The rationale for exacting restoration of skeletal anatomy after unstable ankle fracture is to improve outcomes by reducing complications from malunion; however, current definitions of malunion lack confirmatory clinical evidence. Radiological (absolute radiological measurements aided by computer software) and clinical (clinical interpretation of radiographs) definitions of malunion were compared within the Ankle Injury Management (AIM) trial cohort, including people aged ≥ 60 years with an unstable ankle fracture. Linear regressions were used to explore the relationship between radiological malunion (RM) at six months and changes in function at three years. Function was assessed with the Olerud-Molander Ankle Score (OMAS), with a minimal clinically important difference set as six points, as per the AIM trial. Piecewise linear models were used to investigate new radiological thresholds which better explain symptom impact on ankle function.Aims
Methods
Introduction. Fixation of posterior malleolar fragments associated with ankle fractures aims to stabilise the syndesmosis and prevent posterior
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
Introduction:. Although dislocation of the peroneal tendons (PT's) in association with calcaneal fractures has been described over 25 years ago, it frequently passes unrecognised by radiologists and orthopaedic surgeons. This retrospective study aims to determine the prevalence of PT dislocation in association with calcaneal fractures at a single institution and describe systematic steps to avoid missed diagnosis at each stage of management. Methods:. CT scans of all patients with calcaneal fractures from the Picture Archiving and Communications System (PACS) from 2010 were systematically reviewed. The senior author and a Musculoskeletal Radiologist analysed the images for concomitant dislocation or
We investigated 60 patients (89 feet) with a
mean age of 64 years (61 to 67) treated for congenital clubfoot deformity,
using standardised weight-bearing radiographs of both feet and ankles
together with a functional evaluation. Talocalcaneal and talonavicular
relationships were measured and the degree of osteo-arthritic change
in the ankle and talonavicular joints was assessed. The functional
results were evaluated using a modified Laaveg-Ponseti score. The
talocalcaneal (TC) angles in the clubfeet were significantly lower
in both anteroposterior (AP) and lateral projections than in the
unaffected feet (p <
0.001 for both views). There was significant
medial
Rocker bottom deformity may occur during the conservative treatment of idiopathic congenital clubfoot. Between 1975 and 1996, we treated 715 patients (1120 clubfeet) conservatively. A total of 23 patients (36 feet; 3.2%) developed a rocker bottom deformity. It is these patients that we have studied. The pathoanatomy of the rocker bottom deformity is characterised by a plantar convexity appearing between three and six months of age with the hindfoot equinus position remaining constant. The convexity initially involves the medial column, radiologically identified by the talo-first metatarsal angle and secondly by the lateral column, revealed radiologically as the calcaneo-fifth metatarsal angle. The apex of the deformity is usually at the midtrasal with a dorsal calcaneocuboid
Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint
In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up.Aims
Methods
We describe the medium-term results of a prospective study of 200 total ankle replacements at a single-centre using the Scandinavian Total Ankle Replacement. A total of 24 ankles (12%) have been revised, 20 by fusion and four by further replacement and 27 patients (33 ankles) have died. All the surviving patients were seen at a minimum of five years after operation. The five-year survival was 93.3% (95% confidence interval (CI) 89.8 to 96.8) and the ten-year survival 80.3% (95% CI 71.0 to 89.6). Anterior
Introduction. The attachment of the plantar aponeurosis to the proximal phalanx of the toe, through the plantar plate (PP), forms the main flexor of the toe during gait by the reversed windlass mechanism. Disruption of the plantar plate is a common cause of pain, instability and toe deformity. Surgical techniques have recently been described to repair tears but long term results are awaited. This study aims to review the results of a technique designed to reconstruct and reinforce the failed plantar plate and restore the reversed windlass. Methods. Through a dorsal extra-articular approach the EDL tendon of the affected toe is used to restore the mechanical link between the proximal phalanx and the plantar aponeurosis on the plantar aspect of the joint. 42 PP reconstructions in 39 patients (36 female) aged 44–72 were undertaken, most frequently on the 2. nd. toe. 25 required correction of hallux valgus and four had undergone this previously. Follow up was 2–81 months. Results. Normal alignment and joint stability was obtained in 33 toes (81%). These patients reported no pain and were completely satisfied with the final result. Recurrence of the deformity with an unstable joint occurred in 8 toes, requiring revision surgery. Failure was more likely with pre-operative dislocation, lateral
The diagnosis of Lisfranc ligament disruption is notoriously difficult. Radiographs and MRI scans are often ambiguous therefore a stress-test examination under anaesthesia is commonly required. Two midfoot stress-tests are in current practice, namely the varus first ray stress-test and the pronation abduction test. The optimal type of stress-test is not however evaluated in the literature. We hypothesised that after the loss of the main plantar stabiliser (the Lisfranc ligament) the patient would demonstrate dorsal instability, not the classic 1. st. /2. nd. metatarsal diastasis commonly described. We therefore devised a push-up test (placement of a force under the 2. nd. metatarsal in an attempt to elevate the base away from the middle cuneiform on the lateral radiograph). We aimed to initially test our hypothesis on a cadaveric model. Twelve fresh frozen cadaveric specimens without previous foot injury were used. The 2. nd. tarsometatarsal joint was exposed and the Lisfranc ligament and dorsal capsule were incised. An image intensifier was positioned and standard anteroposterior (AP) and lateral views were obtained. Two previously reported AP stress-tests (varus first ray stress test, pronation abduction test) and the novel test under investigation (‘Lisfranc Push-Up’ test) were duly performed. Images were obtained once the investigator felt the appropriate views were achieved. All twelve of the Lisfranc Push-Up tests showed dorsal
Introduction:. All reported RA forefoot deformities in the literature so far have arisen from shoe wearing populations. Our aim in this study was to compare hallucal deformities seen in a shod to a non-shod population. Methods:. A case-control study was undertaken in two specialist foot and ankle units, one in India and one in the UK. All patients suffering from RA and attending for consideration of forefoot surgery from January 2007 to October 2013 were included in this study. Standardized anteroposterior weight bearing radiographs were obtained to measure the hallux valgus, inter-metatarsal and metatarsus primus varus angles. Results:. In the shod population, there was 1 hallux varus deformity, 10 without hallucal deformity and 90 feet with varying degrees of hallux valgus deformity. In contrast, in the unshod population, there were 19 hallux varus deformities and 6 hallux valgus deformities. There was great variability in the lesser toe deformity seen. In the shod population, it was most common to see dorsal
Introduction:. Isolated Weber B lateral malleolus fractures heal uneventfully, but concern that late
Introduction:. Cone Based CT (CBCT) scanning uses a point source and a planar detector with parallel data acquisition and volumetric coverage of the area of interest. The pedCAT (Curvebeam USA) scanner is marketed as a low radiation dose, compact, faster and inexpensive CT scanner that can be used to obtain both non- weightbearing and true 3 dimensional weightbearing views. Method:. A review of the first 100 CBCT scanning in our unit has been performed to assess ease of scanning, imaging time, radiation dose and value of imaging as opposed to conventional imaging. Results:. A pedcat CT scan was available within minutes of the request, similar to plain radiographs but much earlier than a 6 week delay for a patient to attend a new appointment for a conventional CT. All patients returned to see the clinician for a clinical decision in the same NHS clinic and did not require a new clinic visit; illustrative cases include fracture/
Background. The Weil osteotomy is successful in the management of metatarsalgia and toe deformity. The aim is to achieve controlled shortening whilst avoiding plantarflexion. Recognised complications of the Weil osteotomy include a ‘floating toe’ in up to 20% or more of cases. Aim. Can modification of the Weil osteotomy avoid the metatarsal head plantarflexion and subsequent dorsal
Introduction. There are a number of options available for surgical management of hallux rigidus. Ceramic implants of the first metatarsophalangeal joint (MTPJ) have been available for years; however there are no published long-term results existing. Methods. We performed a retrospective review of all consecutive first MTPJ replacements carried out for later stage hallux rigidus using second generation MOJE ceramic implant with press-fit design. Two specialised foot and ankle surgeons performed these operations at a tertiary referral centre. Patient underwent regular follow ups including clinical review, functional scoring (AOFAS and FFI) and assessment of radiographs. Kaplan Meyer Survival analysis was performed. Results. Our study included 31 prostheses in 24 female patients. Average age at operation was 55.3 years and average follow up time was 80 months. No patients were lost until follow up. Complications included one case of superficial infection and five cases of revision, reasons being fracture of the prostheses (1), unexplained pain (1),
Peroneal tendon
Isolated dislocations of the navicular are rare injuries; we present our experience of six cases in which the navicular was dislocated without fracture. All patients had complex injuries, with considerable disruption of the midfoot. Five patients had open reduction and stabilisation with Kirschner wires. One developed
The purpose of this study was to evaluate the
change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA)
for osteoarthritis and to investigate factors affecting the restoration
of alignment. This retrospective study included 119 patients (120 ankles) who
underwent three component TAA using the Hintegra prosthesis. A total
of 63 ankles had anterior displacement of the talus before surgery
(group A), 49 had alignment in the normal range (group B), and eight
had posterior displacement of the talus (group C). Ankles in group
A were further sub-divided into those in whom normal alignment was
restored following TAA (41 ankles) and those with persistent displacement
(22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more
varus than that in group B, and the posterior slope of the tibial
plafond was greater (p <
0.01 in both cases). The posterior slope
of the tibial component was strongly associated with restoration
of alignment: ankles in which the alignment was restored had significantly
less posterior slope (p <
0.001). An anteriorly translated talus was restored to a normal position
after TAA in most patients. We suggest that surgeons performing
TAA using the Hintegra prosthesis should aim to insert the tibial
component at close to 90° relative to the axis of the tibia, hence
reducing posterior soft-tissue tension and allowing restoration
of normal tibiotalar alignment following surgery. Cite this article:
Involvement of the posterior malleolus in fractures of the ankle
probably adversely affects the functional outcome and may be associated
with the development of post-traumatic osteoarthritis. Anatomical
reduction is a predictor of a successful outcome. The purpose of this study was to describe the technique and short-term
outcome of patients with trimalleolar fractures, who were treated
surgically using a posterolateral approach in our hospital between
2010 and 2014. The study involved 52 patients. Their mean age was 49 years (22
to 79). There were 41 (79%) AO 44B-type and 11 (21%) 44C-type fractures.
The mean size of the posterior fragment was 27% (10% to 52%) of
the tibiotalar joint surface.Aims
Patients and Methods