Foot & Ankle International最新文献

{"title":"Outcomes of Tenosynovial Giant Cell Tumor of the Foot and Ankle.","authors":"James Robert Barnett,&nbsp;Branavan Rudran,&nbsp;Amir Khan,&nbsp;Sarah O'Reilly-Harbidge,&nbsp;Shelain Patel,&nbsp;Karan Malhotra,&nbsp;Nicholas Cullen,&nbsp;Matthew Welck,&nbsp;William Aston","doi":"10.1177/10711007231189491","DOIUrl":"10.1177/10711007231189491","url":null,"abstract":"<p><strong>Background: </strong>Tenosynovial giant cell tumor (TGCT) is a benign proliferative disease affecting synovial membranes. There are 2 forms, localized (L-TGCT) and diffuse (D-TGCT), which although histologically similar behave differently. It is locally invasive and is treated in most cases by operative excision. The aim of this study was to assess current practice, how the patients' presentation affected their outcome, as well as review the recurrence rates and complications.</p><p><strong>Methods: </strong>A retrospective analysis of 123 cases was performed in patients treated between 2003 and 2019 with TGCT of the foot and/or ankle. Data were collected on age at presentation, radiologic pattern of disease, location of disease, treatment provided, and recurrence rates. The minimum follow-up was 2 years with a mean of 7.7 years.</p><p><strong>Results: </strong>There were 61.7% female patients with a mean age of 39 (range, 11-76) years. L-TGCT accounted for 85 (69.1%) cases and D-TGCT for 38 (30.9%). The most prevalent preoperative symptoms were a palpable mass (78/123) and pain (65/123). Radiologically confirmed recurrence in the operative group was noted in 14.5% (16/110) cases. This comprised 4% (3/75) of operatively treated L-TGCT and 37% (13/35) of operatively treated D-TGCT. Patients with pain on presentation and those with erosive changes on presenting magnetic resonance imaging (MRI) were more likely to have persistent postoperative pain (<i>P</i> < .001 for both). Where patients had both preoperative pain and erosive changes, 57.1% had postoperative pain. Thirteen cases were managed nonoperatively where symptoms were minimal, with 1 case requiring surgery at a later date.</p><p><strong>Conclusion: </strong>Outcomes of TGCT management are dependent on the disease type, extent of preoperative erosive changes, and presence of preoperative pain. These data are useful for counseling patients regarding the outcomes of surgical intervention and help guide the timing of intervention.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":" ","pages":"1013-1020"},"PeriodicalIF":2.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10115279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrograde Drilling and Bone Graft for Hepple Stage V Subchondral Bone Lesion of Talus Using 3D Image-Based Navigation-Assisted Endoscopic Technique.","authors":"Xinchen Wu,&nbsp;Yanjun Zhong,&nbsp;Shijun Wei,&nbsp;Helin Wu,&nbsp;Boyu Zheng,&nbsp;Feng Xu","doi":"10.1177/10711007231185084","DOIUrl":"10.1177/10711007231185084","url":null,"abstract":"<p><strong>Background: </strong>Retrograde drilling remains technically challenging, because of the difficulty of identifying the accurate location of cysts during surgery. This study's aim was to evaluate the 3-dimensional (3D) image-based surgical navigation-assisted endoscopic retrograde drilling technique for subchondral bone lesions of the talus.</p><p><strong>Methods: </strong>From March 2017 to June 2020, a total of 21 cases with Hepple stage V subchondral bone lesions of the talus were treated with 3D image-based surgical navigation-assisted endoscopic retrograde drilling and bone graft technique. Arthroscopic views were categorized per Pritsch classifications. The correlation between the drilled tunnel with preoperative cystic lesions were assessed under postoperative computer tomographic (CT) scans. The American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS) scores, and Foot and Ankle Ability Measure (FAAM) sports scales were evaluated at the preoperative and final consultation. All complications were recorded.</p><p><strong>Results: </strong>On postoperative CT scans, in 20 cases (95.2%), the drilled tunnel was judged to have been in the center of previous cysts. Only 9 cases (42.9%) showed intact normal cartilage (grade 0, group A); 12 cases (57.1%) had intact, but soft, cartilage (grade I, group B). The median follow-up time was 24 (24, 30) months, and at final follow-up, there were no significant differences between the mean AOFAS and VAS scores in both groups (89.0 ± 6.4 vs 88.3 ± 7.0 and 1 vs 0.5) or postoperative FAAM sports scales (28.2 ± 2.2 vs 26.6 ± 4.9, <i>P</i> = .363). Two patients had revision surgery in group B.</p><p><strong>Conclusion: </strong>The 3D image-based surgical navigation-assisted endoscopic retrograde drilling and bone graft technique for the subchondral bone lesions of the talus in this small case series showed encouraging results.</p><p><strong>Level of evidence: </strong>Level IV, retrospective case series.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":" ","pages":"1003-1012"},"PeriodicalIF":2.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9975240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-Dimensional Distance Mapping to Identify Safe Zones for Lateral Column Lengthening.","authors":"Ben Efrima,&nbsp;Agustin Barbero,&nbsp;Kuharajan Ramalingam,&nbsp;Cristian Indino,&nbsp;Camilla Maccario,&nbsp;Federico Giuseppe Usuelli","doi":"10.1177/10711007231185328","DOIUrl":"10.1177/10711007231185328","url":null,"abstract":"<p><strong>Background: </strong>Evans (E-LCL) and Hintermann LCL (H-LCL) lateral column lengthening osteotomies are standard surgical solutions for flexible, progressive collapsing feet. E-LCL is performed between the anterior and middle facets and endangers specific os calcis subtalar joint (OCST) subtypes without distinct facets. H-LCL is oriented between the posterior and middle facets and should be suitable for all OCSTs. Both osteotomies are associated with increased subtalar osteoarthritis, indicating iatrogenic damage. Distance mapping (DM) enables visualization of the relative distance between 2 articular surfaces represented by color patterns. This study aims to measure the safe zones for LCL using 3-dimensional (3D) models and DM; we hypothesize that it could be measured with high reproducibility.</p><p><strong>Methods: </strong>Two raters categorized 200 feet across 134 patients into OCSTs based on the Bruckner classification. Four angles were measured independently. The proximal and distal extents of the posterior safe zone (PSZ) angles were determined for H-LCL osteotomies; similarly, the proximal and distal extents of the anterior safe zone (ASZ) angles were identified for E-LCL osteotomies. Consequently, the surface available for safe osteotomies were calculated. An interclass correlation was used to assess the agreement between the 2 raters. Additionally, analysis of variance and Mann-Whitney <i>U</i> test were used to compare the safe zones between OCSTs.</p><p><strong>Results: </strong>The mean proximal and distal extents of the PSZ angles were 68 ± 7 and 75 ± 5 degrees from a line parallel to the lateral border of the calcaneus, respectively, and the proximal and distal extent of the ASZ angles were 89 ± 6 and 95 ± 5 degrees, respectively. There were no statistically significant differences between the OCSTs. Two raters measured the angles with good to excellent interrater and intrarater agreement. In 18 cases, we were unable to plan for H-LCL or E-LCL osteotomies.</p><p><strong>Conclusion: </strong>Distance mapping could be used to measure the safe zone, tailor a preoperative plan, and potentially reduce the risk for iatrogenic damage in LCL. 3D models and DM can increase the reliability of preoperative plans in bones with complex 3D structures.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":" ","pages":"1061-1069"},"PeriodicalIF":2.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midterm Results of AAA Ankle Arthroplasty.","authors":"Franz Endstrasser,&nbsp;Richard A Lindtner,&nbsp;Anna Landegger,&nbsp;Moritz Wagner,&nbsp;Martin Eichinger,&nbsp;Hannes Schönthaler,&nbsp;Gerhard Kaufmann,&nbsp;Alexander Brunner","doi":"10.1177/10711007231186375","DOIUrl":"10.1177/10711007231186375","url":null,"abstract":"<p><strong>Background: </strong>Outcome reports for Alpha Ankle Arthroplasty (AAA), a third-generation implant relying on a mobile bearing design for total ankle replacement, are sparse. This retrospective study evaluated the midterm survivorship, clinical, and radiologic outcomes after implantation of this implant.</p><p><strong>Methods: </strong>For 64 patients who received 65 Triple A ankle implants between 2009 and 2020, implant survival was calculated using the Kaplan-Meier curve. Clinical outcomes were evaluated by measuring the range of motion, stability, Western Ontario and McMaster Universities Osteoarthritis Questionnaire score (WOMAC), and American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The average pain level and satisfaction with the postoperative result were rated on a numeric rating scale (0-10). Additionally, radiologic analysis was performed using anteroposterior and lateral radiographs and tibiotalar alignment was assessed.</p><p><strong>Results: </strong>The implant-survival rate was 61.5% at a mean follow-up of 8.2 years. Twenty-five patients (38.5%) required revision surgery (average time to revision, 3.1 years, 95% CI 2.1-4.1 years). For patients without revisions, the average range of motion in dorsiflexion and plantarflexion were 3.6 ± 4.2 degrees and 21.9 ± 7.8 degrees, respectively. The mean WOMAC and AOFAS scores were 44.7 ± 47.5 and 75.1 ± 14.0, respectively. The average pain and subjective satisfaction scores were 2.0 ± 1.7 and 8.5 ± 1.9, respectively. Mean alignment values did not differ significantly for patients who required revision surgery.</p><p><strong>Conclusion: </strong>We found a high revision rate with use of the AAA. However, patients who did not require revision surgery had, on average, high satisfaction and good functional outcomes.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":" ","pages":"983-991"},"PeriodicalIF":2.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10484307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Outcomes After High-Energy Lisfranc Injuries.","authors":"Margaret A Sinkler,&nbsp;Alex Benedick,&nbsp;Michael Kavanagh,&nbsp;Heather A Vallier","doi":"10.1177/10711007231181121","DOIUrl":"10.1177/10711007231181121","url":null,"abstract":"<p><strong>Background: </strong>Midfoot fractures and dislocations are infrequent and functional outcomes following Lisfranc injuries have not been well described. The purpose of this project was to explore functional outcomes following operative treatment of high-energy Lisfranc injury.</p><p><strong>Methods: </strong>A retrospective cohort of 46 adults with tarsometatarsal fractures and dislocations treated at a single Level 1 trauma center were reviewed. Demographic, medical, social, and injury features of these patients and their injuries were recorded. Foot Function Index (FFI) and Short Musculoskeletal Function Assessment (SMFA) surveys were collected after mean 8.7 years' follow-up. Multiple linear regression was performed to identify independent predictors of outcome.</p><p><strong>Results: </strong>Forty-six patients with mean age 39.7 years completed functional outcome surveys. Mean SMFA scores were 29.3 (dysfunction) and 32.6 (bothersome). Mean FFI scores were 43.1 (pain), 43.0 (disability), and 21.7 (activity), with a mean total score of 35.9. FFI pain scores were worse than published values for fractures of the plafond (33, <i>P</i> = .04), distal tibia (33, <i>P</i> = .04), and talus (25.3, <i>P</i> = .001). Lisfranc injury patients reported worse disability (43.0 vs 29, <i>P</i> = .008) and total FFI scores (35.9 vs 26, <i>P</i> = .02) compared with distal tibia fractures. Tobacco smoking was an independent predictor of worse FFI (<i>P</i> < .05) and SMFA emotion and bothersome scores (<i>P</i> < .04). Chronic renal disease was a predictor of worse FFI disability (<i>P</i> = .04) and SMFA subcategory scores (<i>P</i> < .04). Male sex was associated with better scores in all SMFA categories (<i>P</i> < .04). Age, obesity, or open injury did not affect functional outcomes.</p><p><strong>Conclusion: </strong>Patients reported worse pain by FFI after Lisfranc injury compared to other injuries about the foot and ankle. Tobacco smoking, female sex, and preexisting chronic renal disease are predictive of worse functional outcome scores, warranting further study in a larger sample, as well as counseling of long-term consequences of this injury.</p><p><strong>Level of evidence: </strong>Level IV, retrospective, prognostic.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":" ","pages":"960-967"},"PeriodicalIF":2.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10043419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Calendar.","authors":"","doi":"10.1177/10711007231199191","DOIUrl":"https://doi.org/10.1177/10711007231199191","url":null,"abstract":"","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"939"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10278677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Surgical Treatment for Sural Neuritis: A Retrospective Case Series.","authors":"Chris C Cychosz,&nbsp;Joshua Eisenberg,&nbsp;Natalie Glass,&nbsp;Ignacio Fleury,&nbsp;Joseph A Buckwalter V,&nbsp;Phinit Phisitkul,&nbsp;John E Femino","doi":"10.1177/10711007231184472","DOIUrl":"10.1177/10711007231184472","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Somatic nerve pain is one of the most common complications following surgery of the foot and ankle but may also arise following traumatic injury or chronic nerve compression. The sural nerve is a commonly affected nerve in the foot and ankle; it is at risk given the proximity to frequently used surgical approaches, exposure to crush injuries, and traction from severe ankle inversion injuries. The purpose of this study is to investigate the outcomes of sural nerve neurectomy with proximal implantation for sural neuromas (SN) and chronic sural neuritis (CSN).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients that underwent neurectomy with proximal implantation (20 muscle, 1 adipose tissue) by 2 foot and ankle specialists for isolated SN- and CSN-related pain at a single tertiary institution were included. Demographic data, baseline outcomes including 36-Item Short Form Health Survey (SF-36), Foot and Ankle Ability Measure (FAAM), and visual analog scale (VAS) were recorded. Final follow-up questionnaires using Patient Reported Outcomes Measurement Information System (PROMIS) lower extremity function, pain interference (PI), and neuropathic pain quality, FAAM, and VAS were administered using REDCap. Perioperative factors including neuropathic medications, diagnostic injections, the use of collagen wraps, and perioperative ketamine were collected from the medical record. Descriptive statistics were performed and potential changes in patient-reported outcome measure scores were evaluated using Wilcoxon signed-rank tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The 21 patients meeting inclusion criteria for this study had a median age of 47 years (interquartile range [IQR], 43-49) and had median follow-up duration of 33.7 months (IQR, 4.5-47.6). Median FAAM activities of daily living score improved from 40.6 (38.7-50.7) preoperatively to 66.1 (53.6-83.3) postoperatively, &lt;i&gt;P&lt;/i&gt; = .032. FAAM sports scores improved from 14.1 (7.8-21.9) to 41.1 (25.0-60.9) postoperatively, &lt;i&gt;P&lt;/i&gt; = .002. VAS scores improved from a median of 9.0 (8.0-9.0) to 3.0 (3.0-6.0), &lt;i&gt;P&lt;/i&gt; &lt; .001. At final follow-up, patients reported PROMIS lower extremity function score median of 43.8 (35.6-54.9), PROMIS neuropathic pain quality score of 54.1 (43.6-61.6), and PROMIS PI of 57.7 (41.1-63.8). Patients with both anxiety and depression reported less improvement in pain and physical. Other perioperative factors lacked sufficient numbers for statistical analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Sural nerve neurectomy and proximal implantation (20 muscle, 1 adipose) provided significant improvement in pain and function for patients with sural neuromas and chronic sural neuritis at median follow-up of 33.7 months. Anxiety and depression were associated with significantly poorer outcomes following surgery. Patients with CRPS as well as recent nicotine use tended to report less improvement in pain and worse function after surgery, although this sample size was too lim","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"845-853"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10576148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peroneal Tendon Instability in Calcaneus Fractures: A Commentary.","authors":"David Ciufo,&nbsp;John Ketz","doi":"10.1177/10711007231182628","DOIUrl":"10.1177/10711007231182628","url":null,"abstract":"Like many high-energy bony injuries, a calcaneus fracture is more than just the “fracture.” In this issue of FAI, Vosoughi et al10 provide a large-scale cross-sectional evaluation of peroneal tendon instability in the setting of displaced intra-articular calcaneal fractures. They compared preoperative imaging findings to intraoperative stress testing to quantify the prevalence of peroneal dislocation in one of the largest cohorts to investigate this issue. Similar to previous studies, they noted a significant rate of peroneal tendon dislocations.1,3,7 Despite finding some statistical CT associations, they determined that imaging alone was not sufficient to replace intraoperative stress testing of the peroneal retinaculum stability. As with previous clinical studies, the authors recommend intraoperative stress testing of the peroneal retinaculum to determine stability. There is a lack of studies comparing treatment of acute to chronic peroneal tendon instability, but evidence shows that chronic peroneal dislocation often fails nonoperative management. Acute repair allows for primary repair of the retinaculum, whereas delayed repair of peroneal dislocation often warrants more complex procedures such as fibular groove deepening or tendon rerouting procedures.8 Chronic and recurrent dislocation of the tendons can lead also to tendon tearing, which leads to more challenging repair and reconstruction, or even irreparable tendons. These larger procedures require larger incisions, which lead to risks of soft tissue complications and nerve injury, especially in the proximity of prior calcaneal trauma and approaches.8 Additionally, this adds an additional surgery and recovery timeline to the patient, who has already endured immobilization, therapy, and loss of work after their trauma. Therefore, early diagnosis of peroneal instability is important to maximize recovery after treatment of the primary injury and reduce the need for secondary stabilization procedures. Vosoughi et al10 have provided a large retrospective cohort to corroborate prior studies, suggesting a notable prevalence (16.7%) of peroneal tendon instability in the setting of calcaneus fracture. These higher-energy injuries already lead to significant functional limitations,9 and it is important to identify any features possible to improve patient outcomes. Although some patient anatomy6 may predispose patients to peroneal instability, the calcaneus fracture has a significant association because of the classic widening and lateral displacement of intra-articular calcaneus fractures in light of the anatomic relationship with the peroneal tendons and confluence of the peroneal retinaculum and calcaneus lateral wall. The authors determined that CT findings can be somewhat predictive of peroneal dislocation, but the prevalence was grossly overstated with imaging alone when compared to intraoperative stress testing. Additionally, there was no particular mechanism of calcaneal injury associated wit","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"834-835"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10595811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Progressive Deltoid Ligament Sectioning on Weber B Ankle Fracture Stability.","authors":"Andreas F Dalen,&nbsp;Martin G Gregersen,&nbsp;Aleksander L Skrede,&nbsp;Øystein Bjelland,&nbsp;Tor Åge Myklebust,&nbsp;Fredrik A Nilsen,&nbsp;Marius Molund","doi":"10.1177/10711007231180212","DOIUrl":"10.1177/10711007231180212","url":null,"abstract":"<p><strong>Background: </strong>Conventionally, transsyndesmotic fibula fractures with concomitant signs of deltoid ligament injury have been considered unstable and thus treated operatively. Recent studies have indicated that partial deltoid ligament rupture is common and may allow for nonoperative treatment of stress-unstable ankles if normal tibiotalar alignment is obtained in the weightbearing position. Biomechanical support for this principle is scarce. The purpose of this study was to evaluate the biomechanical effects of gradually increasing deltoid ligament injury in transsyndesmotic fibula fractures.</p><p><strong>Methods: </strong>Fifteen cadaveric ankle specimens were tested using an industrial robot. All specimens were tested in 4 states: native, SER2, SER4a, and SER4b models. Ankle stability was measured in lateral translation, valgus, and internal and external rotation stress in 3 talocrural joint positions: 20 degrees plantarflexion, neutral, and 10 degrees dorsiflexion. Talar shift and talar valgus tilt in the talocrural joint was measured using fluoroscopy.</p><p><strong>Results: </strong>In most tests, SER2 and SER4a models resulted in a small instability increase compared to native joints and thus were deemed stable according to our predefined margins. However, SER4a models were unstable when tested in the plantarflexed position and for external rotation in all positions. In contrast, SER4b models had large-magnitude instability in all directions and all tested positions and were thus deemed unstable.</p><p><strong>Conclusion: </strong>This study demonstrated substantial increases in instability between the SER4a and SER4b states. This controlled cadaveric simulation suggests a significant ankle-stabilizing role of the deep posterior deltoid after oblique transsyndesmotic fibular fracture and transection of the superficial and anterior deep deltoid ligaments.</p><p><strong>Clinical relevance: </strong>The study provides new insights into how the heterogenicity of deltoid ligament injuries can affect the natural stability of the ankle after Weber B fractures. These findings may be useful in developing more targeted and better treatment strategies.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"895-904"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/89/10.1177_10711007231180212.PMC10500948.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10623904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Fate of Delayed Unions After Isolated Ankle Fusion.","authors":"Gregory E Lause,&nbsp;Emily B Parker,&nbsp;Kristen L Stupay,&nbsp;Christopher P Chiodo,&nbsp;Eric M Bluman,&nbsp;Elizabeth A Martin,&nbsp;Christopher P Miller,&nbsp;Jeremy T Smith","doi":"10.1177/10711007231178541","DOIUrl":"10.1177/10711007231178541","url":null,"abstract":"<p><strong>Background: </strong>Nonunion remains the most common major complication of ankle arthrodesis. Although previous studies have reported delayed union or nonunion rates, few have elaborated on the clinical course of patients experiencing delayed union. In this retrospective cohort study, we sought to understand the trajectory of patients with delayed union by determining the rate of clinical success and failure and whether the extent of fusion on computed tomography scan (CT) was associated with outcomes.</p><p><strong>Methods: </strong>Delayed union was defined as incomplete (<75%) fusion on CT between 2 and 6 months postoperatively. Thirty-six patients met the inclusion criterion: isolated tibiotalar arthrodesis with delayed union. Patient-reported outcomes were obtained including patient satisfaction with their fusion. Success was defined as patients who were not revised and reported satisfaction. Failure was defined as patients who required revision or reported being not satisfied. Fusion was assessed by measuring the percentage of osseous bridging across the joint on CT. The extent of fusion was categorized as absent (0%-24%), minimal (25%-49%), or moderate (50%-74%).</p><p><strong>Results: </strong>We determined the clinical outcome of 28 (78%) patients with mean follow-up of 5.6 years (range, 1.3-10.2). The majority (71%) of patients failed. On average, CT scans were obtained 4 months after attempted ankle fusion. Patients with minimal or moderate fusion were more likely to succeed clinically than those with \"absent\" fusion (<i>P</i> = .040). Of those with absent fusion, 11 of 12 (92%) failed. In patients with minimal or moderate fusion, 9 of 16 (56%) failed.</p><p><strong>Conclusion: </strong>We found that 71% of patients with a delayed union at roughly 4 months after ankle fusion required revision or were not satisfied. Patients with less than 25% fusion on CT had an even lower rate of clinical success. These findings may help surgeons in counseling and managing patients experiencing a delayed union after ankle fusion.</p><p><strong>Level of evidence: </strong>Level IV, retrospective cohort study.</p>","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 9","pages":"815-824"},"PeriodicalIF":2.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}