Intraoperative radiation therapy for brain metastasis in a pregnant patient: a case report.

We present the rare case of a 42-year-old woman with oligometastatic lung adenocarcinoma in her first trimester of pregnancy who was treated for brain metastases with metastasectomy and intraoperative radiation therapy (IORT) using the INTRABEAM® system (Zeiss AG, Jena, Germany). This case underscores the potential of IORT in optimizing cancer treatment while safeguarding fetal health in pregnant patients.

Patient-reported outcome measures in studies on hallux valgus surgery: what should be assessed.

INTRODUCTION: In recent years, there has been an increasing demand for patient-reported outcome measures (PROMs) to assess the outcome following orthopedic surgery. But, we are lacking a standard set of PROMs to assess the outcome of hallux valgus surgery. The aim of this study was to analyze the chosen patient rated outcome scores used in studies reporting on hallux valgus surgery. MATERIALS AND METHODS: The study was based on a previously published living systematic review. Included were prospective, comparative studies of different surgical procedures or the same procedure for different degrees of deformity. Four common databases were searched for the last decade. Study selection, data extraction, and risk of bias assessment were made by two independent reviewers. Data assessed were the individual PROMs used to assess the outcome of hallux valgus surgery. RESULTS: 46 studies (30 RCTs and 16 non-randomized prospective studies) met the inclusion criteria. The most commonly used clinical outcome measures were the AOFAS (55%) and the VAS (30%). No differences were found between frequency of the individual scores per the level of evidence or the type of osteotomy. CONCLUSION: Based on a systematic literature review, the AOFAS and VAS are the most frequently used outcome tools in studies assessing the outcome following hallux valgus surgery. Based on the literature available, the MOXFQ is a more valid alternative. LEVEL OF EVIDENCE: Level I; systematic review of prospective comparative (level II) and randomized controlled trials (level I).

Safe drilling zones for anteriorly, central, and posteriorly angulated syndesmotic stabilization devices.

PURPOSE: The purposes of the study were to (1) analyze the shape of the distal fibula at the location of syndesmotic stabilization and to (2) define safe zones at the distal-lateral fibula for three different drilling tunnel orientations: anteriorly-, posteriorly angulated and center-center. METHODS: Postoperative, bilateral CT images of adult patients that underwent syndesmotic stabilization (suture-button system) for an acute, unilateral ankle injury were analyzed. Manual axial CT reconstructions of the uninjured side were generated. First, the axial shape of the distal fibula was classified. The aspect ratio between the anterio-lateral and the posterior-lateral surfaces of the fibula was calculated to assess symmetry. Second, the same axial planes were used to define the safe zones. Each drilling-tunnel orientation (anterior, central, posterior) comprised a fixed medial tibial anchor point and a safe zone on the lateral fibula. For each of the three orientations, the most anteriorly and posteriorly drilling tunnel location was simulated. Next to a cumulative visual analysis, a quantitative analysis of the most anterior and posterior point on the anterio- and posterior-lateral surfaces was calculated. RESULTS: A total of 96 CT datasets were analyzed. (1) 81% of fibulae revealed a triangular convex-, 10% an irregular-, and 8% a quadrilateral shape. The lateral surface ratio was 1.0 ± 0.2 (range: 0.7-1.5), not differing between the fibula types (n.s.). (2) The safe corridor on the lateral surface of the fibula for an anteriorly angulated drilling tunnel was - 8% to - 41%, for a posteriorly angulated drilling tunnel was 0% to 46%, and for a center-center alignment - 7 ± 11% (range: - 28 to 18%). CONCLUSION: The meta-diaphyseal region of the distal fibula revealed a homogeneous crosssectional shape. The lateral apex of the fibula can serve as a landmark defining safe zones to place the drilling tunnels correctly. Applying these safe zones in clinical practice could help to avoid the misplacement of the syndesmotic fixation device. LEVEL OF EVIDENCE: Level III, retrospective radiographic study.

The distal metatarsal screw is not always necessary in third-generation MICA: a case-control study.

INTRODUCTION: To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron-Akin osteotomy (MICA) for hallux valgus deformities. MATERIALS AND METHODS: Between August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II-V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months. RESULTS: Displacement of MTH was 70-90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation. CONCLUSIONS: Fixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.

Pedobarographic evaluation of five commonly used orthoses for the lower extremity.

INTRODUCTION: Orthoses are designed to achieve immobilization or off-loading of certain regions of the foot. Yet, their off-loading capacity for the specific regions has not yet been studied. Therefore, the aim of this study was to analyze the plantar pressure distribution of five commonly applied orthoses for foot and ankle in a healthy population. MATERIALS AND METHODS: Five orthoses (postoperative shoe, forefoot relief shoe, short walker boot, high walker boot, and calcaneus fracture orthosis) were compared pedobarographically using insoles on a treadmill to a ready-made running shoe in eleven healthy subjects (median age 29 years). Peak pressure, maximum force, force-time integral, contact time, and contact area were evaluated separately for the forefoot, midfoot, and hindfoot. RESULTS: The forefoot relief shoe, the short- and high walker boot significantly reduced the peak pressure at the forefoot with no significant differences between these orthoses. None of the five orthoses off-loaded the midfoot, but the calcaneus fracture orthosis and the short walker boot instead increased midfoot load. For the hindfoot, the calcaneus fracture orthosis was the only device to significantly reduce the peak pressure. CONCLUSIONS: This is the first study to investigate the specific off-loading capacities of different orthoses for specific foot regions in a healthy collective. The knowledge of absolute and relative load shifts for the different orthoses is of fundamental interest for targeted clinical decision-making of physicians.

Immediate weight bearing without immobilization for operatively treated ankle fractures is safe - A systematic review.

BACKGROUND: This systematic literature review compared weight bearing (WB) vs. partial- / non-weight bearing (NWB) and mobilization (MB) vs. immobilization (IMB) for surgically treated ankle fractures. METHODS: Five databases were searched. Eligible were (quasi-)randomized controlled trials comparing at least two different postoperative treatment protocols. The risk of bias was assessed using the RoB-2 toolkit. The primary outcome was complication rate, secondary outcome Olerud and Molander Ankle Score (OMAS), range of motion (ROM), and return to work (RTW). RESULTS: Out of 10,345 studies, 24 papers were eligible. Thirteen studies (n = 853) compared WB/NWB, 13 studies (n = 706) MB/IMB with a moderate study quality. WB did not increase the risk for complications but resulted in superior short-term outcomes for OMAS, ROM, RTW. 12 studies found no inferior results for MB compared to IMB. CONCLUSION: Early and immediate WB and MB do not increase the complication rates but result in superior short term outcome scores. LEVEL OF EVIDENCE: Level I Systematic Review.

[Salvage options following failed total ankle arthroplasty]. / Revisionsmöglichkeiten nach gescheiterter Sprunggelenkprothese.

The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. The most frequent reasons for revision of an ankle prosthesis are aseptic loosening, technical implantation errors and persisting pain. For the revision of an ankle prosthesis there are basically two treatment options. For a long time, ankle arthrodesis was considered the gold standard after a failed prosthesis. In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.

[Aftercare following surgical treatment of ankle fractures : What is the current state of knowledge?] / Nachbehandlung von operativ versorgten Sprunggelenkfrakturen : Was ist der aktuelle Wissensstand?

BACKGROUND: Ankle fractures are among the most common fractures in adults but often with unsatisfactory long-term results. In recent years several new surgical treatment approaches have been developed but little has changed regarding the aftercare. The postoperative treatment can be divided into two main components, weight bearing and mobilization. In Germany most patients are still recommended to be immobilized with partial weight bearing for 6 weeks after surgery. OBJECTIVE: The aim of this review is to present the current evidence on postoperative treatment based on an extensive literature search. MATERIAL AND METHODS: A total of seven prospective randomized controlled trials (RCT) compared early and delayed full weight bearing and six RCTs compared ankle mobilization with a form of immobilization. RESULTS: In none of these studies did early full weight bearing lead to an increased complication rate but some studies found a shortened time before return to work and, at least in the short term, better clinical results. Immediate mobilization led to an increased complication rate in only one out of six studies. It also appeared that mobilization led to a reduced time before return to work and, in the short term, to better clinical outcomes. The comparability of the studies was limited as in most cases different clinical scores and parameters were collated. In addition, information on patient age, fracture type, bone quality, comorbidities, and the implants used was often inadequate and post-treatment regimens sometimes differed significantly. CONCLUSION: The early functional therapy following surgically treated ankle fractures increased the rate of wound healing complications in only one of 13 studies, otherwise there were no significant differences in complication rates; however, early functional therapy partly shortened the time to return to work and led to better clinical results in the short term. For future studies, standardization of the parameters assessed would be important to provide clear evidence-based guidelines on follow-up treatment for specific fractures and patient populations.

[Unguis incarnatus-conservative or operative treatment? A practical treatment algorithm]. / Unguis incarnatus ­ konservative oder operative Therapie? Ein praktischer Behandlungsalgorithmus.

Unguis incarnatus, an ingrown toenail, is a common condition in primary care, which is encountered by various medical professions. Inconsistent conservative treatment and nonindicated surgical treatment often result in complications and recurrence of the disease. Patients must be thoroughly informed about the complexity of the nail organ. This is a prerequisite to prevent trivialization of the disease and to achieve appropriate patient compliance for treatment. In this article a practical diagnostic and treatment algorithm for unguis incarnatus is presented. In mild cases of acute unguis incarnatus a consistent conservative treatment is the first-line strategy showing promising results. In cases of moderate to severe forms of acute unguis incarnatus, surgical procedures that preserve the nail matrix should be applied. For cases of chronic unguis incarnatus without an acute infection, elective partial matrixectomy can be indicated. Prior to any surgical intervention, detailed informed consent must be obtained from the patients.

[Arthroscopically assisted fracture treatment and open reduction of the posterior malleolus : New strategies for management of complex ankle fractures. Video article]. / Arthroskopisch assistierte Frakturversorgung und offene Reposition des posterioren Malleolus : Neue Strategien zur Versorgung komplexer Sprunggelenksfrakturen. Videobeitrag.

OBJECTIVE: Identification and treatment of intra-articular injuries, stabilization of the syndesmotic complex by open reduction and internal fixation (ORIF) of the posterior malleolus (PM). INDICATIONS: Bimalleolar and trimalleolar fractures, patients with functional demands. CONTRAINDICATIONS: Soft tissue injuries/infections in the area of the surgical approach, higher grade circulatory disorders, diabetes mellitus. SURGICAL TECHNIQUE: The video exemplarily depicts the arthroscopically assisted treatment (AORIF) of a trimalleolar fracture and ORIF of the PM via the dorsolateral approach. Positioning in an unstable lateral position, arthroscopy via standard ventral portals in external rotation, resection of interposing capsular ligamentous structures, removal of loose bodies, diagnosis and treatment of cartilage lesions. Dorsolateral approach dorsal to the peroneal tendons and incision of the fascia of the lateral and deep lower leg compartments, retraction of the flexor hallucis longus muscle medially, visualization of the PM, reduction and fixation with an antiglide plate. Development of a full thickness flap above the superficial fascia to visualize the lateral malleolus, fixation according to AO principles. Repositioning to the supine position without changing the sterile covers, medial approach for fixation of the medial malleolus, stability testing of the distal tibiofibular joint, final arthroscopy, and wound closure. FOLLOW-UP: Cooling and elevation, 6 weeks of partial weight-bearing (20 kg), early functional exercises, full weight-bearing after clinical radiological follow-up at 6 weeks postoperatively. RESULTS: It is known that relevant chondral injuries frequently occur in complex ankle fractures and that ORIF of the PM leads to stabilization of the distal tibiofibular joint. So far only few clinical results have been published regarding AORIF and ORIF of the PM; however, the majority of the studies available found significantly better results for AORIF and ORIF of the posterior malleolus compared to conventional treatment.

Pain relieve without impairing muscle function after local infiltration anaesthesia in primary knee arthroplasty: a prospective randomized study.

PURPOSE: Purpose of the current study was to compare early effectiveness of pain relieve of 3 in 1 regional pain catheter to local infiltration anesthesia (LIA) in primary total knee arthroplasty (TKA). Secondary endpoint was quadriceps muscle strength after both procedures. MATERIAL AND METHODS: A single-center, prospective, randomized controlled trial was performed. Patients eligible to TKA were either randomized into group 3 in 1 regional pain catheter (C), or group local infiltration anesthesia (L). Pain relieve was assessed by visual analogue scale (VAS) at rest and under physical activity (PA) prior to surgery (t0) and at days one through six. In addition, quadriceps muscle strength ( = straight leg raise) was tested according to the Manual Muscle Testing Scale. Functional outcome was measured using the Oxford Knee Score (OKS) preoperatively and 6 months postoperatively. RESULTS: 121 patients were included in the study. 59 (48.8%) patients were allocated to group C, 62 (51.2%) patients to Group L. No differences concerning pain level evaluated by VAS could be detected between the groups at any time. Comparing straight leg raise test group L was significantly superior over the complete postoperative period (p < 0.03). The mean OKS decreased significantly (p < 0.001) from preoperatively 34.2 ± 7.5 points to 16.9 ± 6.0 points at the six months final follow-up. Regarding OKS there were no intergroup differences at the final follow-up at 6 months postoperative. CONCLUSION: There is no significant difference in pain relieve comparing LIA to 3 in 1 catheter in perioperative pain management in TKA. The advantage of LIA is unimpaired quadriceps muscle function in the short-term follow-up.

[Fractures of the anterior process of the calcaneus-frequently overlooked injuries following ankle sprains]. / Frakturen des Processus anterior calcanei ­ häufig übersehene Verletzungen nach Sprunggelenkdistorsion.

Fractures to the anterior process of the calcaneus (PAC) have long been considered rare injuries and have received little attention in clinical research. On the contrary, recent studies have reported a distinct higher incidence, especially following ankle sprains. Decisive reasons are that fractures of the PAC are regularly missed on plain radiographs and that a clinical differentiation from injuries to the lateral ankle ligaments is difficult. With the broad availability of cross-sectional imaging modalities fractures of the PAC are diagnosed more frequently and more reliably. The purpose of this review is to give an overview on the diagnostics, classification and treatment recommendations to this topic and discuss the studies available. To date no evidence-based recommendations are available for the treatment of fractures of the PAC. The few case reports and case series published, predominantly recommend conservative treatment; however, the treatment regimens vary considerably, ranging from immobilization in a lower leg cast (2-10 weeks) to early functional treatment with full weight-bearing. The surgical treatment by open reduction and internal fixation has been described primarily for large dislocated fractures. Surgical excision is considered mainly in cases of persistent pain or symptomatic non-union following non-operative treatment. For both, non-operative and operative treatment, the case reports and case series report satisfactory outcomes for the majority of patients. Nevertheless, comparative studies and patient-rated outcome measures are missing. Therefore, evidence-based recommendations cannot be given.

[Fractures of the base of the V metatarsal bone-current concepts revised]. / Frakturen der Metatarsale Fünf Basis ­ eine Neubetrachtung.

Fractures of the base of the fifth metatarsal bone are one of the most frequent fractures to the foot and ankle. Despite the high frequency and although a number of studies are now available, treatment frequently does not follow the available evidence. Among the reasons is the inconsistent terminology used and that the studies available are neglected. The aim of this review is to present the current classifications, the available treatment studies and to derive evidence-based treatment recommendations. The term "Jones fracture" has been used inconsistently for different fracture entities and should, therefore, not be used anymore. Fractures are mostly classified according to Lawrence and Botte into three zones. However, the available studies demonstrate that type I and type II fractures according to Lawrence and Botte do not differ with respect to the prognosis. Both fractures can be successfully healed by functional treatment with weightbearing as tolerated. Consequently, a differentiation between these two zones does not seem to be meaningful. Therefore, they should be summarized as epi-metaphyseal fractures. Even dislocated, intra-articular, and multifragmentary fractures in this region can be functionally treated with good results. Fractures in the meta-diaphyseal region (Lawrence and Botte type III, distal to the IV and V intermetatarsal articulation) demonstrate a high rate of symptomatic non-unions after conservative treatment. Therefore, these fractures should be primarily treated operatively by closed reduction and intramedullary screw fixation.

[Fractures of the lateral process of the talus-snowboarder's ankle]. / Frakturen des Processus lateralis tali ­ "snowboarder's ankle".

Fractures of the lateral tubercle of the talus (PLT) are rare. With the increasing popularity of the trend sport snowboarding, the incidence of PLT fractures has increased. The most common classification of PLT fractures is the Hawkins classification. The aim of this review was to raise awareness for the injury and discuss the current evidence. A literature search revealed eight studies, each including at least seven patients. Six out of the eight studies were descriptive, retrospective case series without predefined treatment concepts. These resulted in only moderate treatment outcomes. Due to the low number of patients, the lack of computed tomography (CT) or magnetic resonance imaging (MRI) and inconsistent treatment approaches, these studies do not allow to draw conclusions on a treatment concept for PLT fractures. The other two studies validated existing treatment regimens. Overall, surgical treatment of dislocated fractures and conservative treatment of non-dislocated fractures was carried out with satisfactory results. The outcome of conservative treatment of dislocated factures remains unclear. A reason for the inconsistent treatment results could be the observed concomitant injuries, including dislocation of the tendons of the peroneus muscles (46%), calcaneal chondral injuries (48%) and subluxation of the subtalar joint (7%). Based on the limited evidence available, the authors recommend the application of CT and MRI for PLT fractures to assess concomitant injuries, which are the primary indication for surgery. Dislocated type I and II fractures (>2 mm) should be treated operatively, type III and non-dislocated type I and II fractures can be treated conservatively by immobilization and partial weight-bearing for 6 weeks.

[Acute achilles tendon rupture : State of the art]. / Die akute Achillessehnenruptur : Wo stehen wir heute?

The most favorable treatment for acute Achilles tendon ruptures remains controversial. In particular, three key questions are intensively debated: is operative or non-operative treatment superior? If surgery is performed, should open or minimally invasive percutaneous techniques be used? How should the follow-up treatment be carried out? The aim of this article is to answer these essential questions based on the currently available evidence. Non-operative treatment leads to a higher rate of re-ruptures and inferior functional results when compared to operative treatment. The major disadvantage of open surgery is the increased risk of wound healing problems and wound infections. Due to the development of minimally invasive percutaneous techniques, complication rates could be significantly reduced and patient satisfaction could be significantly improved, without increasing the risk of re-ruptures. The functional outcome is still partially unsatisfactory independent of the type of treatment. This is particularly expressed in weakness of the gastrocnemius-soleus muscle complex; therefore, the follow-up treatment is of fundamental importance. The available evidence clearly underlines the importance of early weight bearing and mobilization of the ankle joint, as it is safe and leads to better function, patient satisfaction and faster return to work or sport, compared with partial weight bearing and immobilization. Nevertheless, treatment protocols vary greatly with the majority still carrying out open suture and immobilizing follow-up treatment with fixed plantar flexion. Based on the available data the authors recommend minimally invasive percutaneous suture of the tendon followed by progressive functional rehabilitation. Implementation of the available evidence into routine practice is the next important step for successful treatment of this challenging injury.

[Insertional Achilles tendinopathy : Differentiated diagnostics and therapy]. / Ansatznahe Erkrankungen der Achillessehne : Differenzierte Diagnostik und Therapie.

Achilles tendinopathy at the calcaneal insertion is classified into insertional tendinopathy, retrocalcaneal and superficial bursitis. The aim of this study was to present the current evidence on conservative and surgical treatment of insertional tendinopathy of the Achilles tendon. Conservative first-line therapy includes reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization. In addition, further conservative therapy options are also available. Eccentric stretching exercises should be integral components of physiotherapy and can achieve a 40% reduction in pain. Extracorporeal shock wave therapy has been shown to reduce pain by 60% with a patient satisfaction of 80%. Due to the limited evidence, injections with platelet-rich plasma (PRP), dextrose (prolotherapy) or polidocanol (sclerotherapy) cannot currently be recommended. Operative therapy is indicated after 6 months of unsuccessful conservative therapy. Open debridement allows all pathologies to be addressed, including osseous abnormalities and intratendinous necrosis. The success rate of over 70% is contrasted by complication rates of up to 40%. The Achilles tendon should be reattached, if detached by >50%. No valid data are available for the transfer of the tendon of the flexor hallucis longus (FHL) muscle but it is frequently applied in cases of more than 50% debridement of the diameter of the Achilles tendon. Lengthening of the gastrocnemius muscle cannot be recommended because insufficient data are available. Tendoscopy is a promising treatment option for isolated retrocalcaneal bursitis and has shown similar success rates to open debridement with significantly lower complication rates.

[Arthroscopically assisted treatment of ankle fractures]. / Arthroskopisch assistierte Frakturversorgung am oberen Sprunggelenk.

Acute ankle fractures are one of the most common fractures in adults with an incidence of 0.1-0.2 % per year. Operative treatment by open reduction and internal fixation (ORIF) is the standard method of treatment for unstable or dislocated fractures. The main goal of the operation is the anatomical realignment of the joint and restoration of ankle stability; nevertheless, anatomical reduction does not automatically lead to favorable clinical results. According to several studies the mid-term and in particular the long-term outcome following operative treatment is often poor with residual symptoms including chronic pain, stiffness, recurrent swelling and ankle instability. There is growing evidence that this poor outcome might be related to occult intra-articular injuries involving cartilage and soft tissues. In recent studies the frequency of fracture-related osteochondral lesions was reported to be approximately 64 %. By physical examination, standard radiography or even computed tomography (CT), these intra-articular pathologies cannot be reliably diagnosed; therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment as it has become a safe and effective diagnostic and therapeutic procedure. Arthroscopically assisted open reduction and internal fixation (AORIF) allows control of the reduction as well examination of all intra-articular structures. If necessary, intra-articular pathologies can be addressed by removing ruptured ligaments and loose bodies, performing chondroplasty or microfracturing. So far there is no evidence that supplementary ankle arthroscopy increases the complication rate. On the other hand, the positive effect of AORIF has also not been clearly documented; nevertheless, there are clear indications that arthroscopically assisted fracture treatment is beneficial, especially in complex fractures.

[Arthroscopic tibiotalocalcaneal arthrodesis]. / Arthroskopische Rückfußkorrekturarthrodese.

Tibiotalocalcaneal arthrodesis (TTCA) is indicated for a variety of disorders, including end-stage osteoarthritis, severe deformities and complications after operative interventions on the upper and lower ankle joints. Due to the biomechanical advantages, TTCA is predominantly performed with curved retrograde intramedullary nails allowing compression before locking. Hindfoot arthrodesis is most commonly performed by extensive open surgical approaches. Despite a patient satisfaction rate greater than 80 %, current reviews have reported mean complication rates of more than 50 % with a pronounced variance in bone union rates. This is influenced by the sometimes severe preexisting diseases in this patient collective. A predictive risk assessment for complications following TTCA revealed a significantly increased risk in the presence of diabetes mellitus, revision surgery or preoperative ulceration. In these high-risk patients, a reduction of the invasiveness of the procedure could possibly reduce the complication rates. Arthroscopic TTCA therefore appears to be a promising alternative approach. Even though only few case reports and one case series have been published, in the total collective of 17 patients only one subtalar non-union and one minor complication were reported. Despite the limited evidence available, arthroscopic TTCA appears to be a promising therapy option in patients with an increased risk profile and comorbidities, such as critical soft tissue situations, plantar ulceration, peripheral arterial occlusive disease (PAOD) and diabetes mellitus.

[Lisfranc dislocation fracture: Dynamic examination under anesthesia and minimally invasive stabilization with mini-TightRope®]. / Lisfranc-Luxationsfraktur: Dynamische Narkoseuntersuchung und minimal-invasive Stabilisierung mittels Mini-TightRope®.

As Lisfranc joint injuries are rare and standard radiographic examinations can be difficult to interpret the correct diagnosis is often initially overlooked. Delayed treatment frequently results in painful and disabling arthritis, consequently, primary targeted diagnostics are essential for the functional outcome. We report on a patient with a Lisfranc fracture dislocation, with the injury severity only becoming obvious by dynamic examination with the patient under anesthesia. Due to the massive swelling we performed a minimally invasive primary stabilization using one K-wire and a mini-TightRope®.