, and follow-up duration of patients underwent ACL reconstruction using single-bundle hamstring graft by the senior author between 2007 and 2011 were evaluated, retrospectively. Mid-quadriceps circumference difference, passive range of motion of the joint, anterior drawer test, Lachman test, and pivot shift test were assessed for each case. Function of the knee joint was calculated using International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores.

RESULTS

Of 50 cases in the AMP group (age 30.6 ± 6.5), 45 were male and of the 44 patients in the TT group (age 30.0 ± 6.5), forty were male. Mean follow-up times in the AMP and TT group were 18.2 months (range 12-84 months) and 25.7 months (range 16-48 months), respectively. No statistically significant difference was found in mid-quadriceps circumference difference (P = 0.861). Also, functional knee scores (P values of IKDC = 0.329, Lysholm score = 0.08, Tegner = 0.504) and stability tests (P values of anterior drawer test = 0.07, Lachman test = 0.486, pivot shift test = 0.348) did not differ statistically between groups.

CONCLUSION

There is no superiority of AMP technique on TT technique in ACL reconstructive surgeries. It could be suggested that performing a well-done technique, either TT or AMP, may be more important than only choosing a technique.