Foot & ankle specialist最新文献

{"title":"Correlation Between Statin Use and Symptomatic Venous Thromboembolism Incidence in Patients With Ankle Fracture: A Machine Learning Approach.","authors":"Nour Nassour, Bardiya Akhbari, Noopur Ranganathan, Ahmed Tawakol, Rachel P Rosovsky, Daniel Guss, Christopher W DiGiovanni, Soheil Ashkani-Esfahani","doi":"10.1177/19386400231207692","DOIUrl":"10.1177/19386400231207692","url":null,"abstract":"<p><strong>Background: </strong>Identifying factors that correlate with the incidence of venous thromboembolism (VTE) has the potential to improve VTE prevention and positively influence decision-making regarding prophylaxis. In this study, we aimed to investigate the correlation between statin consumption and the incidence of VTE in patients who sustained an ankle fracture.</p><p><strong>Methods: </strong>In this retrospective, case-controlled study, cases were those who developed VTE and controls were those who had no VTE, and the ratio was 1:4. Patients' demographics, history of hyperlipidemia, and reported statins use were obtained. A random forest classifier (RFC) model was used to predict whether statin consumers were at risk of VTE after ankle fracture regardless of VTE prophylaxis administration based on statin consumption, body mass index (BMI), age, and biological sex.</p><p><strong>Results: </strong>Of the 1175 patients with ankle fractures, 238 had confirmed VTE (case group), and 937 had no symptomatic VTE (control group; ratio 1:4). Fifty (21%) cases and 407 (43%) controls were on a statin. Statin users had a significantly lower incidence of VTE after ankle fracture, odds ratio (OR) = 0.35, 95% CI: 0.25, 0.49, P < .001. Our model showed an area under the receiving operator curve (AUROC) of 78%, a sensitivity of 73%, and a specificity of 83% in predicting the risk of VTE. The importance of the predictors of VTE, other than the use of statins (model importance = 0.1), were age (model importance of 0.72), BMI (model importance of 0.24), and biological sex (model importance of 0.02).</p><p><strong>Conclusion: </strong>Statins were significantly associated with a lower rate of VTE in our population of patients who sustained an ankle fracture.</p><p><strong>Levels of evidence: </strong><i>3</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"604-612"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Fibular Malrotation on Tibiotalar Joint Contact Mechanics in a Weber B Ankle Fracture Model.","authors":"Alfonso E Ayala, Ansab Khwaja, Brianna C Goodison, Simeon L Smith, Samuel Y Kim, Jared T Irwin, L Daniel Latt","doi":"10.1177/19386400221127835","DOIUrl":"10.1177/19386400221127835","url":null,"abstract":"<p><strong>Background: </strong>In minimally displaced Weber B ankle fractures, the distal fibular fracture fragment can be externally rotated. This malrotation is difficult to detect on radiographs and, when left malreduced through nonoperative treatment, may contribute to altered joint mechanics, predisposing to posttraumatic osteoarthritis. This study evaluates the effects of fibular malrotation on tibiotalar joint contact mechanics.</p><p><strong>Methods: </strong>Six cadaveric ankles were tested using a materials testing system (MTS) machine. A tibiotalar joint sensor recorded contact area and pressure. Samples were tested in the intact, neutrally rotated, and malrotated state. Each trial applied a 686N axial load and a 147N Achilles tendon load in neutral position, 15° dorsiflexion, and 15° plantarflexion.</p><p><strong>Results: </strong>In the comparison of malrotated to intact ankles, peak contact pressure was found to be significantly greater at neutral flexion (intact 5.56 MPa ± 1.39, malrotated 7.21 MPa ± 1.07, P = .03), not significantly different in dorsiflexion, and significantly decreased in plantarflexion (intact 11.2 MPa ± 3.04, malrotated 9.01 MPa ± 1.84, P = .01). Significant differences in contact area were not found between conditions.</p><p><strong>Conclusion: </strong>The findings suggest that fibular malrotation contributes to significant alterations in tibiotalar joint contact pressures, which may contribute to the development of posttraumatic osteoarthritis. When malrotation of the fibula is suspected on plain radiographs, a computer tomography (CT) scan should be obtained to evaluate its extent and further consideration should be given to surgical treatment.</p><p><strong>Levels of evidence: </strong>Level V: Bench testing.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"577-584"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33494971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Open Ankle Fractures in Elderly Patients With a Fibula Nail is a Safe and Reliable Technique.","authors":"Abdulrahman Odeh, James Archer, Basil Budair, Alastair Marsh, Paul Fenton","doi":"10.1177/19386400221099660","DOIUrl":"10.1177/19386400221099660","url":null,"abstract":"<p><strong>Background: </strong>Ankle fractures are becoming more common in the elderly and their management is frequently challenging. There is increasing evidence of good outcomes following fibula nail fixation in the management of ankle fractures. The use of a fibula nail in open fractures comes with potential advantages such as minimal soft tissue dissection, early rehabilitation, and decreased wound complications. We aimed to assess their use in the management of open ankle fractures in the elderly.</p><p><strong>Methods: </strong>A review of patients aged 60 years or older with an open ankle fracture treated with a fibular nail at a major trauma center was conducted. All patients were managed with joint Orthopaedic and Plastic Surgical input to determine their optimal management. Functional outcome scores, postoperative complications, and re-operation rates were determined.</p><p><strong>Results: </strong>Fifteen patients were identified with a mean age of 76 years. Patient-reported outcomes (Olerud and Molander Score) were calculated in 73% of patients. Our results demonstrated excellent outcome scores (>91) in 1 patient, good outcome scores (61-90) in 7 patients, and fair outcome scores (31-60) in 3 patients. There were no postoperative complications or re-operations within our study group.</p><p><strong>Conclusion: </strong>This article is the largest series presenting the outcomes of fibula nails in the management of open ankle fractures in elderly patients. We conclude that it can be used as a treatment option to safely manage open ankle fractures in the elderly. It provides a stable fixation, early weight-bearing, low risk of postoperative complications while maintaining good patient-reported functional outcomes.</p><p><strong>Level of evidence: </strong><i>Level 4</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"561-566"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40410272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Pronation External Rotation IV Fracture Pattern and Regional Bone Density.","authors":"Dominick Casciato, Daniel T DeGenova, Zachary Hill, Jia Bao Lin, Tucker Peabody, Nolan Schmitz, Benjamin Taylor","doi":"10.1177/19386400231173163","DOIUrl":"10.1177/19386400231173163","url":null,"abstract":"<p><strong>Introduction: </strong>Throughout the musculoskeletal system, fracture patterns and subsequent healing rely partly on bone density. In the foot and ankle, bone density has been shown to play a role in supination and external rotation fracture patterns. Adding to previous research, this investigation examines the association between bone density and trimalleolar versus trimalleolar equivalent fracture patterns following pronation and external rotation injuries using computed tomography (CT)-derived Hounsfield units (HU).</p><p><strong>Methods: </strong>A retrospective chart review was conducted among patients without a history of fracture or osteoporosis who sustained a PER IV fracture. Demographic data were collected. Fractures were separated between PER IV equivalent and fracture groups. CT-derived HU was assessed at the distal tibia and fibula. Density was compared between PER IV equivalent and fracture groups and among posterior malleolar fracture patterns.</p><p><strong>Results: </strong>Seventy-five patients met the selection criteria, with 17 comprising the equivalent group and 58 in the fracture group. There were 38 type 1, 9 type 2, and 11 type 3 posterior malleolus fractures. The ankle bone density of the PER fracture equivalent group (331.98 ± 65.71HU) was greater than the PER fracture group (281.61 ± 76.99HU; <i>P</i> = .008). A statistically significant difference in tibial bone densities among equivalent and all PER fracture types (<i>P</i> = .01) with the equivalent group (331.98 ± 65.71HU) maintaining a greater tibial bone density than the type 2 posterior malleolus fracture group (252.35 ± 57.33HU; <i>P</i> = .009).</p><p><strong>Conclusion: </strong>Higher bone density was associated with PER IV equivalent fractures; however, there was no density difference among posterior malleolus fracture types. When presented with PER IV fractures, consider fixation that addresses a lower bone density.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"598-603"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9530943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unstable Rotational Ankle Fractures Treated With Anatomic Mortise Repair and Direct Posterior Malleolus Fixation.","authors":"Connor P Littlefield, Jack H Drake, Kenneth A Egol","doi":"10.1177/19386400221110087","DOIUrl":"10.1177/19386400221110087","url":null,"abstract":"<p><p><i>Introduction:</i> The purpose of this study was to evaluate patient outcomes following a standardized algorithmic approach to ankle mortise stabilization, following rotational fracture, utilizing direct repair of the posterior malleolus in the prone position. <i>Methods</i>: Eighty consecutive patients with unstable rotational ankle fractures that involved the posterior malleolus were analyzed. All underwent direct repair of the posterior malleolus regardless of size through a posterolateral approach. Electronic records were retrospectively reviewed for demographic information, initial injury and operation details, healing status, and complications. Preoperative and postoperative radiographs were obtained to assess the initial injury and healing was determined both by radiographic and clinical progress at follow-up visits. <i>Results</i>: Average posterior malleolus fragment width was 8.1 ± 3.7 mm (range = 2.1-19.9 mm) and percentage of the articular surface was 23.6% (range = 7.1%-56.7%) on the lateral radiograph. Overall, 80/80 (100%) patients healed their ankle fractures by a mean 2.9 ± 1.1 months. Only 1 (1.3%) patient required transsyndesmotic fixation following posterior malleolus repair. Mean range of ankle motion was as follows: dorsiflexion 20° ± 10°, plantarflexion 34° ± 10°, inversion 8° ± 4°, and eversion 7° ± 4°. Seventy-nine patients (98.8%) had an anatomic mortise reduction. Nine patients (11.3%) had a superficial wound complication, 3 patients (3.8%) had dysesthesia in the sural nerve distribution, and 1 patient (1.3%) lost reduction of the medial malleolus. <i>Conclusion</i>: Patients who undergo direct repair of the posterior malleolus in the prone position can expect a high rate of healing with superficial wound breakdown being the biggest problem, which was associated with an ankle fracture dislocation. Posterior malleolus fixation may obviate the need of transsyndesmotic stabilization.<b>Levels of Evidence</b>: Retrospective Level IV.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"567-576"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40610470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Operative Indications in Lisfranc Injuries: A Systematic Review.","authors":"Christian Pearsall, Emily Arciero, Puneet Gupta, Henrik Bäcker, Direk Tantigate, David P Trofa, J Turner Vosseller","doi":"10.1177/19386400231175376","DOIUrl":"10.1177/19386400231175376","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this review was to determine operative indications for Lisfranc injuries.</p><p><strong>Methods: </strong>A systematic review using a MEDLINE literature search was performed using the index \"Lisfranc Injury\" from 1980 onward using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines where applicable. Inclusion criteria were all clinical studies reporting on the management of Lisfranc injuries obtained via the search index, including case reports, review articles, cohort studies, and randomized trials. Non-English-language articles, inaccessible articles, those not relevant to the management of Lisfranc injuries (biomechanical, cadaveric, and technique articles), and those that did not explicitly state operative indications (vague or absent indications) were excluded.</p><p><strong>Results: </strong>After identifying 737 studies, the full text of 391 studies was reviewed, and 58 reports providing explicit operative indications were included in the final analysis. Fifty-one (81.1%) studies provided diastasis cutoffs varying ≥2 mm (35/58; 60.4%), ≥<i>1 mm (13; 22.4%), and</i> ≥3 mm (3; 5.2%); the diastasis location was most commonly unspecified (31/58; 53.5%) or varied between combinations of metatarsal, tarsal, cuboid, and cuneiform bones (20/58; 27.6%). Specific imaging criteria for surgery included an avulsion fracture or fleck sign (3/58; 5.2%), arch height loss (3/58; 5.2%), and a tear on magnetic resonance imaging (5; 8.6%). The 11 (19%) studies defining operative indications in terms of classification schemes used the Nunley and Vertullo (8/58; 13.8%), Myerson (2; 3.5%), and Buehren (1; 1.7%) systems. Twenty-one (36.2%) studies provided multiple operative indications.</p><p><strong>Conclusion: </strong>The most common Lisfranc operative indications among the limited reporting studies varied from a 1- to 3-mm diastasis across several locations. It is imperative for operative indications to be reported with an increased frequency and in a homogenous fashion to guide the clinical management of these subtle injuries.</p><p><strong>Levels of evidence: </strong>Level IV; systematic Review.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"632-638"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9951425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Wait Time for Surgery Following Injury Affects Functional Outcomes and Complications After an Ankle Fracture: A Propensity Score-Matched Multicenter Study, the TRON Study.","authors":"Takayuki Sugino, Yasuhiko Takegami, Kosuke Bando, Toshifumi Sato, Tomoki Fujita, Yoshiharu Oka, Shiro Imagama","doi":"10.1177/19386400231164211","DOIUrl":"10.1177/19386400231164211","url":null,"abstract":"<p><strong>Background: </strong>The present study aimed to evaluate the hypothesis that a 1-week extension of the waiting period to perform surgery for ankle fracture might affect postoperative results and complications.</p><p><strong>Methods: </strong>We used our multicenter database named TRON (Trauma Research Group of Nagoya). In all, 779 patients who underwent surgery for ankle fracture, who had no comorbidities were eligible. After exclusion, we analyzed 596 patients. We divided the patients into 2 groups according to whether they were operated on within 7 days after the injury with propensity score matching.</p><p><strong>Results: </strong>The operative time of the delayed operation group (DO group) was significantly longer than that of the early operation group (EO group) (115.87 ± 56.59 vs 85.93 ± 34.58 minutes; P < .001). The rate of infection in the DO group was significantly higher than that of the EO group (16 patients [6.5%] vs 4 patients [1.6%]; P = .016).</p><p><strong>Conclusion: </strong>Waiting for more than a week to perform ankle surgery may lead to longer operative times and increased infection rates.</p><p><strong>Levels of evidence: </strong>III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"592-597"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9675380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Which Cases Do We Operate? Posterior Malleolar Fractures-Intraobserver and Interobserver Reliability of the Bartoníček/Rammelt Classification and Corresponding Surgery Rates.","authors":"Michael Sarter, Felix Krane, Tim Leschinger, Michael Hackl, Lars P Müller, Andreas Harbrecht","doi":"10.1177/19386400241250154","DOIUrl":"10.1177/19386400241250154","url":null,"abstract":"<p><strong>Introduction: </strong>The Bartoníček/Rammelt classification is established for posterior malleolar fractures. It subdivides the fractures into 5 types and outlines treatment recommendations. This study aims to determine the intraobserver and interobserver reliability of the Bartoníček/Rammelt classification and investigates its applicability regarding treatment recommendations.</p><p><strong>Materials and methods: </strong>Computed tomography (CT) scans of 80 ankle fractures with a posterior malleolar fracture were analyzed by four observers at two different time points 30 days apart (d1 and d2). Intrarater and interrater reliability was measured using kappa values. The corresponding surgery rates of the fracture subtypes were analyzed, and the surgery rates were correlated with fragment sizes and displacements.</p><p><strong>Results: </strong>A moderate interobserver reliability for d1 0.41 (CI 0.35-0.47) and d2 0.42 (CI 0.36-0.48) was detected. Intraobserver reliability was documented as perfect, with a mean kappa of 0.83. Type II fractures were operated on in 50% of cases. In 50% of type II cases, a nonoperative treatment was chosen. Fragment size correlated strongly with the chosen therapy, and osteosynthesis was performed significantly more often when the fragment size exceeded 3 cm³ (P < .01).</p><p><strong>Conclusions: </strong>The Bartoníček/Rammelt classification system showed moderate interobserver reliability and perfect to substantial intraobserver reliability. In clinical practice of this study cohort, the size of the posterior malleolar fragment rather than the dislocation and joint impaction seemed to have the decision to operate on type II or III fractures. Existing treatment recommendations based on the Bartoníček/Rammelt classification correspond to the therapy algorithm carried out in this cohort of patients.<b>Levels of Evidence:</b> Level III: Retrospective study.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"613-620"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Lateral X-Rays Reliably Determine Which Posterior Malleolus Ankle Fractures Need a CT?","authors":"Ayush Thomas, Ryan Fredette, George Han, Patrick Curtin, Eric Swart","doi":"10.1177/19386400221128159","DOIUrl":"10.1177/19386400221128159","url":null,"abstract":"<p><strong>Background: </strong>For rotational ankle fractures with a posterior malleolus fracture (PMF), the decision to further evaluate the ankle injury with computed tomography (CT) is challenging. The objective of this study is to determine how well PMF fracture size on x-rays correlates with size on CT, and how well x-rays can predict which patients receive PMF fixation after CT review.</p><p><strong>Methods: </strong>This is a retrospective study of adult ankle fractures with PMFs that had preoperative radiographs and CT imaging over a 5-year period. PMF x-ray and CT measurements were recorded, and relationships between x-ray measurements and final PMF fixation plan after CT review were evaluated.</p><p><strong>Results: </strong>A total of 98 patients were identified with both x-rays and preoperative CT imaging. Pearson's rank correlation demonstrated a strong relation between PMF width percentage measured on x-ray and CT (r = 0.724). Of the 45 patients with a PMF size under 20% on x-ray, only one patient (with an apparent incarcerated fragment) underwent PMF fixation after review of the CT.</p><p><strong>Conclusions: </strong>PMF width on lateral x-ray correlates well with CT size and is sensitive for predicting the need for dedicated posterior malleolus based on one institutional practice pattern. Below 20% fracture width on lateral x-ray, a dedicated CT rarely leads to a decision to perform PMF fixation. Limiting pre-operative CT to those with PMF width >20% could reduce CT utilization by as much as 45% without negatively affecting patient care.</p><p><strong>Levels of evidence: </strong>Level III: Diagnostic.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"585-591"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33501002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"May the Symptomatic Subtalar Joint Be Conservatively Treated With Intra-Articular Hyaluronic Acid Injections After a Calcaneus Fracture?","authors":"Henrique Mansur, Daniel Augusto Maranho, Isnar Moreira de Castro Junior, Fernanda Ferreira Gomes","doi":"10.1177/19386400211068256","DOIUrl":"10.1177/19386400211068256","url":null,"abstract":"<p><strong>Background: </strong>Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture.</p><p><strong>Methods: </strong>We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection.</p><p><strong>Results: </strong>Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week (<i>P</i> = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week (<i>P</i> = .001).</p><p><strong>Conclusion: </strong>For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement.</p><p><strong>Level of evidence: </strong>IV, Case series.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"537-544"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39596086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}