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Aims

Arthroscopic microfracture is a conventional form of treatment for patients with osteochondritis of the talus, involving an area of < 1.5 cm2. However, some patients have persistent pain and limitation of movement in the early postoperative period. No studies have investigated the combined treatment of microfracture and shortwave treatment in these patients. The aim of this prospective single-centre, randomized, double-blind, placebo-controlled trial was to compare the outcome in patients treated with arthroscopic microfracture combined with radial extracorporeal shockwave therapy (rESWT) and arthroscopic microfracture alone, in patients with ostechondritis of the talus.

Methods

Patients were randomly enrolled into two groups. At three weeks postoperatively, the rESWT group was given shockwave treatment, once every other day, for five treatments. In the control group the head of the device which delivered the treatment had no energy output. The two groups were evaluated before surgery and at six weeks and three, six and 12 months postoperatively. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. Secondary outcome measures included a visual analogue scale (VAS) score for pain and the area of bone marrow oedema of the talus as identified on sagittal fat suppression sequence MRI scans.


Bone & Joint Open
Vol. 4, Issue 12 | Pages 957 - 963
18 Dec 2023
van den Heuvel S Penning D Sanders F van Veen R Sosef N van Dijkman B Schepers T

Aims

The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS).

Methods

All patients included in the ‘ROutine vs on DEmand removal Of the syndesmotic screw’ (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups.


The Bone & Joint Journal
Vol. 103-B, Issue 11 | Pages 1709 - 1716
1 Nov 2021
Sanders FRK Birnie MF Dingemans SA van den Bekerom MPJ Parkkinen M van Veen RN Goslings JC Schepers T

Aims

The aim of this study was to investigate whether on-demand removal (ODR) is noninferior to routine removal (RR) of syndesmotic screws regarding functional outcome.

Methods

Adult patients (aged above 17 years) with traumatic syndesmotic injury, surgically treated within 14 days of trauma using one or two syndesmotic screws, were eligible (n = 490) for inclusion in this randomized controlled noninferiority trial. A total of 197 patients were randomized for either ODR (retaining the syndesmotic screw unless there were complaints warranting removal) or RR (screw removed at eight to 12 weeks after syndesmotic fixation), of whom 152 completed the study. The primary outcome was functional outcome at 12 months after screw placement, measured by the Olerud-Molander Ankle Score (OMAS).


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_14 | Pages 8 - 8
1 Dec 2015
Mushtaq N Al Obaidi B Iranpour F Bhattacharya R
Full Access

Introduction. Different techniques for fixation of lateral malleolus have been described. We report our results of using fibula rod for unstable ankle fractures in level one major trauma centre. Methods. We reviewed the results of 40 ankle fractures (14 open and 26 closed) with significant soft tissue injuries and open fractures that were treated with a fibula rod between 2012 and 2015. The median age of patients was 60 (17–98 years). Results. Satisfactory fracture reduction was achieved in all of these patients Two patients had loss of syndesmosis fixation. All fibula fractures healed but 3 medial malleolus non unions occurred which did not need further surgery. 1 patient developed post-operative deep infection and had removal of metalwork. The median physical component Short-Form 12 (PSF12), Olerud and Molander score (OMS), and American Academy of Orthopaedic Surgeons Foot and Ankle outcome scores (AOFAS) were 40 (19 to 52), 57 (0 to 85) and 75 (20 to 95), respectively. The median PSF12, OMS and AOFAS were 33, 35 and 47 for open fractures and 42, 60 and 78 for closed fractures respectively. Conclusion. Using the fibula rod resulted in good radiological and satisfactory functional outcomes with minimal complications. In spite of lower scores in the open fracture group, only one patient needed removal of metal work for deep infection. We recommend using the fibula rod in unstable ankle fracture in patients with significant soft tissue injuries and consider its use in open injuries


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 17 - 17
1 Nov 2014
Siddiqui M Brogan K Rymaszewski L Atiya S Kumar CS
Full Access

Introduction:. Isolated Weber B lateral malleolus fractures heal uneventfully, but concern that late subluxation may occur due to unrecognised medial ligament tearing, despite an intact mortice on initial radiographs, often results in overtreatment. The aim of this study was to determine the incidence of late talar shift with nonoperative management in a cohort of patients with no initial talar shift, and also record functional outcomes at 16–28 months following injury. Methods:. This was a retrospective review of 129 patients with Weber B lateral malleolar fractures initially referred to the fracture clinic between October 2011 and October 2012. Eight had obvious talar shift and therefore underwent surgery, with the remaining 121 treated in plaster (n=41), a Velcro boot (n=70) or bandage (n=10). No stress x-rays or MRI scans were performed. Weight-bearing was permitted as pain allowed. Radiographs taken on discharge from the clinic were reviewed to assess talar shift. Functional outcomes assessment was carried out using Manchester Oxford Foot Questionnaire and Olerud-Molander score. Results:. None of the 121 patients had talar shift initially; 21 patients where medial injury was strongly suspected were closely followed and had check x-rays more often (average 2.9 appointments per patient) than the other groups. No patients had talar shift in any of the subsequent x-rays and therefore none underwent delayed internal fixation. The mean MOXFQ and Olerud-Molander scores were 27 and 78 respectively in 57 patients and the functional outcomes were not influenced by type of immobilisation or suspected medial injury. Conclusion:. Our observation is that the risk of late talar shift is likely to be low in patients where initial x-rays had showed no talar displacement. It may be unnecessary to perform additional tests/imaging to establish the integrity of the medial ligament as satisfactory functional results are routinely observed


The Bone & Joint Journal
Vol. 102-B, Issue 3 | Pages 345 - 351
1 Mar 2020
Pitts C Alexander B Washington J Barranco H Patel R McGwin G Shah AB

Aims

Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion.

Methods

We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome.


The Bone & Joint Journal
Vol. 101-B, Issue 4 | Pages 447 - 453
1 Apr 2019
Sanders FRK Backes M Dingemans SA Hoogendoorn JM Schep NWL Vermeulen J Goslings JC Schepers T

Aims

The aim of this study was to evaluate the functional outcome in patients undergoing implant removal (IR) after fracture fixation below the level of the knee.

Patients and Methods

All adult patients (18 to 75 years) undergoing IR after fracture fixation below the level of the knee between November 2014 and September 2016 were included as part of the WIFI (Wound Infections Following Implant Removal Below the Knee) trial, performed in 17 teaching hospitals and two university hospitals in The Netherlands. In this multicentre prospective cohort, the primary outcome was the difference in functional status before and after IR, measured by the Lower Extremity Functional Scale (LEFS), with a minimal clinically important difference of nine points.


The Bone & Joint Journal
Vol. 100-B, Issue 10 | Pages 1352 - 1358
1 Oct 2018
Clough TM Alvi F Majeed H

Aims

Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent.

Patients and Methods

A total of 278 consecutive total ankle arthroplasties (251 patients), performed by four surgeons over a six-year period in Wrightington Hospital (Wigan, United Kingdom) were prospectively reviewed. There were 143 men and 108 women with a mean age of 64 years (41 to 86). The data were recorded on each follow-up visit. Any complications either during initial hospital stay or subsequently reported on follow-ups were recorded, investigated, monitored, and treated as warranted. Literature search included the studies reporting the outcomes and complications of TAA implants.


The Bone & Joint Journal
Vol. 98-B, Issue 9 | Pages 1197 - 1201
1 Sep 2016
Ashman BD Kong C Wing KJ Penner MJ Bugler KE White TO Younger ASE

Aims

Patients with diabetes are at increased risk of wound complications after open reduction and internal fixation of unstable ankle fractures. A fibular nail avoids large surgical incisions and allows anatomical reduction of the mortise.

Patients and Methods

We retrospectively reviewed the results of fluoroscopy-guided reduction and percutaneous fibular nail fixation for unstable Weber type B or C fractures in 24 adult patients with type 1 or type 2 diabetes. The re-operation rate for wound dehiscence or other indications such as amputation, mortality and functional outcomes was determined.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 8 | Pages 1100 - 1106
1 Aug 2010
Kapoor SK Kataria H Patra SR Boruah T

Open reduction and internal fixation of high-energy pilon fractures are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. A total of 17 consecutive patients with pilon fractures of AO/OTA type 43-B3 (n = 1), type C2 (n = 12) and type C3 (n = 4) were treated by indirect reduction by capsuloligamentotaxis and stabilisation using an ankle-spanning Ilizarov fixator. The calcaneal ring was removed at a mean of 3.7 weeks (3 to 6). A total of 16 patients were available for follow-up at a mean of 29 months (23 to 43). The mean time to healing was 15.8 weeks (13 to 23). Nine patients had pin-track infections but none had deep infection or osteomyelitis. Four patients (25%) had malunion. Fair, good or excellent ankle scores were found in 14 patients. External fixation with a ring fixator achieves stable reduction of the fractured fragments without additional trauma to soft tissues.

With minimum complications and good healing results, the Ilizarov apparatus is particularly useful for high-energy pilon fractures.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 6 | Pages 772 - 777
1 Jun 2007
von Knoch F Reckord U von Knoch M Sommer C

We investigated the clinical and radiological outcome after unilateral fracture of the lateral process of the talus in 23 snowboarders with a mean follow-up of 3.5 years (12 to 76 months). In this consecutive cohort study both operative and non-operative cases were considered.

The mean American Orthopaedic Foot and Ankle Society hindfoot score was 94 (82 to 100). The non-operative group of seven with a minimally-displaced fracture scored higher (98 points) than the operative group of 16 with displaced or unstable fractures (93 points). In 88% of operative cases, significant concomitant hindfoot injuries were found at operation. All but eight (35%) patients (six operative and two non-operative) regained their pre-injury level of sporting activity. Subtalar osteoarthritis was present in nine (45%) of the 20 patients available for radiological review, including one late-diagnosed non-operative case and eight operative cases with associated injuries or fracture comminution.

The outcome after fracture of the lateral process of the talus in snowboarders is favourable provided an early diagnosis is made and adequate treatment, which is related to the degree of displacement and associated injuries, is undertaken.