Journal of Foot & Ankle Surgery最新文献

{"title":"Direct or indirect reduction internal fixation for posterior ankle fractures: A systematic review and meta-analysis","authors":"GuiSong Yu ,&nbsp;YuPeng Dong ,&nbsp;YuBo Cui ,&nbsp;ZhiJun Yang ,&nbsp;Xing Fu ,&nbsp;Dian Li ,&nbsp;WenLong Yang ,&nbsp;FengYun Yang","doi":"10.1053/j.jfas.2025.03.014","DOIUrl":"10.1053/j.jfas.2025.03.014","url":null,"abstract":"<div><div><span>Direct or indirect internal fixation for posterior ankle fractures<span> remains a controversial topic. While direct plate or screw internal fixation is believed to provide better reduction, it may also cause more severe soft tissue damage<span><span>, while indirect screw internal fixation is thought to result in less damage but may carry the risk of poor reduction. We conducted this meta-analysis to investigate the clinical efficacy and safety of direct versus indirect reduction internal fixation for posterior ankle fractures. The Preferred Reporting Items for Systematic Evaluation and Meta-Analysis (PRISMA) guidelines were used to search the China Knowledge Network database (CNKI), PubMed, Web of Science, Embase, and other databases from the year of establishment- February 2025, and relevant journals were manually searched to collect the relevant literature, and articles that met the requirements were screened and analyzed. Meta-analysis was conducted using RevMan 5.4 software, and a systematic evaluation was carried out when the data from the included studies could not be synthesized. A total of 17 articles involving 1538 study subjects were included, and the results showed that there were no statistical differences in postoperative AOFAS scores, complications, and Dorsiflexion restriction between ankle fractures after direct plate or screw reduction and fixation and those after indirect screw reduction and fixation; however, the Radiological evaluation&gt;2 mm and </span>Osteoarthritis (</span></span></span><em>P</em> &lt; 0.05) were statistically different. Direct reduction and fixation of posterior ankle fractures has better imaging performance and reduces the incidence of postoperative arthritic events.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 665-675"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-reader reliability in multi-plane and multi-time point Hallux valgus correction evaluation on post-operative weight-bearing radiographs from a prospective multi-center trial and correlation with patient reported outcome measures","authors":"Shyam S. Ramachandran ,&nbsp;Seth Reine ,&nbsp;Holden Archer ,&nbsp;Jennifer Koay ,&nbsp;Dane K. Wukich MD ,&nbsp;Avneesh Chhabra MD","doi":"10.1053/j.jfas.2025.04.011","DOIUrl":"10.1053/j.jfas.2025.04.011","url":null,"abstract":"<div><div>The primary purpose of this study was to determine interreader reliability (IRR) of hallux valgus<span> (HV) related parameters on different time-points in dorsoplanar and coronal planes, i.e. hallux valgus angle (HVA), metatarsal rotation, sesamoid subluxation<span>, metatarsal sesamoid osteoarthritis, tibial sesamoid point, and lateral round sign. The secondary purpose was to correlate these measurements with patient-reported outcome measures (PROMs) at the initial presentation for HV surgery and at 6 weeks, 4 months, 6 months, 12 months, and 24 months. Radiographic imaging and PROMs were collected at 5 different postoperative time points. Two musculoskeletal radiologists independently performed all readings and foot measurements blinded to each other’s reads and the clinical information. Intraclass coefficient and kappa were obtained for interreader analysis. A partial spearman rank order was used to correlate radiographic foot measurements and PROMs. Across all 5 follow-up time points (6 weeks, 4 months, 6 months, 12 months, and 24 months), we found excellent IRR for HVA and poor reliability for lateral round sign, sesamoid subluxation, and metatarsal-sesamoid OA. We found excellent IRR for TSP at all follow-up time points except for at 6 weeks. There was a weak, positive correlation between sesamoid subluxation and PROMIS depression score at 24-month follow-up (R=0.21), and a negative correlation between metatarsal-sesamoid OA and PROMIS social score at 24-month follow-up (R=-0.21). We report excellent reproducibility for HVA in post-operative radiographs but variable- poor to excellent IRR for a range of HV-related parameters assessed on the axial view. There were no major trends in the correlation between the quantitative radiographic foot measurements and PROMs except for some weak correlations.</span></span></div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 634-637"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal tibial osteophytes are more accurate than medial malleolar anatomy when using patient specific instrumentation in total ankle replacement","authors":"Jason George DeVries DPM, FACFAS ,&nbsp;Andrew Regal DPM, FACFAS ,&nbsp;Tisileli S. Tuifua MD ,&nbsp;Brandon M. Scharer DPM, FACFAS","doi":"10.1053/j.jfas.2025.03.012","DOIUrl":"10.1053/j.jfas.2025.03.012","url":null,"abstract":"<div><div><span>Total ankle replacement<span> (TAR) is a treatment for end stage ankle arthritis. Patient specific instrumentation (PSI) has been used and shown to allow for accurate placement and alignment in TAR in the coronal and sagittal plane. PSI systems are available and use different anatomic landmarks for the cutting guides. This is a retrospective matched case control study comparing accuracy in alignment using 2 different PSI systems. The case series uses a medial malleolar landmark (MM Group), and each case patient was matched based on preoperative coronal plane alignment with 2 ankles in the control series using the distal tibial osteophytes as landmarks (DT Group), as this system has been in use and studied more. A total of 48 ankles were studied, 16 in the MM Group and 32 in the DT Group matched by coronal plane alignment. There was a difference in accuracy of postoperative coronal plane alignment, with the MM Group deviated from expected by 1.6° ± 1.3° compared to the DT Group at 1.1° ± 0.6°, </span></span><em>p</em> = 0.04. This corresponded to 68.8 % of MM Group ankles being within 2° of expected compared to 93.4 % of DT Group ankles. There was no statistically significant difference in sagittal plane alignment between the groups, <em>p</em> = 0.57. Procedure time was the only other statistically significant difference with the MM Group taking longer than the DT Group, 97.4 min and 80.6 min, respectively, <em>p</em> = 0.04. While both groups show good accuracy, alignment based on the distal tibial osteophytes is more accurate than using the medial malleolus.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 546-551"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study of postoperative clinical outcomes of lateral ankle ligament repair for early-stage ankle osteoarthritis in middle-aged and elderly patients","authors":"Taihei Miura MD, PhD,&nbsp;Yasuyuki Jujo MD,&nbsp;Jun Horng Tan MBBS, FHKCOS, FHKAM (Ortho), FRCSEd (Ortho),&nbsp;Kazuaki Okugura PT,&nbsp;Yukinori Mori PT,&nbsp;Kenta Komesu PT,&nbsp;Masato Takao MD, PhD","doi":"10.1053/j.jfas.2025.05.003","DOIUrl":"10.1053/j.jfas.2025.05.003","url":null,"abstract":"<div><div><span>Although lateral ankle ligament repair has demonstrated favorable postoperative outcomes, few studies have focused on elderly patients. The aim of this study was to compare the postoperative clinical outcomes of lateral ankle ligament repair in middle-aged and elderly patients with early-stage ankle </span>osteoarthritis (OA). This study was a retrospective analysis of 99 patients aged 40 years or older with chronic lateral ankle instability (LAI) associated with ankle OA who were followed up for at least 12 months after surgery. The patients were divided into two groups: 60 patients in the middle-aged group (40-64 years) and 39 patients in the elderly group (≥65 years), all of whom underwent lateral ankle ligament repair. The recovery time to preoperative walking levels and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) scores preoperatively and postoperatively were investigated and compared between the two groups. Compared with the preoperative scores, SAFE-Q scores improved significantly across all items in both groups at 12 months post-surgery. There was no difference in pain or pain-related scores between the two groups up to 12 months post-surgery. Furthermore, all patients recovered to their preoperative walking levels or above. However, the elderly group took significantly longer to recover after surgery than the middle-aged group did. Lateral ankle ligament repair yields favorable clinical outcomes even in elderly patients. However, elderly patients took significantly longer to recover walking levels after surgery than middle-aged patients. Therefore, preoperative patient education and postoperative rehabilitation protocols may need to be adjusted accordingly.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 649-654"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover 1 -- cover prints black and PMS 261","authors":"","doi":"10.1053/S1067-2516(25)00214-5","DOIUrl":"10.1053/S1067-2516(25)00214-5","url":null,"abstract":"","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Page OFC"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of local flap reconstruction for limb salvage in patients with moderate to severe medial arterial calcification","authors":"Rachel N. Rohrich BS ,&nbsp;Karen R. Li BBA ,&nbsp;Ryan P. Lin MD ,&nbsp;Sami Ferdousian MS ,&nbsp;Isabel A. Snee BS ,&nbsp;Roumina Adab BS ,&nbsp;Jayson N. Atves DPM, FACFAS ,&nbsp;John S. Steinberg DPM, FACFAS ,&nbsp;Richard C. Youn MD ,&nbsp;Karen K. Evans MD ,&nbsp;Cameron M. Akbari MD ,&nbsp;Christopher E. Attinger MD","doi":"10.1053/j.jfas.2025.03.013","DOIUrl":"10.1053/j.jfas.2025.03.013","url":null,"abstract":"<div><div><span>The medial arterial calcification (MAC) scoring system (Figure 1) predicts adverse limb events. This study applies MAC scoring to patients undergoing local flap reconstruction. To do so, we reviewed patients that underwent foot and ankle local flaps from January 2010 to November 2022. Radiographs were used to assign MAC scores: absent (MAC=0-1), moderate (MAC=2-3), or severe (MAC≥4). 182 patients underwent local flap reconstruction: 104 (57.1 %) absent MAC, 32 (17.6 %) moderate MAC, and 46 (25.3 %) severe MAC. Patients with severe MAC demonstrated significantly higher rates of diabetes mellitus (</span><em>p</em> = 0.001), end-stage renal disease (<em>p</em> &lt; 0.001), and peripheral neuropathy (<em>p</em> &lt; 0.001), and more often required a vascular intervention before reconstruction (<em>p</em><span> = 0.001). Flap-related outcomes and major limb amputation<span> rates were statistically comparable among MAC groups. By a median of 16.5 (IQR: 36.6) months, limb salvage was 84.1 % and not independently associated with MAC on multivariable analysis. Postoperative vascular intervention (absent: 10.7 % vs. moderate: 28.1 % vs. severe: 17.4 %; </span></span><em>p</em><span> = 0.054), podiatric reoperation (absent: 35.6 % vs. moderate: 40.6 % vs. severe: 56.5 %; </span><em>p</em> = 0.056), and mortality (absent: 19.4 % vs. moderate: 34.4 % vs. 32.6 %; <em>p</em> = 0.102) were not independently associated with MAC on multivariable analysis. Given these results, local flaps are a viable option in patients with MAC. If utilizing a vasculo-plastic approach, severe MAC should not prevent limb salvage efforts via local flap reconstruction.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 552-558"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of pre-operative reduction quality on post-operative wound complications in ankle fractures: A review of 247 cases","authors":"Rye Yern Yap MRCS,&nbsp;Peter Logan MRCS,&nbsp;Mohammad Iqbal MRCS,&nbsp;Vishwajeet Kumar FRCS Tr & Orth,&nbsp;Zaid Al-Wattar FRCS Tr & Orth","doi":"10.1053/j.jfas.2025.04.010","DOIUrl":"10.1053/j.jfas.2025.04.010","url":null,"abstract":"<div><div><span><span><span><span>Opinions vary on the definition of an adequate pre-operative reduction for unstable ankle fractures that require surgical fixation. We hypothesized that residual tibiotalar </span>subluxation may impair post-operative </span>wound<span><span><span> healing. This study aimed to evaluate the influence of pre-operative reduction quality on the rate of wound complications following ankle fracture fixation. A </span>retrospective cohort study<span> of consecutive ankle fractures in adults treated with surgical fixation at a district general hospital from January 2020 until July 2023 was conducted. Pre-operative reduction was categorized as inadequate if there was residual tibiotalar joint </span></span>subluxation of &gt; 2mm on post-manipulation radiographs. Wound complication was defined as any wound problem requiring additional dressing care, </span></span>antibiotics, or a return to the operating room. Two hundred and forty-seven patients were included in this study, with a median age of 56.9 (range 18.3 – 88.7). One hundred and sixty-six (67.2 %) patients were female. The median follow-up duration was 12.3 (range 2 – 148). Ninety-eight (39.7 %) patients had an inadequate pre-operative reduction. There were 29 (11.7 %) cases of post-operative wound complications. The rate of wound complications was higher in patients with an inadequate pre-operative reduction compared to those in whom adequate reduction was achieved (17.3 % versus 8.1 % respectively, </span><em>p</em><span> = 0.03). Persistent pre-operative tibiotalar joint subluxation was associated with an increased rate of wound complications following ankle fracture fixation. Initial closed reduction should aim to restore the tibiotalar alignment for soft tissue resuscitation. Urgent intervention is warranted in cases with persistent subluxation despite initial attempts at closed reduction.</span></div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 629-633"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedentary lifestyle and hallux valgus: Unraveling the causal pathways and the mediating role of calcium homeostasis through mendelian randomization","authors":"Maolin Liu ,&nbsp;Yan Liu ,&nbsp;Miao Sun ,&nbsp;Zhongyao Zeng ,&nbsp;Yuanzhi Song ,&nbsp;Erlong Jia ,&nbsp;Shengde Wu","doi":"10.1053/j.jfas.2025.04.003","DOIUrl":"10.1053/j.jfas.2025.04.003","url":null,"abstract":"<div><div><span><span>The causal relationships between hallux valgus (HV), sedentary </span>behavior and </span>calcium homeostasis<span> remain unclear. This study aimed to explore these associations using Mendelian randomization<span><span> (MR) analysis. Leisure screen time (LST) was used as an indicator of sedentary behavior, while seven traits and three diseases were selected to represent calcium homeostasis. Two-sample MR was performed to assess the causal effect of sedentary behavior and calcium homeostasis on HV. Two-step MR was conducted to quantify the mediating roles of calcium homeostasis-related traits in the association between sedentary behavior and HV. Our results showed that longer LST was strongly associated with higher risk of HV (odds ratio (OR) = 1.1902, 95 %CI = 1.0129–1.3986, p = 0.0343). By contrast, </span>serum calcium (S-Ca) levels were negatively associated with HV risk (OR = 0.7530, 95 %CI = 0.5675–0.9992, p = 0.0494). Mediation analyses found that S-Ca played an important mediating role in the effect of LST on HV (proportion mediated = 10.4 %). Our results extend the understanding of the pathogenesis of HV, and highlight the importance of preoperative metabolic optimization and postoperative behavioral and calcium supplementation strategies to enhance surgical outcomes and mitigate recurrence.</span></span></div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 592-596"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of open or closed treatment of foot fractures: A database study comparing patients with and without diabetes","authors":"Dhruv Nandakumar ,&nbsp;Benjamin M. Conover ,&nbsp;Matthew J. Johnson DPM, FACFAS ,&nbsp;Katherine M. Raspovic DPM, FACFAS ,&nbsp;Dane K. Wukich MD","doi":"10.1053/j.jfas.2025.05.004","DOIUrl":"10.1053/j.jfas.2025.05.004","url":null,"abstract":"<div><div>Treatment of ankle and foot fractures<span><span> in patients with diabetes mellitus (DM) is challenging, and complications may arise. Although much data exists on complication rates in tibial, fibular, and malleolar fractures<span>, there exists a comparable lack of data on complication rates in fractures of the tarsal, metatarsal, and phalanx bones of the foot. Therefore, we aimed to compare post-procedural outcomes after such fractures in diabetic vs non-diabetic patients. A commercially available de-identified database was searched using ICD-10 codes for the open or closed surgical treatment in patients with fractures of the </span></span>calcaneus, cuboid, navicular, talus, cuneiforms, metatarsals, and phalanges from 2010 to 2023. Patients with at least 1 year of post-procedural follow-up were included. We then separated patients into two groups: those with diabetes (108,603, 26.4 %) and those without diabetes (302,464, 73.6 %).</span></div><div>Post-procedural complications assessed including those related to hardware when surgical treatment was pursued (reoperation, non-union, malunion, delayed union, wound disruption<span><span>, surgical site infection) and health complications after fracture treatment (AKI, </span>DVT, MI, pneumonia, sepsis) were assessed at 1 year and odds ratios were used to compare rates of these complications in diabetics vs non-diabetics for each bone. Rates of complications after fracture treatment were found to be significantly higher in all bones for diabetic patients compared to non-diabetic patients.</span></div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 655-659"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iatrogenic medial malleolar fracture and stress fracture considerations in total ankle joint replacement: A multicenter retrospective study","authors":"Dr. James M. Cottom DPM, FACFAS (Director) ,&nbsp;Dr. Jay S. Badell DPM, MS, FACFAS ,&nbsp;Dr. Karl W. Dunn DPM, FACFAS ,&nbsp;Dr. Josh Ekladios DPM","doi":"10.1053/j.jfas.2025.04.008","DOIUrl":"10.1053/j.jfas.2025.04.008","url":null,"abstract":"<div><div>Total ankle replacement<span><span> (TAR) is a challenging but rewarding treatment option for primary or post-traumatic tibiotalar osteoarthritis<span><span><span>. Acute and latent postoperative stress fractures of the </span>medial malleolus, however, pose a common potential complication that may arise during joint resection, especially during implantation of the tibial component. This is a multicenter retrospective study highlighting considerations for iatrogenic </span>medial malleolar fractures during and after TAR surgery by assessing relationships between fractures and medial malleolus width (MMW). 159 patients undergoing primary TARs without prophylactic tibial fixation from 2016-2022 were selected from multiple institutions. MMW (mm) was measured as the distance between the tibial tray component placement and the medial malleolus’ outer cortex using standard AP ankle radiographs intraoperatively and postoperatively. Demographics included </span></span>BMI, gender, age, and implant type. Average MMW of the 148 patients without fracture was 11.12 mm. Average MMW was 9.43 mm in the 11 patients who suffered intraoperative medial malleolus fracture (n = 7) or developed postoperative stress fracture (n = 4). Tibial fixation was performed only in the fracture group. The difference in MMW between the two groups was statistically significant (p &lt; 0.05). There were no statistically significant differences among all the demographics. Mean follow-up, age, and BMI were 20.9 months, 64.4 years, and 30.4, respectively, and there were no statistically significant differences among demographics. This data demonstrates how shorter MMW, specifically a threshold of 9.43 mm or shorter, may be associated with higher probability of intraoperative or postoperative stress fracture of the medial malleolus.</span></div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 5","pages":"Pages 619-623"},"PeriodicalIF":1.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}