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Fösel AC, Seidel A, Attinger MC, Zderic I, Gueorguiev B, Krause FG. Ankle Joint Pressure in Supination-External Rotation Injuries: A Biomechanical Study in an Unrestrained Cadaver Model. Foot Ankle Spec 2022; 15:330-337. [PMID: 32875824 DOI: 10.1177/1938640020950183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous biomechanical studies simulating supination-external rotation (SER) IV injuries revealed different alterations in contact area and peak pressure. We investigated joint reaction forces and radiographic parameters in an unrestrained, more physiological setup. METHODS Twelve lower leg specimens were destabilized stepwise by osteotomy of the fibula (SER II) and transection of the superficial (SER IVa) and the deep deltoid ligament (SER IVb) according to the Lauge-Hansen classification. Sensors in the ankle joint recorded tibio-talar pressure changes with axial loading at 700 N in neutral position, 10° of dorsiflexion, and 20° of plantarflexion. Radiographs were taken for each step. RESULTS Three of 12 specimen collapsed during SER IVb. In the neutral position, the peak pressure and contact area changed insignificantly from 2.6 ± 0.5 mPa (baseline) to 3.0 ± 1.4 mPa (SER IVb) (P = .35) and from 810 ± 42 mm2 to 735 ± 27 mm2 (P = .08), respectively. The corresponding medial clear space (MCS) increased significantly from 2.5 ± 0.4 mm (baseline) to 3.9 ± 1.1 mm (SER IVb) (P = .028).The position of the ankle joint had a decisive effect on contact area (P = .00), center of force (P = .00) and MCS (P = .01). CONCLUSION Simulated SER IVb injuries demonstrated radiological, but no biomechanical changes. This should be considered for surgical decision making based on MCS width on weightbearing radiographs. LEVELS OF EVIDENCE Not applicable. Biomechanical study.
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Affiliation(s)
- Andreas C Fösel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK).,AO-Research Institute Davos, Switzerland (IZ, BG).,Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland (ACF)
| | - Angela Seidel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK).,AO-Research Institute Davos, Switzerland (IZ, BG).,Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland (ACF)
| | - Marc C Attinger
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK).,AO-Research Institute Davos, Switzerland (IZ, BG).,Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland (ACF)
| | - Ivan Zderic
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK).,AO-Research Institute Davos, Switzerland (IZ, BG).,Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland (ACF)
| | - Boyko Gueorguiev
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK).,AO-Research Institute Davos, Switzerland (IZ, BG).,Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland (ACF)
| | - Fabian G Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Berne, Berne, Switzerland (AS, MCA, FGK).,AO-Research Institute Davos, Switzerland (IZ, BG).,Department of Orthopaedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn, Switzerland (ACF)
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Abstract
Since its introduction in 1966, the Bröstrom repair has been the workhorse for the treatment of chronic ankle instability. The procedure has expanded with the advent of arthroscopy, ultrasound, and other techniques. Because chronic ankle sprains/instability pose a barrier to athletes who perform high-level activities for a living, discussions concerning postoperative recovery and return to play criteria are important. Here we present an update on the Bröstrom-Gould procedure from preoperative management to return to play.Level of Evidence: Level V.
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Affiliation(s)
- Daniel Chiou
- Warren Alpert Medical School, Providence, Rhode Island
| | - Brandon Morris
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory Waryasz
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Crafton JW, Basile P, Cook J. Intraosseous Anchorage of a Collagen Matrix Graft to Enhance Repair of Peroneus Brevis Tendon Degeneration. Foot Ankle Spec 2021; 14:445-452. [PMID: 33749366 DOI: 10.1177/19386400211000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chronic degeneration of the peroneus brevis tendon (PBT) at its insertion to the base of the fifth metatarsal is uncommon; however, when present it can be a challenge to treat. Repair of the PBT often requires tubularization with or without a peroneus longus tendon transfer. These repairs, however, may not provide resultant full muscle strength, especially if ostectomy of the fifth metatarsal base is required. We report outcomes following a novel technique for anatomic repair of degenerative PBT with intraosseous fifth metatarsal base fixation of a collagen matrix graft. METHODS Thirteen consecutive patients (14 procedures) with degeneration of PBT that underwent tendon repair augmented with collagen matrix graft from 2011 to 2019 were reviewed retrospectively. We present outcome data of these 13 patients that were followed for at least 12 months. RESULTS Muscle strength, complications, and patient-reported subjective outcomes were reported. There were 10 females and 3 males. Average age was 49.1 years, and average follow-up was 34.9 months. Muscle strength was reported at 5/5 to the PBT by the final follow-up for 92% of patients. There were minimal complications, 84.6% (11/13) of patients had no limitation in activity level, and 92% (12/13) would recommend this procedure to a friend. CONCLUSION Outcomes for this novel repair technique for insertional degenerative PBT have never been reported before and show excellent results with long-term follow-up.
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Affiliation(s)
- Jordan W Crafton
- Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Philip Basile
- Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jeremy Cook
- Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, Massachusetts.,Department of Surgery, Harvard Medical School, Boston, Massachusetts
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Abstract
BACKGROUND Complications after plate and screw fixation of ankle fractures are frequently reported in the literature, with a higher rate in patients with advanced age, comorbidities, and poor skin conditions. A reduced complication rate has been reported with intramedullary nailing (IMN) of the fibula; however, the indication has been based on the surgeon's preferences. We report the results after IMN in patients with compromised soft tissue exclusively. METHODS A total of 71 patients with 72 distal fibula fractures were included in this retrospective study. Information about medical history, the ankle injury, treatment, and complications were collected from the medical records. Additionally, the preinjury and 6-week follow-up radiographs were evaluated. RESULTS Postoperative information was available for a minimum of 4.3 years postoperatively or until death. In all, 10 patients had complications related to the nail and required secondary surgery. These included 6 symptomatic hardware issues, 2 construct failures, 1 deep infection, and 1 combined deep infection and construct failure. CONCLUSIONS After IMN of the fibula, 14% of the patients required reoperation. Our results support the previous literature suggesting IMN as an acceptable surgical alternative where the risk of complications with plate and screw fixation is considered too high. Compromised soft tissue is one important indication. LEVEL OF EVIDENCE Level IV: Case series without control.
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Affiliation(s)
| | | | - Marius Molund
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, Graalum, Norway
| | - Bengt Östman
- Department of Orthopaedic Surgery, Ostfold Hospital Trust, Graalum, Norway
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Kulakli-Inceleme E, Tas DB, Smeeing DP, Houwert RM, van Veelen NM, Link BC, Iselin LD, Knobe M, Babst R, Beeres FJ. Tibiotalocalcaneal Intramedullary Nailing for Unstable Geriatric Ankle Fractures. Geriatr Orthop Surg Rehabil 2021; 12:21514593211020705. [PMID: 34211800 PMCID: PMC8216405 DOI: 10.1177/21514593211020705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tibiotalocalcaneal (TTC) intramedullary nailing has been suggested as an alternative to open reduction and internal fixation (ORIF) for the primary treatment of unstable fragility ankle fractures with a poor soft tissue envelope. This study aims to investigate the clinical efficacy of TTC intramedullary nail fixation for the primary treatment of unstable ankle fractures in frail elderly patients with poor soft tissue condition, by assessing the number of postoperative complications and the patient-reported functional outcomes. METHODS A retrospective cohort study was performed including patients with an unstable ankle fracture treated between 2015 and 2019 with TTC stabilization using a retrograde intramedullary hindfoot nail that was inserted without joint preparation and allowing immediate weight-bearing postoperatively. The primary outcome was the total number of postoperative complications. RESULTS A total of 10 patients were included out of 365 operatively treated ankle fractures. The mean age was 85.2 years (range 66-92) with a mean follow-up of 11.2 months (range 6-16). Fracture types included AO/OTA 44-B2 (n = 1), 44-B3 (n = 6), 44-C1 (n = 2) and 44-C3 (n = 1). Postoperative complications were observed in 4 patients (40%), including 3 nonunions, 2 implant related complications and 1 wound infection. No wound healing disorder or below-the-knee amputation was observed. Four patients (40%) deceased between post-operative 6 to 16 months due to medical conditions unrelated to surgery. The mean Foot and Ankle Outcome Score was 52.6 (range 44.2-73.8). CONCLUSION Hindfoot nailingis a viable treatment option in selected high-risk patients with an advanced age, unstable ankle fractures with significant bone loss, poor soft tissue condition and/or severely impaired pre-injury mobility. In a frail geriatric population, hindfoot nailing may be a safe alternative fixation method with a low risk of wound complication or major amputation. However, unprepared joint may lead to symptomatic nonunion after TTC intramedullary nailing.
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Affiliation(s)
- Elif Kulakli-Inceleme
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- These two co-authors contributed equally
| | - David B. Tas
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- These two co-authors contributed equally
| | | | - Roderick M. Houwert
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht Traumacenter, Utrecht, The Netherlands
| | - Nicole M. van Veelen
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Bjoern-Christian Link
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lukas D. Iselin
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Reto Babst
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Frank J.P. Beeres
- Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Abstract
Peroneal tendon disorders remain an often overlooked source of lateral hindfoot pain and tenderness. Medical professionals who specialize in foot and ankle care are still far more likely to diagnose a peroneal tendon disorder as an ankle injury. In fact, acute peroneal dislocations are misdiagnosed in up to 40% of cases. The major subsets of peroneal disorders include peroneal tendonitis and tenosynovitis, painful os peroneum syndrome, subluxation, and tearing of the peroneal tendons. Proper history and physical exam maneuvers must be performed to help identify the source of the injury and differentiate these categories. Detailed imaging through X-ray and magnetic resonance imaging must also be used to diagnose the etiology of the patient's condition in order to direct management. Currently, there is very limited knowledge on peroneal pathologies, and treatment protocol is highly variable and limited to expert opinion. Despite the individual preferences and nuances held by each surgeon when it comes to operating, the overarching principles that guide appropriate management of tendonitis, subluxation, and tendon tear should maintain a higher level of consistency. Therefore, the authors of this review aim to elucidate the most current methods to diagnose these disorders as well as evidence-based practices for optimal management.Levels of Evidence: Level V.
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Affiliation(s)
- Akhil Sharma
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (AS, SGP).,Duke Fuqua School of Business, Durham, North Carolina (SGP)
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Husebye EE, Molund M, Hvaal KH, Stødle AH. Endoscopic Transfer of Flexor Hallucis Longus Tendon for Chronic Achilles Tendon Rupture: Technical Aspects and Short-Time Experiences. Foot Ankle Spec 2018; 11:461-466. [PMID: 29338333 DOI: 10.1177/1938640017754234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic Achilles tendon ruptures can lead to reduced power of plantar flexion in the ankle with impaired gait ability. The open 1- or 2-incision technique for flexor hallucis longus transfer has proven good functional outcome but has the disadvantage of relatively extensive surgery performed at a vulnerable location. To reduce the risk of soft tissue problems, the flexor hallucis longus transfer can be performed endoscopically. MATERIAL AND METHOD An endoscopic technique for flexor hallucis longus transfer is presented together with the experiences from the first six patients operated with this method. RESULTS No wound healing problems or infections. Five of 6 patients managed single leg heel raise on the affected side 12 months after surgery. CONCLUSION The functional results are promising. The soft tissue dissection is minor, and no patients had postoperative wound healing problems or infection. Endoscopic flexor hallucis longus transfer may be an operative procedure that can be considered also in patients with potential wound healing problems. LEVELS OF EVIDENCE Level IV: Technical note/case series without controls.
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Affiliation(s)
- Elisabeth Ellingsen Husebye
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway (EEH, KHH, AHS).,Department of Orthopaedic Surgery, Ostfold Hospital, Grålum, Norway (MM)
| | - Marius Molund
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway (EEH, KHH, AHS).,Department of Orthopaedic Surgery, Ostfold Hospital, Grålum, Norway (MM)
| | - Kjetil Harald Hvaal
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway (EEH, KHH, AHS).,Department of Orthopaedic Surgery, Ostfold Hospital, Grålum, Norway (MM)
| | - Are Haukåen Stødle
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway (EEH, KHH, AHS).,Department of Orthopaedic Surgery, Ostfold Hospital, Grålum, Norway (MM)
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8
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Abstract
UNLABELLED Ankle fractures are among the most common traumatic injuries encountered by orthopaedic surgeons, but obtaining anatomic syndesmosis fixation can be difficult. Previous authors have described the centroidal axis of the syndesmosis. Our group has developed a novel technique of aligning the tibia and fibula along their anatomic centroidal axis using a targeting guide, which has showed good results in 1 patient at 1-year follow-up. LEVELS OF EVIDENCE Level V: Expert opinion.
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Affiliation(s)
- Daniel Scott
- Department of Orthopaedic Surgery, Durham, North Carolina
| | | | - Samuel Adams
- Department of Orthopaedic Surgery, Durham, North Carolina
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9
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Abstract
UNLABELLED Entrapment of soft tissues in the anterolateral gutter of the ankle can cause impingement. When symptomatic, patients complain of chronic ankle pain exacerbated with dorsiflexion. Symptoms of instability and a history of recurring ankle sprains are common findings. Plain radiographs and magnetic resonance imaging may assist clinicians in identifying associated pathology. We present 2 cases of ankle impingement occurring in the setting of equivocal examination and imaging findings. In both cases, arthroscopy revealed a likely congenital, intra-articular plica. LEVELS OF EVIDENCE Therapeutic, Level IV: Case Study.
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Affiliation(s)
- Andrew J Rosenbaum
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
| | - Rock G Positano
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
| | - Rock C J Positano
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
| | - Joshua S Dines
- Albany Medical College, Division of Orthopaedic Surgery, Albany, New York (AJR)Joe DiMaggio Sports Medicine Foot and Ankle Center, Hospital for Special Surgery, New York (RGP)NY College of Podiatric Medicine, New York (RCJP)Hospital for Special Surgery, New York (JSD)
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