Long term results and patient reported outcome measures following lisfranc injuries treated with memory staple fixation.

INTRODUCTION: Various modalities of fixation have been proposed for Lisfranc injuries. Memory staple fixation offers a simple option for transarticular fixation in suitable fracture configuration with no diaphyseal extension. However there is little evidence available in the literature regarding its efficacy and patient reported outcomes. Aim of the study was to present the long term outcomes of Lisfranc injuries treated with memory staple fixation and patient reported outcomes at average follow-up of four years. METHOD: This was a retrospective analysis of all the patients who underwent fixation for Lisfranc injury using shape memory alloy (Nitinol) staples from December 2010 to October 2018. Patient demography, mechanism of injury, classification of Lisfranc injury, duration of followup, complication, revision surgery, implant removal and patient reported outcomes (AOFAS midfoot score) was noted. RESULTS: 31 patients satisfied the inclusion criteria. Mean age was 50 years and 17 patients were females. 54 % patients reported low to moderate energy trauma which included simple fall from standing height or twisting injury. 28 (90.3 %) had B2 type of fracture pattern. 13 had fixation with staples only, 15 with a staple and home run screw. No patient had primary fusion. One patient had superficial infection treated with antibiotics only. Three patients developed symptomatic arthritis, out of which one proceeded to fusion. Six had implant removal for hardware related symptoms. Average AOFAS midfoot score at average four years follow-up was 77.8 which are satisfactory. CONCLUSION: This paper highlights good outcome following memory staple fixation for Lisfranc injuries. We believe staples are more suited for the dorsal buttressing that is typically required and provide stable, reproducible fixation Our findings also suggest less need for implant removal compared to transarticular screw or plate fixation though larger studies would be required to make definitive conclusions.

Clinical and Patient reported outcomes following open reduction and internal fixation for distal tibial intra-articular fractures.

INTRODUCTION: Intra-articular distal tibial plafond fractures are rare injuries, provide a challenge for the surgeon and can often have poor outcomes. The aim of this paper was to report long term patient reported functional outcomes, health related quality of life (QoL) scores and rates of complications in order to fully counsel the patient on likely outcomes and set realistic post-operative expectations for the patient. METHODS: We conducted a retrospective review of 20 patients with distal tibial intra-articular fractures that presented to our institution between September 2014 and September 2020. All patients underwent open reduction and internal fixation (ORIF). Clinical, radiological and patient reported outcome measures (PROMS), quality of life (QoL) scores and complications were collected. RESULTS: The mean age of the patients at the time of surgery was 50.6 years (24-71). There were 7 males and 13 females. There were 4 open and 16 closed fractures. There were 7 Rüedi and Allgöwer (RA) Type 1, 9 Type 2 and 4 Type 3 fractures. The mean follow-up was 3.8 years [1-7]. The mean OMAS score was 54.3, reaching a peak at 2 years from injury. The mean QoL score (EQ5D5L) was 0.602, representing only 70 % of aged matched, UK population based norms. CONCLUSIONS: Whilst clinical outcomes are comparable with other studies, this report highlights this is a devastating injury, with most people taking 2 years to reach peak recovery. QoL outcome scores only reach 70 % normal and only 35 % of patients return to within 10 % of age matched population based norms.

Preconsultation Questionnaires for Patients Attending Elective Foot and Ankle Clinics: Is This the Way Forward in Outpatient Clinics?

Orthopaedic clinics can often be overbooked' busy and delayed appointments are a common sight in the National Health Service. We recognize this is becoming a growing problem that needs to be addressed; therefore, we have carried out a quality improvement project (QIP) that can save clinicians time. We have developed the "Stockport Foot and Ankle Questionnaire," a novel preconsultation questionnaire to gather information about patient history and symptoms. We found that the average time required for consultation reduced from a mean of 22 minutes, without questionnaires, to a mean of 15 minutes with the questionnaire, effectively saving 7 minutes per consultation. The preconsultation questionnaire in foot and ankle clinics is a novel technique to improve efficiency, productivity, and standardization in outpatient clinics. It is a patient-centered approach that identifies where effective changes can be implemented in how outpatient services are run. We recommend routine use of these questionnaires to save valuable clinician time.Levels of Evidence: Level II.

Flexor Hallucis Longus Tendon Single-Incision Transfer Stabilized With Autologous Bone Fixation.

Flexor hallucis longus transfer is routinely used as a technique to salvage a chronic or neglected Achilles tendon rupture. The single-incision (or short harvest) technique provides adequate graft suitable for fixation with interference screws. We have used a bore corer instead of a drill to establish the tendon tunnel and at the same time use the harvested autograft for interference fit and avoid the use of screws, providing what we consider to be a more biologic form of fixation.

Tibialis anterior tendon traumatic rupture secondary to a closed talar neck fracture: A case report.

A case of a 22 year-old woman who sustained a closed Hawkins type II talar neck fracture after her left foot was caught in a rope while rock climbing outdoors is described. She presented to emergency department with a swollen and neurovascularly intact foot and a displaced talar neck fracture was identified. Intraoperatively a traumatic rupture of tibialis anterior tendon was found and was primarily repaired after the talar fixation. Revisiting the mechanism of injury it was evident that the jagged fracture ends ruptured the tibialis anterior tendon while she was hanging upside down on the strapping with the foot in forced equinus. This is the first case of such complication associated with a talar fracture and signifies the importance of tibialis anterior examination in such fractures.

Modified incision for Brostrom lateral ligament reconstruction of the ankle.

PURPOSE: To describe a modified incision for the Brostrom procedure to correct lateral ankle instability. METHODS: 14 men and 12 women aged 23 to 38 (mean, 27) years with lateral ankle instability underwent the Brostrom procedure with a modified incision to repair both the anterior talofibular and calcaneofibular ligaments, without endangering the sural or superficial peroneal nerves. The incision ran longitudinally over the distal fibula extending 2.5 cm distal to the tip of the lateral malleolus. RESULTS: There were no instances of wound healing problems, neurological damage, and repair failure. Surgical exposure of all patients was graded as excellent. CONCLUSION: The modified incision enables easy repair without endangering the sural and superficial peroneal nerves. Access to the peroneal tendons is allowed if necessary.

Flexor hallucis longus tendon transfer for reconstruction of chronically ruptured Achilles tendons.

PURPOSE: To report the mid-term results of flexor hallucis longus (FHL) tendon transfer for reconstruction of chronically ruptured Achilles tendons. METHODS: 24 men and 12 women aged 56 to 78 (mean, 70) years underwent FHL tendon transfer for reconstruction of chronically ruptured Achilles tendons by a single surgeon. Ruptures were secondary to trauma (n=20), long-term steroid intake (n=12), or chronic renal failure (n=6). Two patients had bilateral ruptures. The mean interval from rupture to surgery was 15 (range, 12-24) weeks. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores were compared. Wound healing, push-off, and patient satisfaction were evaluated. RESULTS: The mean follow-up period was one year. The mean AOFAS scores were 69 (range, 58-76) preoperatively and 88 (range, 79-94) postoperatively; the mean improvement was 19 (p<0.001). 28 patients had excellent and 8 had fair results. 33 patients graded their outcome as 'very satisfactory' and 3 as 'satisfactory'. Five patients developed wound healing complications but only one needed debridement. There was no fixation-related complication or sural nerve injury. CONCLUSIONS: Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.

Single transverse, dorsal incision for lesser metatarsophalangeal exposure.

BACKGROUND: The exposure of the lesser metatarsophalangeal joints is often difficult and inadequate in the presence of rheumatoid arthritis and associated deformities. We describe our results following the use of a single curved transverse, dorsal incision for the Mann-Thompson type of forefoot arthroplasty,(5, 9) multiple Weil osteotomies,(1, 2, 7, 11) and other forefoot procedures. MATERIALS AND METHODS: One hundred thirty-nine consecutive patients (163 feet) were included in the study. Wound healing, and patient and surgeon satisfaction were assessed. RESULTS: Ease of exposure and visualization of the target area was good-to-excellent in all patients. There were eight minor wound complications. There were no neurovascular complications. CONCLUSION: A single transverse incision offers adequate exposure of lesser metatarsophalangeal joints and good cosmesis.

Secondary chondrosarcoma in an enchondroma in a proximal phalanx of toe. A diagnostic problem. A case report.

The authors present a case of secondary chondrosarcomatous transformation in enchondroma in toe. The authors have discussed the available literature to throw light on differentiation of benign and malignant form.