Aims. This paper documents the epidemiology of adults (aged more than 18 years) with a
Objectives. The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2
In this paper, we critically appraise the recent
publication of the United Kingdom Heel Fracture Trial, which concluded
that when patients with an absolute indication for surgery were
excluded, there was no advantage of surgical over non-surgical treatment
in the management of
Aims. Management of intra-articular
Aims. No randomized comparative study has compared the extensile lateral approach (ELA) and sinus tarsi approach (STA) for Sanders type 2
Three dimensional printing is an emerging new technology in medicine and the current educational value of 3D printed fracture models is unknown. The delayed surgery and need for CT imaging make
Introduction:. Although dislocation of the peroneal tendons (PT's) in association with
Purpose of the study: is to evaluate the wound healing problems following. Open reduction and internal fixation (ORIF) of
Persistent pain is a common cause of disability in patients after fractures of the calcaneum. Amongst the possible causes for post traumatic pain is the development of degenerative osteoarthritis of the posterior facet of the subtalar joint. However there are many other causes of post-traumatic hindfoot pain which require consideration prior to treatment. Knowledge of the patho-anatomy of
This is a case series report on the outcomes of patients that have received ORIF of their
Between 2000 and 2004 we used subtalar arthrodesis to treat 44 patients for continued pain after intra-articular
Background: Closed reduction of intra-articular
Aim. The optimal treatment of displaced intra-articular
We present a novel approach to the management of patients with longstanding heel ulcers complicated by open
The late results of treatment of
Different calcaneal plates with locked screws were compared in an experimental model of a
Materials &
Methods: A retrospective study. 25 cases of fracture Calcaneum during April 2001–2004 were reviewed for their clinical outcome. Aim of the study: To assess the clinical and functional outcome of the Management of Intra and Extra articular
Aims. Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. Methods. A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular
Aims. We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. Methods. HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peripheral vascular disease, or other significant limb injuries were excluded. Participants were randomly allocated to open reduction and internal fixation (ORIF) or nonoperative treatment. We report Kerr-Atkins scores, self-reported difficulty walking and fitting shoes, and additional surgical procedures at 36, 48, and 60 months. Results. Overall, 60-month outcome data were available for 118 patients (78%; 52 ORIF, 66 nonoperative). After 60 months, mean Kerr-Atkins scores were 79.2 (SD 21.5) for ORIF and 76.4 (SD 22.5) for nonoperative. Mixed effects regression analysis gave an estimated effect size of -0.14 points (95% confidence interval -8.87 to 8.59; p = 0.975) in favour of ORIF. There were no between group differences in difficulty walking (p = 0.175), or on the type of shoes worn (p = 0.432) at 60 months. Additional surgical procedures were conducted on ten participants allocated ORIF, compared to four in the nonoperative group (p = 0.043). Conclusion. ORIF of displaced intra-articular
Thirty-six patients with 39 fresh fractures of the calcaneus were investigated by standard radiography and by computerised tomography. It was found that the size and disposition of the fracture fragments and the degree of involvement of the posterior facet of the subtalar joint were more clearly shown by CT scanning. We recommend this technique for assessment and particularly for pre-operative planning.
Open reduction and internal fixation for displaced intra-articular fractures of the calcaneum has become an established method of treatment. A recent randomised, controlled trial has questioned the benefits of surgery, in particular, pain relief. We reviewed the cases undertaken in our department, complications, which have arisen, and their treatment. We have devised a management plan in conjunction with the department of plastic surgery to minimise the effect of these complications. There were 124 procedures carried out over a 12 years period, 116 unilateral and 4 bilateral in 120 patients (106 males and 14 females, age range [18 to 66]). Two further patients were included who had had surgery in another hospital and had been referred to our plastic surgery unit with significant wound complications. The patients were retrospectively assessed with a case note review and an updated clinical evaluation. The assessment focussed particularly on wound complications including breakdown classified as either major or minor, and association with infection, haematoma and drainage. Neurological symptoms were also noted. There were five major wound complications, three from our unit and two from another hospital. Infection was present in three cases. Four healed uneventfully but one of the infected group subsequently had a below knee amputation for refractory infection. Minor wound breakdown was more common. There was no association with haematoma or drainage but wound breakdown occurred more frequently in patients who smoked. Neurological complications were infrequent and temporary. In conclusion this study confirmed that there is a significant morbidity associated with the surgical management of these fractures, although, the vast majority of patients’ wounds healed uneventfully. With a sensible management plan, which involves working in conjunction with plastic surgeons, even major soft tissue complications may be addressed.
The patients were retrospectively assessed with a case note review and an updated clinical evaluation. The assessment focussed particularly on wound complications including breakdown classified as either major or minor, and association with infection, haematoma and drainage. Neurological symptoms were also noted.
Background. Traditionally, the extended lateral approach (ELA) was the favoured approch for
To identify the demographics, mechanisms of injury and treatment modalities of patients presenting at CHBAH with
Background. Optimal management of displaced intra-articular
The February 2023 Foot & Ankle Roundup. 360. looks at: Joint inflammatory response in ankle and pilon fractures; Tibiotalocalcaneal fusion with a custom cage; Topical application of tranexamic acid can reduce blood loss in
This edition of the Cochrane Corner looks at the three reviews that were published in the second half of 2023: surgical versus non-surgical interventions for displaced intra-articular
Treatment of comminuted intraarticular
Introduction. Intraarticular
Displaced intraarticular
Introduction:.
Böhler’s historical tuber-joint angle of the calcaneus has been used since 1931. Surprisingly, there is a paucity of literature on the topic. The aims of this study were to confirm the normal range for Böhler’s angle and determine the angle with the highest accuracy in the diagnosis of
Treatment of posterior malleolar (PM) ankle fractures remain controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the medium-to-long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation. A retrospective cohort study of patients aged 18–55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013 with PM ankle fractures was performed. Inclusion criteria were that all patients must mobilise independently pre-trauma, have no pre-existing ankle pathologies, and had satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar
Despite the current trend favoring surgical treatment of displaced intra-articular
Despite the current trend favoring surgical treatment of displaced intra-articular
Aims and objectives. The aim of this study was to statistically analyse the
Our study was undertaken to assess the inter- and intra-observer variability of the classification system of Sanders for
Introduction:. We report our 10-year experience of post-operative complications of
Introduction and purpose:
Introduction:. Percutaneous fixation of intraarticular
It is unclear whether combat casualties with complex hindfeet fractures would have an improved outcome with reconstruction or amputation. This study aimed to determine the outcomes of British military casualties sustaining
Background: We present the results of the surgical treatment of
Although modern operative intervention for
As the population ages, we can expect to see more elderly patients with
Opinions is divided among surgeons whether to operatively fix displaced
We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced
Opinions differ among surgeons whether to operatively fix displaced
Aim: The purpose of this study was to report the long-term follow-up (mean of 15 years) of patients with displaced intra-articular
Introduction and Objective. Management of bone loss associated with bone contamination or infection represents a double biological and clinical challenge frequent in traumatology. The advent of new biomaterials can allow a different approach in the treatment of bone gap. The purpose of this study was to evaluate the prophylactic and therapeutic effectiveness of addition of a new absorbable bone substitute (BS) eluting different antibiotics in reconstruction of bone defects after infections and fractures with soft tissue damage. Materials and Methods. We conducted a review of patients with contaminated or infected bone defects treated using a new biomaterial, a porous composite of collagen matrices and Beta tricalcium phosphate (β TCP), able to provide a long-term release of different antibiotics. We have included treatment of osteomyelitis and osteosynthesis of exposed fracture (Gustilo Anderson 1–3b) or fractures with soft tissue damage and high risk of contamination. Surgical technique included debridement filling bone defect with BS eluting antibiotics, osteosynthesis (plate, nail, external fixator, kirschner wire), soft tissue coverage, and systemic antibiotic therapy. Radiographic and clinical data including complications (wound dehiscence, superficial or deep infection, osteomyelitis) were collected. Results. We treated 25 patients (21 male, 4 female) with mean age 47 yrs. (range 21–83). The locations treated (for incidence) was: 9 femurs (7 plates, 2 nail), 7 calcanei (one bilateral), 3 tibias, 2 forearms, 2 metatarsi, 2 hands, 1 elbow. 6 patients had large bone loss. 7 patients had bone infections (4 were Cierny Madern 4); 8 patients had osteosynthesis of exposed fractures Gustilo Anderson 1–3b (9 plate, one bilateral calcaneus). 8 patients had treatment for pseudoarthrosis of exposed fractures (6 femurs, 1 forearm, 1 metatarsus) and 3 patients a prophylactic treatment for
The June 2014 Foot &
Ankle Roundup. 360 . looks at: peroneal tendon tears associated with
We reviewed in retrospect the preliminary results of ilizarov type fixator for the treatment of severely comminuted
Introduction. We present a consecutive series of 19 patients with 22 intra-articular
Introduction: There is a controversy regarding conservative or surgical treatment of
Objectives. This study aimed to investigate the functional effects of microRNA (miR)-214-5p on osteoblastic cells, which might provide a potential role of miR-214-5p in bone fracture healing. Methods. Blood samples were obtained from patients with hand fracture or intra-articular
Aims: A study was undertaken using foot pressure analysis, to assess the biomechanical outcomes following
We report the 15 year follow-up of displaced intra-articular
The October 2014 Foot &
Ankle Roundup360 looks at: multilayer compression bandaging superior for post-traumatic ankle oedema; compression stockings for ankle fractures; weight bearing ok in Achilles tendon ruptures; MRI findings can predict ankle sprain symptoms; salvage for malreduced ankle fractures; locking fibular plates are more expensive; is fixation better early or late in pilon
The February 2015 Trauma Roundup. 360 . looks at: Evaluating the syndesmosis in ankle
The October 2013 Foot &
Ankle Roundup. 360 . looks at: Operative treatment of
Aim: The aim of the study is to evaluate the usefulness of the MDCT scan in the diagnosis of
Introduction: The aim of our study was to assess any difference in outcome between non-surgical and surgical treatment of displaced
Background: The reported incidence of calcaneocuboid joint (CCJ) involvement in
The December 2013 Trauma Roundup. 360 . looks at: Re-operation for intertrochanteric hip fractures; Are twin incisions better than one round the acetabulum?; Salvage osteotomy for
The December 2014 Trauma Roundup. 360 . looks at: infection and temporising external fixation; Vitamin C in distal radial fractures; DRAFFT: Cheap and cheerful Kirschner wires win out; femoral neck fractures not as stable as they might be; displaced sacral fractures give high morbidity and mortality; sanders and
The June 2013 Foot &
Ankle Roundup. 360 . looks at: soft-tissue pain following arthroplasty; pigmented villonodular synovitis of the foot and ankle; ankles, allograft and arthritis; open
The August 2013 Foot &
Ankle Roundup. 360 . looks at: mobility, ankles and fractures; hindfoot nailing: not such a bad option after all?; little treatment benefit for blood injection in tendonitis; fixed bearing ankles successful in the short term; hindfoot motion following STAR ankle replacement; minimally invasive
Anti-vehicle mines (AV) and Improvised Explosive Devices (IEDs) remain the most prevalent threat to Coalition troops operating in Iraq and Afghanistan. Detonation of these devices results in rapid deflection of the vehicle floor resulting in severe injuries to calcaneus. Anecdotally referred to as a ‘deck-slap’ injury, there have been no studies evaluating the pattern of injury or the effect of these potentially devastating injuries since World War II. Therefore the aim of this study is to determine the pattern of injury, medical management and functional outcome of UK Service Personnel sustaining calcaneal injuries from under-vehicle explosions. From Jan 2006 – Dec 2008, utilising a prospectively collected trauma registry (Joint Theatre Trauma Registry, JTTR), the records of all UK Service Personnel sustaining a fractured calcaneus from a vehicle explosion were identified for in depth review. For each patient, demographic data, New Injury Severity Score (NISS), and associated injuries were recorded. In addition, the pattern of
These results support the use of an injectable, in situ hardening calcium phosphate paste to prevent the early loss of calcaneal height and maintain a more anatomic calcaneal reduction. The purpose of this prospective randomized controlled trial was to determine whether ORIF plus an injectable bioresorbable calcium phosphate paste (_-BSM) is superior or inferior to ORIF alone in the treatment of calcaneal bone voids encountered after operative treatment of displaced intraarticular fractures of the calcaneus. Forty-four patients (forty-eight displaced intraarticular
The August 2014 Trauma Roundup. 360 . looks at: On-table CT for
Introduction The results of open reduction and internal fixation of displaced intra-articular
We describe the surgical technique and results of arthroscopic subtalar release in 17 patients (17 feet) with painful subtalar stiffness following an intra-articular
We have devised a new scoring system using visual analogue scales (VAS) to determine the functional outcome in 15 patients with 20 displaced intra-articular
A consensus regarding management of
Aims: Internal Fixation of complex
Purpose: We wanted to ascertain whether the advantages of functional treatment on trophicity could be combined with the advantages of surgical treatment on anatomic results in patients with displaced
Tarsal fractures are rare in children. Clinical and radiographic evaluation of these injuries can be difficult. We present a retrospective study documenting all tarsal fractures presenting to an inner-city children’s hospital in the UK over a fifteen year period. Of 70 case notes retrieved from the hospital database, 7 patients were excluded due to inadequate data. This resulted in 69 tarsal injuries in 63 patients being included. Mean age at presentation was 9.3 years (2.5 – 13.9). 80% were male. 72% were
Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intraarticular
Aim: Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intra-articular
Introduction and purpose:
CT- scan as an management tool is being used extensively in managing
Between June 1996 and April 2002, 56 patients underwent closed reduction and percutaneous fixation of
Background: The Calcaneus is the largest of the tarsal bones. 2% of all adult and 60 % of all tarsal fractures involve the Calcaneus. A true consensus regarding the management of these fractures still eludes orthopaedic surgeons. While operative treatment for displaced fractures has gained more acceptance in the last decade, surgical morbidity still remains high. Aim: A retrospective review of the early complications and radiological outcomes following open reduction and internal fixation of displaced
The purpose of this study was to present the long team functional results after conservative treatment of intraarticular
Introduction: The optimal treatment of intra-articular
Introduction. Considerable controversy exists with regard to the surgical management of displaced intra-articular
The purpose of the study was to perform an independent assessment of the results of open reduction and internal fixation (ORIF) on a selected group of displaced intra-articular
The purpose of the study was to perform an independent assessment of the results of open reduction and internal fixation (ORIF) on a selected group of displaced intra-articular
To evaluate the cost-effectiveness of operative versus non-operative management of displaced intra-articular
This study aimed to establish the optimal fixation methods for calcaneal tuberosity avulsion fractures with different fragment thicknesses in a porcine model. A total of 36 porcine calcanea were sawed to create simple avulsion fractures with three different fragment thicknesses (5, 10, and 15 mm). They were randomly fixed with either two suture anchors or one headless screw. Load-to-failure and cyclic loading tension tests were performed for the biomechanical analysis.Aims
Methods
Displaced intra-articular fractures of the calcaneus need anatomic reduction of the joint surfaces and overall shape to restore function and minimize the risk of posttraumatic subtalar arthritis. The morbidity associated with extended approaches is a major concern. In the present study we compared the medium-term results after percutaneous reduction and screw fixation (PRSF) with that of open reduction and internal fixation (ORIF) for displaced fractures with less severe fracture patterns (Sanders type II). Material and Methods: In a matched cohort study from March 1998 to October 2004 the results of 36 patients treated either with PRSF or ORIF for displaced Sanders type II
Arthrodesis of both the ankle and the hindfoot has been discussed in the literature since the early part of the last century. Techniques have been modified substantially since these early discussions, though complications remain a frustrating element in patient management. Early procedures relied on molded plaster casts to hold fixation in corrected positions. Successful outcomes were hampered by loss of reduction in these casts and subsequent malunions. In addition, motion within these casts lead to a high rate of nonunion between the opposed bony surfaces. The era of internal fixation allowed compression across arthrodesis sites, enhancing union but creating a host of technical errors leading to unsatisfying results. Malunion is also seen in post-traumatic situations. In particular, non-operative management of calcaneus fracture (or other hindfoot fractures) leads to not only arthritis of the involved joint surfaces, but malunion complicating successful fusion. Fusion in-situ leads to a high level of patient dissatisfaction, leading surgeons to challenging deformity correction while trying to achieve successful arthrodesis in compromised joints. This lecture will focus on two types of malunion, one iatrogenic, one acquired. Revision triple arthrodesis (iatrogenic) can range from simple to challenging. A variety of studies document patient dissatisfaction following correction via this technique, ranging from Graves and Mann (1993) where the highest dissatisfaction rate was in highest in valgus malunion, to Sangeorzan and Hansen (1993), who found a 9% failure rate, most with varus malunion. The precarious balance required to create a plantigrade foot via triple arthrodesis with pre-existing deformity leaves even the most skilled surgeon challenged. As such, this component of the lecture will focus on recognition and correction of malunion based on a structured algorithmic approach we first presented in 1997. This algorithm is based on recognition of the apex of the deformity, and creating osteotomies to achieve balance. We reviewed 28 patients who returned for follow-up examination who received treatment through this algorithm and found a statistically significant improvement in pre- and postoperative AOFAS ankle/hindfoot score, from an average of 31 points preoperatively to 59 postoperatively (p<0.01). All patients united, and all stated they would undergo the revision procedure again. Comparisons of pre- and postoperative shoe wear modification demonstrated a statistically significant improvement (p=0.01). Preoperatively, 20 patients required restrictive devices such as ankle foot orthoses and orthopaedic shoes. Postoperatively, only 1 patient required such a restrictive device. In fact, 17 patients required no modifications to their shoe wear at all. The second component to this lecture will assess acquired hindfoot deformity, from malunion created by calcaneus fractures. A 2005 JBJS study by Brauer, et.al. found operative management resulted in a lower rate of subtalar arthrodesis with a shorter time off work compared to non-operative management. Removing the expense of time off work still netted a $2800 savings for operative management over non-operative management. Sanders echoed these thoughts in a JBJS 2006 paper, suggesting patients with displaced intra-articular
Background. This study analyzes position of the peroneal tendons and status of the superior peroneal retinaculum (SPR) whenever a lateral malleolar bony flake fracture occurs. Methods. Twenty-four patients had a lateral malleolar bony fleck on anteroposterior ankle radiographs, either in isolation or associated with other hindfoot injuries. We studied size of the bony flecks, presence or absence of peroneal tendon dislocation and pathoanatomy on CT scans. Results. In 11 patients, a small bony fleck lies within the superior peroneal retinaculum and contiguous periosteum, which are stripped off the lateral fibula (Class II lesions). Tendons dislocate into the subperiosteal pouch thus formed, resembling Class I lesions without associated bony avulsion. Treatment for Class II is same as for Class I injuries. In 8 patients with big bony fleck, tendons dislocate into the fracture site and SPR is intact (Class III lesions). Surgical approach for tendon relocation and bone fixation differs. In particular, the intact attachment of the SPR on the bony fleck must not be incised. The healing process of neglected Class III lesions resembles a groove deepening procedure, representing an attempt to form a stable platform for the dislocated tendons. A neglected Class II lesion resembles a neglected Class I lesion. In Class IV lesions, observed in 5 patients with 2-part
The August 2023 Foot & Ankle Roundup360 looks at: Achilles tendon rupture: surgery or conservative treatment for the high-demand patient?; First ray amputation in diabetic patients; Survival of ankle arthroplasty in the UK; First metatarsophalangeal joint fusion and flat foot correction; Intra-articular corticosteroid injections with or without hyaluronic acid in the management of subtalar osteoarthritis; Factors associated with nonunion of post-traumatic subtalar arthrodesis; The Mayo Prosthetic Joint Infection Risk Score for total ankle arthroplasty.
The December 2022 Trauma Roundup360 looks at: Anterior approach for acetabular fractures using anatomical plates; Masquelet–Ilizarov for the management of bone loss post debridement of infected tibial nonunion; Total hip arthroplasty – better results after low-energy displaced femoral neck fracture in young patients; Unreamed intramedullary nailing versus external fixation for the treatment of open tibial shaft fractures in Uganda: a randomized clinical trial; The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK; Cost-utility analysis of cemented hemiarthroplasty versus hydroxyapatite-coated uncemented hemiarthroplasty; Unstable ankle fractures: fibular nail fixation compared to open reduction and internal fixation; Long-term outcomes of randomized clinical trials: wrist and calcaneus; ‘HeFT’y follow-up of the UK Heel Fracture Trial.
Since 2008 the improvised explosive device has been responsible for a significant proportion of injuries sustained whilst on operational duty in Afghanistan. Vehicles have been developed and adapted to offer maximal protection to service personnel. As a result of the decrease in mortality, there has been an increase in the severity of injuries to the lower limb. Hind-foot injuries are a difficult cohort of injuries to treat successfully. Those that are amenable to reconstruction carry a significant morbidity, which may result in either early or delayed amputation. There has been a new injury pattern to the lower limb, not previously described in the medical literature. This pattern consists of a displaced intra-articular