Foot & Ankle Orthopaedics最新文献

{"title":"Asymmetric Cavovarus Deformity Presentation in Charcot-Marie-Tooth Disease.","authors":"Melissa R Requist, Andrew C Peterson, Bopha Chrea, Amy L Lenz","doi":"10.1177/24730114261454986","DOIUrl":"10.1177/24730114261454986","url":null,"abstract":"<p><strong>Background: </strong>The characteristic cavovarus foot deformity associated with Charcot-Marie-Tooth disease (CMT) is highly variable between individuals. Although substantial progress has been made in characterizing foot morphology in CMT, previous investigations have not addressed limb symmetry within individuals. This is relevant to functional assessment scales, which typically measure only the dominant limb, and has implications for surgical treatment planning. This study aimed to use weight-bearing computed tomography (WBCT) to examine similarity in deformity between limbs in individuals with CMT.</p><p><strong>Methods: </strong>Bilateral WBCT images of 31 individuals with CMT were analyzed through automatic calculation of 9 radiographic measurements and generation of a statistical shape model (SSM). Morphologic variation in the SSM was described with principal components analysis (PCA). Absolute differences in radiographic measures and PCA scores between paired limbs were analyzed with appropriate statistical tests with Bonferroni correction.</p><p><strong>Results: </strong>Significant absolute differences between paired limbs were identified in all radiographic measures, ranging from a median difference of 1.2° in calcaneal inclination angle to 5.8° in the axial plane Meary angle. Similarly, significant absolute differences between limbs were identified on all 3 analyzed modes of variation in the SSM, with the greatest difference seen in in hindfoot varus rotation. Significant laterality-dependent morphologic differences could not be identified.</p><p><strong>Conclusion: </strong>Both radiographic measures and SSM demonstrated statistically significant absolute differences between limbs. In both methods, greater magnitude of difference was seen between limbs in hindfoot varus rotation than arch height.</p><p><strong>Clinical relevance: </strong>These data provide quantitative characterization of the clinically suspected limb-to-limb asymmetry in CMT-related cavovarus deformity. Alignment differences between limbs support the use of limb-specific assessment in functional outcome measures and surgical algorithms. This supports the need for further research quantifying clinically significant differences in foot morphology and consideration of limb asymmetry in research and patient education for CMT.</p><p><strong>Level of evidence: </strong>Level III, retrospective cross-sectional study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261454986"},"PeriodicalIF":0.0,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13287404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148316653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Management of Weber B/SER Lateral Malleolus Fractures With Immediate Weightbearing: Outcomes in Stable and Potentially Unstable Patterns.","authors":"Raquel Lima Cunha, António Madureira, Pedro Atilano Carvalho, António Miranda, Filipa Oliveira, João Teixeira","doi":"10.1177/24730114261450952","DOIUrl":"10.1177/24730114261450952","url":null,"abstract":"<p><strong>Background: </strong>Isolated lateral malleolus fractures account for a significant proportion of ankle fractures, and complications related to surgical treatment are common. This study aimed to assess the feasibility of conservative treatment with walker boot and immediate weightbearing as tolerated for Weber B / supination-external rotation (SER) lateral malleolus fracture, by comparing stable (SER2) and potentially unstable (SER4a) fractures. The distinction between stable and unstable fractures is crucial to guide treatment decisions.</p><p><strong>Methods: </strong>This prospective study included patients with Weber B/SER lateral malleolus fractures who met specific criteria. Fracture stability was assessed via medial clear space (MCS) measurement on weightbearing radiographs and conservative (walker boot and immediate weightbearing as tolerated) or surgical treatment was determined accordingly. Clinical and functional outcomes-including visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Ability Measure (FAAM) scores, and 36-Item Short Form Health Survey (SF-36) scores-were evaluated in outpatient clinic follow-up, with a minimum duration of 12 months.</p><p><strong>Results: </strong>Out of 155 identified Weber B fractures with MCS <7 mm, 141 patients completed follow-up: 114 with SER2 and 27 with SER4a fractures. The SER2 group demonstrated excellent outcomes at 12 months (VAS 0.1, AOFAS 98.9, FAAM activities of daily living (ADL)/Sport 99.4/99.6), with 98.2% return to sport, 100% return to work, and 100% return to ADL. The SER4a group demonstrated comparable outcomes at 12 months (VAS 0.0, AOFAS 100, FAAM ADL/Sport 100/100), with full return to sport, work, and ADL. One patient in the SER4a group evolved to nonunion and required surgery during follow-up. With the numbers available, no significant intergroup differences in outcome scores or return to function could be detected.</p><p><strong>Conclusion: </strong>This study supports conservative treatment-with walker boot and immediate weightbearing as tolerated-for stable SER2 lateral malleolus fractures, and was associated with reduced need for surgery and lower exposure to surgical complications. It also suggests that potentially unstable SER4a fractures may achieve comparable outcomes under the same conservative protocol. Weightbearing radiographs assessment with MCS measurement appears to be an effective method for guiding treatment decisions in Weber B/SER lateral malleolus fractures.</p><p><strong>Level of evidence: </strong>Level II, therapeutic, prospective cohort study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261450952"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13269955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes Following Lisfranc Fixation via Articular Bridge Plating Combined With the Suture Tape Ligament Reconstruction Technique.","authors":"Matthew Sun, Sophia Padovano, Tanita Botha, Sasha Roshan-Zamir","doi":"10.1177/24730114261449243","DOIUrl":"10.1177/24730114261449243","url":null,"abstract":"<p><strong>Background: </strong>Lisfranc injuries are challenging presentations frequently encountered by foot and ankle and trauma surgeons, with no definitive consensus regarding the optimal fixation technique. This study aimed to evaluate the safety and efficacy of a modified stabilisation technique combining tarsometatarsal joint (TMTJ) bridge plating with a suture tape-endobutton construct for Lisfranc joint stabilisation, using patient-reported outcomes in a cohort of patients with acute injuries.</p><p><strong>Methods: </strong>A retrospective review was performed on 20 consecutive patients with acute Lisfranc injuries treated with open reduction and internal fixation (ORIF). Fixation involved TMTJ bridge plating and stabilisation of the Lisfranc interval using a suture tape-endobutton construct spanning the medial cuneiform (C1) and the base of the second metatarsal (M2). All patients underwent planned removal of bridge plates with retainment of the suture tape construct. Pre- and postoperative visual analogue scale (VAS) scores and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were collected, along with postoperative complication and reoperation rates.</p><p><strong>Results: </strong>The cohort comprised 9 males (45%) and 11 females (55%). Time to surgery ranged from 1.5 to 12 weeks. Mean follow-up was 31.8 months (range 12-61 months). At final follow-up, 18 of 19 patients (95%) who exercised preoperatively reported return to regular exercise or sporting activity. Mean AOFAS scores improved from 32.1 ± 19.9 preoperatively to 90.6 ± 9.4 postoperatively, and VAS scores improved from 6.2 ± 2.2 to 1.6 ± 0.8. There were no cases of unplanned reoperation, recurrent radiographic diastasis, or conversion to arthrodesis.</p><p><strong>Conclusion: </strong>Our study of combined TMTJ bridge plating and suture tape ligament augmentation provides preliminary evidence of safety and efficacy for acute Lisfranc injuries in a small retrospective series. It appears to be a safe and effective technique for acute Lisfranc injuries, demonstrating favorable patient-reported outcomes and maintenance of reduction at intermediate follow-up. The suture tape construct minimises transarticular instrumentation and may reduce iatrogenic articular injury, potentially lowering the risk of midfoot stiffness, pain, and posttraumatic arthrosis.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261449243"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locking Stitch Techniques Demonstrate Improved Biomechanical Performance in Cadaveric Midsubstance Achilles Tendon Repair.","authors":"D Trey Remaley, Eric M Cohen, Conrad Stoy, Jon Raso, Stephen Fernicola, Miguel A Diaz","doi":"10.1177/24730114261450946","DOIUrl":"10.1177/24730114261450946","url":null,"abstract":"<p><strong>Background: </strong>Surgical repair of the Achilles tendon (AT) requires high failure load while limiting elongation. Midsubstance repairs are particularly reliant on suture techniques and typically use either a whip stitch or a locking stitch, such as the Krackow. Enhancements to the Krackow, such as the gift box, epitendinous, or alternative locking stitch techniques, aim to simplify surgical processes and improve biomechanics. The purpose of this study was to evaluate biomechanical properties of 3 enhanced techniques for midsubstance AT repair. We hypothesized that locking stitch constructs would demonstrate improved biomechanical performance compared with nonlocking constructs by minimizing elongation and increasing failure load.</p><p><strong>Methods: </strong>A total of 30 cadaveric lower leg specimens with simulated midsubstance AT ruptures were divided into 3 repair groups: whip stitch with gift box (WG), locking whip stitch with gift box (LG), Krackow stitch with epitendinous baseball (KB) stitch. Samples were preconditioned and then loaded from 20 to 100 N for 1000 cycles, followed by load to failure. Elongation, stiffness, failure load, survival, failure mode, and suture weight (burden) were compared.</p><p><strong>Results: </strong>KB had the significantly lowest cyclic elongation, whereas LG had the significantly highest failure load. LG failure load increase was achieved while using less suture material than KB. All samples survived the cyclic loading protocol, and all whip stitch groups failed from tissue pull-through, whereas LG and KB failed only 40% from pull-through.</p><p><strong>Conclusion: </strong>This study presents 2 stitch techniques that can improve AT repair failure load (LG) and limit elongation (KB). Locking stitch techniques LG and KB demonstrated a significant improvement in biomechanical performance compared with nonlocking WG. Inferences should be limited to the 3 tested constructs rather than individual technical variables in isolation.</p><p><strong>Clinical relevance: </strong>The locking whip stitch gift box and Krackow epitendinous baseball stitch techniques are both viable methods for Achilles tendon repair. Nonlocking whip stitch gift box does not provide sufficient fixation.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261450946"},"PeriodicalIF":0.0,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13250428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensory Nerves at Risk During Hallux Valgus Surgery: Anatomical Insights and Preventive Strategies-A Systematic Review.","authors":"Paul Chanzy, Agathe Yvinou, Hugues Pascal-Moussellard, Laura Marie-Hardy, Grégoire Rougereau","doi":"10.1177/24730114261451225","DOIUrl":"10.1177/24730114261451225","url":null,"abstract":"<p><strong>Background: </strong>Hallux valgus is a common forefoot deformity. Sensory complications after correction can result from iatrogenic injury to the medial branch of the medial dorsal cutaneous nerve (MDCNm), lateral dorsal cutaneous nerve (LDCN), medial plantar cutaneous nerve (MPCN), and lateral plantar cutaneous nerve (LPCN). We synthesized evidence and landmarks to aid nerve identification and reduce injury.</p><p><strong>Methods: </strong>Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, and Cochrane were searched to February 2025 using 'nerve anatomy', 'hallux valgus' and 'bunion'. English/French studies describing course, measurements or localization of hallux sensory nerves from the first tarsometatarsal to interphalangeal joints were included.</p><p><strong>Results: </strong>From 863 records, 13 studies were included comprising cadaveric, imaging, and clinical series with both normal and hallux valgus feet. Evidence was most robust for MDCNm localization. Palpation during resisted hallux extension and targeted ultrasonography were reported as low-cost methods to define the MDCNm in relation to the extensor hallucis longus (EHL). Palpation showed 100% sensitivity (positive predictive value [PPV] 99%), whereas novice ultrasonography achieved 75% sensitivity (PPV 100%) in cadaveric feet before dissection. At the metatarsophalangeal (MTP) level, a transverse 'clock-face' reference (EHL at 12 o'clock) typically locates the MDCNm between 10 and 12 o'clock for a right foot. A communicating dorsoplantar 'sentinel' vein crosses the MDCNm about 2 cm proximal to MTP, with the nerve running deep to the vein. Limited data place the LDCN at 11-12, LPCN at 5-6 and MPCN at 7-8 o'clock. Most maps were derived from non-deformed feet. Hallux valgus severity shifts the MDCNm-EHL intersection proximally and may widen the medial danger zone to ~19 mm. Ultrasonography suggests MPCN lies within 3 to 4 mm of the metatarsal head and medial sesamoid, helping define capsulotomy limits; data for LPCN remain still limited.</p><p><strong>Conclusion: </strong>Combining palpation, ultrasonography and vein-based landmarks with awareness of axial danger zones may reduce sensory nerve injury during hallux valgus surgery; clinical validation in deformed feet remains necessary.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261451225"},"PeriodicalIF":0.0,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148203700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Flexible Flatfoot: A Cross-Sectional Analysis of Radiographs, Arch Index, and Plantar Pressure.","authors":"Ngoc Minh Ho, Duc Huy Le, Van Thanh Nam Ta, Huu Phuc Luu, Nhat Anh Luong, Duc Trung Nguyen, Ba Quynh Phan, Duc Thang Vu, Tu Nam Vu, Trung Dung Tran","doi":"10.1177/24730114261450616","DOIUrl":"10.1177/24730114261450616","url":null,"abstract":"<p><strong>Background: </strong>Pediatric flatfoot is a prevalent condition, and its assessment often involves clinical, radiographic, and functional measures. Although symptoms remain central to treatment decisions, radiographic angles, plantar-pressure metrics, and the Arch Index offer quantitative descriptors. Studying their interrelationships is useful to understand how structure and function are linked. This study examined plantar pressure distribution and the relationships among radiographic parameters, Arch Index, and dynamic loading.</p><p><strong>Methods: </strong>This retrospective single-center study included 27 children (51 feet) aged 10-18 years who were diagnosed with flexible flatfoot. Dynamic plantar pressure and contact area were measured, with foot segmentation guided by a foot axis defined as a straight line drawn from the midpoint between the second and third toes to the point of highest pressure in the heel region. Weight-bearing radiographs were used to assess the Meary angle and calcaneal pitch. The Arch Index was derived from dynamic footprints. Correlations among plantar pressure ratios, Arch Index, and radiographic angles were analyzed.</p><p><strong>Results: </strong>Radiographic assessment confirmed flatfoot deformity (mean Meary angle, 20.07°; calcaneal pitch, 11.75°) and an elevated Arch Index. Forefoot loading showed significant anteromedial predominance (medial pressure ≈1.5 × lateral, <i>P</i> < .01), whereas no mediolateral differences were observed in the midfoot or hindfoot. Correlation analysis revealed no significant relationships among the plantar pressure ratio, Arch Index, and radiographic measurements.</p><p><strong>Conclusion: </strong>In adolescent flexible flatfoot, dynamic loading demonstrates anteromedial forefoot predominance. Radiographic angles and dynamic (pedobarography) assessments capture complementary, non-interchangeable aspects of flatfoot. Dynamic analysis may provide additional insight into region-specific loading patterns. Further studies are needed to define its role in clinical decision making.</p><p><strong>Level of evidence: </strong>Level III, diagnostic, retrospective.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261450616"},"PeriodicalIF":0.0,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linking FAAM and PROMIS Physical Function Scores: A Crosswalk Study.","authors":"Devon Nixon, Taylor Mendenhall, Kade Wagers, Nikolas Kazmers, Gretchen Maughan-Egbert","doi":"10.1177/24730114261451248","DOIUrl":"10.1177/24730114261451248","url":null,"abstract":"<p><strong>Background: </strong>Within orthopaedic surgery, Patient-Reported Outcomes Measurement Information System (PROMIS) and legacy patient-reported outcomes (PRO) scores are both commonly reported. Although PROMIS and PROs often correlate, mathematical modeling is needed to create linkage tables that can be used for further research and possible clinical applicability. Such studies have been performed in varying orthopaedics subspecialities. However, no linkage study has been performed in foot and ankle research for any PRO metrics.</p><p><strong>Methods: </strong>In this study, we aimed to create linkage tables for PROMIS physical function and Foot and Ankle Ability Measure (FAAM) scores. The FAAM is a valid, legacy PRO used in foot and ankle research. We retrospectively collected FAAM and PROMIS PF scores on 745 patients undergoing surgery. Correlations were performed between FAAM and PROMIS PF scores. Statistical models were then used to link the metrics including linear regression, identity, mean, linear, circle-arc, and equipercentile techniques.</p><p><strong>Results: </strong>FAAM and PROMIS PF scores were correlated. All linking methods resulted in an ICC of at least 0.57 and an <i>R</i> ² of at least 0.49. Both the linear and equipercentile methods demonstrated an <i>R</i> ² value of 0.93, though the ICC for the equipercentile model was slightly higher than the linear model. The linear model resulted in a lower SE and was therefore used to evaluate population invariance.</p><p><strong>Conclusion: </strong>No prior studies have linked patient-reported outcomes tools in foot and ankle research. Here, we successfully linked two commonly used metrics (PROMIS PF and FAAM scores). Creating crosswalk tables, we hope, can enhance data comparison in larger-scale orthopaedic foot and ankle research.</p><p><strong>Level of evidence: </strong>Level III, retrospective study.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261451248"},"PeriodicalIF":0.0,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midfoot Skeletal Tuberculosis Managed With Single-Stage Tarsometatarsal and Naviculocuneiform Arthrodesis and Antitubercular Therapy.","authors":"Julia C Tolin, Christine Jones, Akshay Jain, Jeffrey Manway, Ricardo Arbulu","doi":"10.1177/24730114261445963","DOIUrl":"10.1177/24730114261445963","url":null,"abstract":"<p><p>Graphical Abstract.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261445963"},"PeriodicalIF":0.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148198013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to \"Long-term Impact of Axial Alignment, Sesamoid Position, and Joint Degeneration on Recurrence and Clinical Outcomes After Hallux Valgus Correction\".","authors":"","doi":"10.1177/24730114261459451","DOIUrl":"https://doi.org/10.1177/24730114261459451","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1177/24730114261427473.].</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261459451"},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13230645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148162486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Fibular Nail for Ankle Fractures: An Anatomic Mapping Study.","authors":"Matheus Levy A T de Souza, Frederick Michels, Hugo Bertani Dressler, Roberto Zambelli, Gustavo Araujo Nunes, Miki Dalmau-Pastor","doi":"10.1177/24730114261444261","DOIUrl":"10.1177/24730114261444261","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary fibular nailing for ankle fracture fixation has gained popularity, particularly in patients at elevated risk of wound complications. Despite its benefits, concerns remain regarding its safety and the quality of fracture reduction achieved through the minimally invasive approach. This anatomical study evaluated the potential risks to adjacent structures during percutaneous retrograde locked intramedullary fibular nail implantation and assessed fracture reduction via radiographic analysis.</p><p><strong>Methods: </strong>Ten cadaveric lower extremities underwent simulated Weber B or C fractures and fixation with a nail. Reduction quality was evaluated fluoroscopically and graded accordingly. Specimens were dissected to assess damage to nearby anatomical structures, and the shortest distances between surgical sites and adjacent structures were measured.</p><p><strong>Results: </strong>Reduction quality was deemed adequate in all specimens. No peroneal tendon injuries were observed. The mean distance between the sural nerve and the distal portal was 14.95 mm (SD 3.99); therefore, this was considered a safe zone. The superficial peroneal nerve (SPN) was identified as the structure at the highest risk of injury, with a mean distance of 4.52 mm (SD 3.27) from the anterior portal and 14.17 mm (SD 5.25) from the lateral portal. The SPN was found in contact with the anterior portal in 3 specimens; however, no structures were injured during instrumentation.</p><p><strong>Conclusion: </strong>In this cadaveric model, the superficial peroneal nerve was the structure at greatest anatomic risk, particularly at the anterior portal, where direct contact was observed in 3 of 10 specimens. All specimens achieved the study-specific reduction threshold. No macroscopic nerve or tendon injury was observed during instrumentation; however, microscopic or functional injury cannot be excluded given the limitations of cadaveric dissection.</p><p><strong>Clinical relevance: </strong>The current findings support intramedullary nailing as an effective method for achieving adequate fracture reduction while minimizing soft-tissue complications. Nevertheless, strict adherence to the percutaneous technique is essential to minimize iatrogenic injury to neighboring structures. This includes using skin-only incisions, performing blunt dissection down to the bone, and maintaining close approximation of protection sleeves and bone at all times.</p>","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"11 2","pages":"24730114261444261"},"PeriodicalIF":0.0,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13226963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148155918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}