Nonunion Rate Following Primary Arthrodesis for Acute Lisfranc Injuries.

Injury to the tarsometatarsal joint (TMT) results in instability throughout the midfoot that does not often improve with conservative management. If instability is identified, surgical intervention is frequently recommended, either open reduction and internal fixation (ORIF) or primary arthrodesis (PA). These 2 treatment options have been compared in the literature multiple times, often reporting similar outcomes. Due to this, as well as the need for subsequent hardware removal after ORIF has led many surgeons towards PA at the index surgery. Concern for nonunion is a leading concern with surgeons who advocate instead for ORIF. The purpose of this study is to review patients who underwent PA and observe nonunion rates. Nonunion at the TMT has been previously studied, but only in the chronic setting. We performed a retrospective study of 34 patients who had PA in the management of an acute Lisfranc injury. The average age in our study was 43.9 years old (range 19-72, SD 17.4) with an average follow-up of 9.4 months (range 4-33, SD 6.2). Radiographs were evaluated for signs of nonunion at regular postoperative intervals. Within the patients included in the study, a total of 71 TMT joints were fused. Overall successful fusion rate was 95.8% at an average of 7.9 weeks (range 6-12, SD 1.4) postoperatively. Individual nonunion rates at the first, second, and third TMT were 0%, 1.4% and 2.8% respectively. Our study demonstrates that primary arthrodesis provides a predictable outcome with low nonunion rates in the management of acute Lisfranc injury.

Age-Related Outcomes in Total Ankle Arthroplasty: An Analysis of 112 Patients.

Traditionally, total ankle replacement has been reserved for elderly patients with low physical demands. With nearly 80% of end-stage ankle arthritis being secondary to prior trauma, patients may require a replacement at a much younger rate than primary hip and knee arthritis. Historical accounts of implant failure and high revision rates in younger patients have been reported in the literature. With increasing technology and surgeon experience, implants are being used in younger patients with significantly fewer complications than early reports. In this retrospective review, we evaluated the patient-reported outcome measures and implant complications in three age subsets in arthroplasty patients; Group 1: <55 years-old, Group 2: 55-70 years-old, and Group 3: >70 years-old. In our study, mean postoperative American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores were 75.5 for group 1, 79.7 for group 2, and 86.9 for group 3, which improved from preoperative scores of 50, 52.4, and 53.8, respectively. Mean postoperative Foot Function Index (FFI) scores were 10 for group 1, 23.9 for group 2, and 12.3 for group 3, which improved from 59.4, 62.8, and 47.6 preoperatively, respectively. The overall complication rate was found to be 11.2%. The complication rate for group 1 was 18%, the complication rate for group 2 was 11.6%, and the complication rate was 9.4% for group 3. The differences in patient AOFAS hindfoot, FFI scores, and complication rates between the groups were not found to be statistically significant. Our results show that patients younger than age 55 years have similar complication rates and reported satisfaction scores to patients 55 years of age and older.

The Effect of Tobacco Use on Incision Healing in Total Ankle Arthroplasty: A Review of 114 Patients.

The purpose of this study was to compare wound complication rates after total ankle replacement in 3 groups of patients based on tobacco status. The total cohort was divided into 3 groups based on tobacco history. Group 1 included patients who were actively tobacco users. Group 2 included patients with a history of tobacco user. Group 3 served as the control group and included patients who had never used tobacco. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by 1 surgeon. Patient demographics, tobacco history, and postoperative wound complications were recorded. A total of 114 patients with tobacco history were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. Group 1 included 11 active smokers. Group 2 included 38 former smokers, and group 3 had a total of 65 never smokers included. The average follow-up was 28 months for group 1 (range 10-55 months), 34.1 months for group 2 (range 12-60 months), and 32.8 months for group 3 (range 11-60 months). The wound complication rate was noted to be statistically significant when comparing active smokers to never smokers using Fisher's exact test (P = .0223). When comparing former smokers with never smokers, the difference in wound complication rate did not reach statistical significance (P = 0.7631). All patients underwent at least 1 concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement wound healing complication rates are significantly higher in active tobacco users. There was no significant difference in wound healing complications when comparing former tobacco users versus never tobacco users. Levels of Evidence: Level III: Retrospective comparative study.

Relationship Between Body Mass Index and Complications in Total Ankle Arthroplasty: A Single Surgeon's Experience in Ninety-Seven Replacements.

The purpose of this study was to compare complication rates of total ankle replacement in 2 groups of patients based on their body mass index (BMI). The total cohort was divided into 2 groups based on BMI. Group 1 included patients with a BMI ≤30 kg/m2. Group 2 included patients with a BMI >30 kg/m2. Available charts were reviewed for patients who underwent primary total ankle arthroplasty. Patient demographics, BMI, prosthesis used, concomitant procedures, and intraoperative and postoperative complications were recorded. Ninety-seven patients met the inclusion criteria and underwent total ankle replacement between March 2012 and July 2016. Mean follow-up was 26.3 (range 12 to 62) months. Mean age was 66.4 (range 23 to 85) years. Mean BMI was 29.6 (range 20.6 to 49.5) kg/m2. Forty-three males and 54 females were included. There were 53 patients in group 1 (BMI ≤30 kg/m2) and 44 patients in group 2 (BMI >30 kg/m2). Total complication rates for group 1 and 2 were 18.9% (10 of 53) and 11.4% (5 of 44), respectively. There were a total of 10 minor complications and 5 major complications. There was no statistical difference between the groups (p = .308) in terms of complication rates. All patients underwent at least 1 concomitant procedure at the time of the index ankle replacement. We found that total ankle replacement can be safely utilized in patients with a BMI >30 kg/m2. In the present study, there was no statistical significance in complication rates in the 2 groups.

Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures.

Fractures of the calcaneus are detrimental injuries, often caused by high-energy trauma. To best restore the functionality of a limb and allow normal ambulation, it is recommended to repair displaced intra-articular calcaneus fractures surgically. This article presents several methods of reduction and repair of the calcaneus. Traditionally, calcaneal fractures have been repaired through a lateral extensile incision that has been shown to have a high percentage of wound healing complications. In recent times, there has been a shift toward minimally invasive and sinus tarsi incisional approaches in the repair of calcaneus fractures.

The Relationship Between Polyethylene Insert Size and Complications in Total Ankle Replacement.

The purpose of this study was to compare complication rates after total ankle replacement in 2 groups of patients based on polyethylene insert size. The total cohort was divided into 2 groups based on insert size. Group 1 included patients with polyethylene insert size less than 10 mm in thickness. Group 2 included patients with polyethylene insert sizes 10 mm and larger. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by one surgeon. Patient demographics, polyethylene insert size, implant used, concomitant procedures, postoperative complications, and patient-reported outcome scores were recorded. One hundred patients were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. The average follow-up was 31.3 months (range = 10-60 months). Forty-eight females and 52 males were included in this study. There were a total of 63 patients in group 1 and 47 patients in group 2. The total complication rate for patients in group 1 was 11.1% (7/63), and in group 2 it was 16.2% (6/32). There was no statistical significance in complication rates when comparing the 2 groups (P = 0.5427). All patients underwent at least one concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement complication rates are equal when comparing large polyethylene inserts commonly utilized to correct deformities, versus small polyethylene inserts commonly utilized in primary resurfacing. Levels of Evidence: Level IV, Retrospective comparative study.

A Critical Radiographic Analysis of Coronal Plane Deformity Correction Using a 3-Piece Mobile Bearing Ankle Joint Replacement: A Retrospective Study of 25 Patients.

Total ankle replacement can be a viable option for patients with end-stage ankle arthritis associated with coronal plane deformity. With proper ankle balancing, a well-aligned ankle implant can be maintained over time and provide successful patient outcomes. The purpose of this study was to evaluate radiographic and subjective outcomes in patients with ankle arthritis along with coronal plane deformity who underwent total ankle arthroplasty with a 3-piece mobile-bearing implant. Our primary inclusion criterion was patients who demonstrated more than 5° of tibiotalar coronal deformity in either varus or valgus direction. Sixty-three consecutive patients who underwent total ankle replacement were reviewed. Of these, 25 (39.7%) met the inclusion criteria. Sixteen (64%) patients had a varus deformity (Group 1) and 9 (36%) had valgus deformity (Group 2) preoperatively. Alignment was evaluated radiographically at 5 different intervals: preoperative, immediate postoperative, and 6, 12, and 36 months postoperative. In patients with varus deformity, the mean tibiotalar angle was 12.6°, 0.8°, 1.0°,1.0°, and 0.8° for preoperative, immediate postoperative, and 6, 12, and 36 months, respectively. The same measurements and intervals for patients with valgus deformity were found to be 10.3°, 1.4°, 1.6°, 1.4°, and 1.4°. A statistically significant difference was observed in preoperative and postoperative coronal plane deformity. This correction was maintained at final follow-up visit. American Orthopaedic Foot and Ankle Society scores and visual analogue scale scores were recorded as well, and statistically significant improvements in preoperative and postoperative scores were found (p < .001). In conclusion, coronal plane deformity correction of the ankle can be accomplished and maintained in total ankle replacement procedures with proper soft tissue balancing and osseous procedures as indicated.

Severe Ankle Arthritis After Multiple Hemarthrosis Secondary to Factor XI Deficiency: A Case Report.

Hemophilic arthropathy of the ankle is an extremely unique condition that affects a small subset of the population in the United States. We present the case of a 66-year-old male with factor XI deficiency, which, over years of repetitive microtrauma as a professional soccer player, led to multiple hemarthrosis and severe arthropathy of his right ankle. The patient successfully underwent total ankle replacement arthroplasty and was able to return to recreational sports and competitive road cycling.

Retrospective Analysis of the Akin Osteotomy.

Hallux abductovalgus is one of the most common deformities addressed by foot and ankle surgeons. Surgically, it can be approached using a wide variety of procedures. After performing the first metatarsal osteotomy, the final step is often to realign the great toe in a rectus position. This is performed with an osteotomy of the proximal phalanx. The Akin osteotomy is a medially based closing wedge osteotomy of the proximal phalanx. When executing the osteotomy, the goal is not only to correct abduction, but also to keep the lateral cortex intact, which allows it to act as an additional point of fixation. However, the lateral cortex can be iatrogenically compromised during surgery or in the postoperative period. We investigated the frequency of disruption of the lateral cortex, osteotomy displacement, healing time, and the need for surgical revision associated with the Akin procedure. A total of 132 patients who had undergone Akin osteotomy were included in the present retrospective study. Intraoperative fluoroscopy showed the lateral cortex was compromised in 47 (35.6%) patients and remained intact for 85 (64.4%) patients. Of the 47 (35.6%) patients with lateral cortex disruption intraoperatively, 9 (19.1%) experienced displacement during the postoperative period, of whom, 3 (6.38%) required surgical revision. Although intact during surgery, the other 6 (4.55%) patients sustained lateral cortex fractures postoperatively, 2 (33.3%) of whom required surgical revision. A statistically significant difference was found between the integrity of the lateral cortical hinge and the healing time of the osteotomy. All the osteotomies with displacement postoperatively were noted to have lateral cortex failure, either during surgery or during the follow-up period.