The Conventional Weil Osteotomy Does Not Require Screw Fixation.

The Weil osteotomy is an established procedure to reduce plantar pressure in chronic metatarsalgia. Historically, the refixation of the displaced metatarsal head is performed by screw fixation. We aimed to demonstrate that screw fixation is not always necessary. Between 2016 and 2021, 155 patients with 278 Weil osteotomies (20 males and 135 females, mean age: 63 years) were retrospectively enrolled. Group A (n = 96) underwent 195 Weil osteotomies with screw fixation; group B (n = 59), 83 without screw fixation. Demographic, Visual Analog Scale Foot and Ankle (VAS-FA), SF-12 questionnaire, and toe mobility data were recorded. The mean follow-up period was 4.5 years. The mean VAS-FA was 75.5; mean SF-12 physical component summary, 42.0; and mean SF-12 mental component summary, 51.0. The overall revision rate was 20% (group A: 25%, group B: 10.2%), primarily for arthrolysis of the metatarsophalangeal joint in group A. Clinical comparisons showed no significant difference between the groups (p > 0.05). The revision rate was significantly higher in group A (p < 0.05), with equal satisfaction in clinical outcomes. Based on the available data, the need for regular screw fixation after a Weil osteotomy cannot be justified.

Value of closed suction drainage in arthroscopic and minimally invasive surgery of the ankle joint: a prospective randomised study.

INTRODUCTION: Closed suction drainage is an established procedure in arthroscopic surgery. It is intended to reduce the retention of wound and irrigation fluids, which form the basis for postoperative swelling, pain, and infection. However, currently, there is no scientific review of the actual benefit of this procedure. METHODS: Between 2020 and 2021, 84 patients (53 males, 31 females; mean age: 42 years) were prospectively randomised into this study. The patients underwent arthroscopic surgery of the ankle joint with (group A) or without (group B) insertion of a closed suction drain (42 patients per group). Assessments included upper ankle swelling using the figure-of-eight-20 method, pain preoperatively and 48 h postoperatively, and unexpected events within 6 weeks postoperatively. RESULTS: The measurements performed 48 h postoperatively showed a mean circumferential increase of 1.38 cm (1.48 and 1.28 cm in groups A and B, respectively; p > 0.05) in all patients. The mean pain at rest, assessed using the visual analogue scale (maximum 10 points), was 2.7 and 2.4 in groups A and B, respectively (p > 0.05). Overall, two minor complications occurred: residual swelling in group A and persistent limitation of movement in group B. The average length of hospital stay was 2.4 days (p > 0.05). CONCLUSIONS: Based on the available data, the routine insertion of a closed suction drainage at the upper ankle does not offer any objective benefit and must be considered obsolete. From both a medical and an economic point of view, the decision to conduct this procedure should be justified on an individual basis. LEVEL OF EVIDENCE: Level I, prospective randomised trial.

[Diagnosis and Therapy of Acute Achilles Tendon Ruptures]. / Diagnose und Therapie der akuten Achillessehnenruptur.

Diagnosis and Therapy of Acute Achilles Tendon Ruptures Abstract. Acute Achilles tendon ruptures are a common pathology and often affect young athletic patients. Diagnosis is mostly clinical and by ultrasound. Conservative and operative treatment algorithms exist. The result of the treatment is mostly influenced by the elongation of the tendon during healing. Operative procedures tend to lead to less elongation but have a complication risk. After-treatment should be functional to reduce complication rate and faster rehabilitation. Treatment results are good in general, but some weakness is often found on the injured side.

A 10-Year Follow-Up of Ankle Syndesmotic Injuries: Prospective Comparison of Knotless Suture-Button Fixation and Syndesmotic Screw Fixation.

Background: Acute syndesmosis injury (ASI) is an indication for surgical stabilization if instability is confirmed. In recent years, fixation using the knotless suture-button (SB) device has become increasingly established as an alternative to set screw fixation (SF). This study directly compared the clinical long-term results after prospective randomized inclusion. Materials and Methods: Between 2011 and 2012, 62 patients with ASI were enrolled in a prospective, randomized, and monocentric study. Forty-one patients were available for a 10-year follow-up ((31 males and 10 females), including 21 treated with SB (mean age 44.4 years), and 20 with SF (mean age 47.2 years)). In addition to comparing the demographic data and syndesmosis injury etiology, follow-up assessed the Olerud−Molander Ankle Score (OMAS) and FADI-Score (Foot and Ankle Disability Index Score) with subscales for activities of daily living (ADL) and sports activity. Results: The mean OMAS was 95.98 points (SB: 98.81, SF: 93.00), the mean FADI ADL was 97.58 points (SB: 99.22, SF: 95.86), and the mean FADI Sport was 94.14 points (SB: 97.03, SF: 91.10). None of the measurements differed significantly between the groups (p > 0.05). No clinical suspicion of chronic instability remained in any of the patients, regardless of treatment. Conclusions: The short-term results showed that athletes in particular benefit from SB fixation due to their significantly faster return to sports activities. However, the available long-term results confirm a very good outcome in the clinical scores for both approaches. Chronic syndesmotic insufficiency was not suspected in any of the patients. Level of evidence: I, randomized controlled trial.

Electrothermal Denervation of Synovial and Capsular Tissue Does not Improve Postoperative Pain in Arthroscopic Debridement of Anterior Ankle Impingement-A Prospective Randomized Study.

Purpose: The purpose of the study was to investigate the added value of electrothermal denervation (ETD) in arthroscopic debridement of anterior ankle impingement. Methods: Between May 2019 and December 2020, 58 patients who received arthroscopic anterior decompression for the impingement of the anterior tibiotalar joint were randomized to Group A (n = 29) with ETD of synovial and capsular tissue of the ankle and Group B (n = 29) without ETD. Patients included 37 men and 21 women, with a mean age of 42 years. The pain, range of motion (ROM), and function were recorded using the visual analog scale foot and ankle (VAS FA), the Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society Score (AOFAS), both preoperatively and postoperatively. Results: Twenty-four hours after surgery, the pain level at rest using the VAS (worst 10 points) was 3.8 points on average (Group A: 3.7, Group B: 3.9). After 6 weeks, the mean VAS FA was 62.6 points, and ROM improved by an average of 9.1° (Group A: 9.8°, Group B: 8.6°; P > .05), the mean FFI was 40.4 points (Group A: 37.8, Group B: 42.8), the mean AOFAS was 73.1 points (Group A: 71.3, Group B: 75.1). All postoperative scores improved significantly compared with preoperative scores. No significant differences were observed between groups. Conclusions: The hypothesis of pain reduction with the use of ETD was refuted. The addition of ETD as part of the arthroscopic debridement of the anterior ankle impingement did not show any significant superiority in terms of the collected scores (VAS-FA, FFI, and AOFAS) at 24 hours and 6 weeks after the surgery and resulted in a comparable length of stay in the hospital and incapacity to work. Level of Evidence: Level I, prospective cohort study.

Adult-Acquired Flatfoot Deformity: Combined Talonavicular Arthrodesis and Calcaneal Displacement Osteotomy versus Double Arthrodesis.

BACKGROUND: Adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults. HYPOTHESIS: Our study aimed to confirm that the combined procedures of calcaneal displacement osteotomy and talonavicular arthrodesis are equivalent to double arthrodesis. METHODS: Between 2016 and 2020, 41 patients (13 male and 28 females, mean age of 63 years) were retrospectively enrolled in the comparative study. All deformities were classified into Stages II and III of PTTD, according to Johnson and Strom. All patients underwent isolated bony realignment of the deformity: group A (n = 19) underwent calcaneal displacement osteotomy and talonavicular arthrodesis, and group B (n = 23) underwent double arthrodesis. Measurements from the Foot Function Index-D (FFI-D) and the SF-12 questionnaire were collected, with a comparison of pre- and post-operative radiographs conducted. The mean follow-up period for patients was 3.4 years. RESULTS: The mean FFI-D was 33.9 (group A: 34.5; group B: 33.5), the mean SF-12 physical component summary was 43.13 (group A: 40.9; group B: 44.9), and the mean SF-12 mental component summary was 43.13 (group A: 40.9; group B: 44.9). The clinical data and corrected angles showed no significant intergroup differences. CONCLUSION: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes.

Superiority of upper ankle arthrodesis over total ankle replacement in the treatment of end-stage posttraumatic ankle arthrosis.

PURPOSE: Surgical treatment of end-stage posttraumatic upper ankle arthrosis is challenging. Highly variable revision rates have been reported with total ankle arthroplasty (TAA) of the upper ankle joint. The aim of this retrospective study was to compare revision rates with tibiotalar arthrodesis (TTA) and TAA with a prosthesis to determine the superior treatment approach. METHODS: Data for 148 patients (96 males and 52 females) with end-stage posttraumatic upper ankle arthrosis-including 88 treated with TTA and 60 with TAA between 2008 and 2013, with a mean follow-up of 59 months-were analysed. Bone fusion was confirmed by x-ray radiography and computed tomography. RESULTS: The overall revision rate was 28%; the rate was higher with TAA (42%) than with TTA (18%). The TAA group showed an increase in revisions from 12- to 24-month postsurgery. The most common cause of revision in the TAA group was cysts (20%), and the most frequent reason for revision was nonunion (8%). Mean American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome (FAO) scores in all patients were 55.5 and 53.1, respectively, with no significant difference between the TTA and TAA groups (p > 0.05). In nine cases (15%) the prosthesis was explanted or converted to TTA. TAA patients who underwent conversion to TTA had worse outcomes (AOFAS score = 39; FAO score = 35.29). CONCLUSION: TAA is associated with a high rate of revisions, especially from the 2nd year postsurgery. Therefore, TTA is the treatment of choice for end-stage posttraumatic upper ankle arthrosis. Level of evidence Level III, comparative series.

Secondary reconstruction of chronic Achilles tendon rupture: flexor hallucis longus transfer versus plantaris longus augmentation.

INTRODUCTION: Chronic Achilles tendon rupture is primarily caused by degenerative processes of multifactorial origin. In addition to secondary repair (SR) with augmentation of the plantaris longus tendon, the transfer of the flexor hallucis longus tendon (FHL) to the calcaneus is a recognised reconstruction procedure. This paper aims to provide a direct comparison based on clinical scores and objectifiable strength measurements. METHODS: We analysed data for 60 patients (46 males and 14 females) with chronic Achilles tendon rupture, including 34 (mean age 57 years) treated with FHL and 26 (mean age 52 years) with SR between 2016 and 2020 (mean follow-up of 49 months). The follow-up included the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scoring System (AOFAS-AH) and Visual Analogue Scale Foot and Ankle (VAS FA), the 12-item Short Form Survey (SF-12) and the objectifiable strength measurement using the dynamometer BIODEX®. Pre-existing gait disorders and permanent pain therapy led to exclusion. RESULTS: The mean AOFAS-AH was 87.8 points (FHL: 85.6, SR: 90.6), the mean VAS FA was 78.1 points (FHL: 73.7, SR: 83.6), the mean PCS was 48.2 points (FHL: 46.3, SR: 50.7) and the mean MCS was 54.1 points (FHL: 55.0, SR: 53.0). The maximum torque for plantar flexion was 56.7 Nm on average (FHL: 51.0, SR: 63.7). A total of seven (11.7%) wound infections requiring revision occurred (FHL: 4 (11.8%), SR: 3 (11.5%)). All measurements did not differ significantly between the groups (p > 0.05). CONCLUSION: The results of the study prove the equivalence of FHL and SR based on the clinical scores as well as on the strength measurement using BIODEX®. Nevertheless, a higher withdrawal because of morbidity with a tendency for prolonged incapacity to work in the FHL group has to be taken into account. The present work provides the basis for a prospective comparison in future studies.

Surgical experience as a decisive factor for the outcome of calcaneal fractures using locking compression plate: results of 3 years.

INTRODUCTION: Calcaneal fractures account for 60-75% of all tarsal fractures and represent surgical challenges because of their frequency and complexity. Despite standardized procedures and new implants, literature reports high revision rates and unsatisfactory results. The study aims to describe the role of the surgeon with respect to the clinical outcome. METHODS: Between 2014 and 2017, 94 calcaneal fractures (all type AO C1-3) were re-examined in 86 patients (67 male and 19 female; mean age: 51 years). The treatment was always carried out by means of locking compression plate via the extensile lateral approach. A comparison was made between treatment by an experienced (ES) and less experienced surgeon (LES). Annually, the ES performed at least 30 procedures for calcaneus fracture treatment as compared to < 10 operations performed by the LES. RESULTS: The mean AOFAS, VAS FA, and Kiel Score in the ES group were 77.0 (SD 15.9), 69.0 (SD 18.8), and 65.0 (SD 20.6), respectively. The corresponding values in the LES group were 68.1 (SD 21.0), 60.3 (SD 22.4), and 53.0 (SD 21.9) (p < 0.05). The operation time was on average 14 min shorter in the ES group than the LES group (p < 0.05). CONCLUSION: The significantly better scores, along with shorter operation time, shorter duration of incapacity to work, and lower complication rate prove the importance of having an experienced surgeon perform complex intra-articular calcaneal fracture repairs. The extensile lateral approach is still considered the standard method. LEVEL OF EVIDENCE: Level III, comparative series.

Muscle Fascicles Exhibit Limited Passive Elongation Throughout the Rehabilitation of Achilles Tendon Rupture After Percutaneous Repair.

Achilles tendon rupture (ATR) results in long-term functional and structural deficits, characterized by reduced ankle mobility and plantarflexor muscle atrophy. However, it remains unclear how such functional impairments develop after surgical repair. While it is known that this injury negatively affects the tendon's function, to date, limited work has focused on the short-term effect of ATR on the structure of the muscles in series. The aim of this study was to characterize changes in medial gastrocnemius architecture and its response to passive lengthening during the post-surgical rehabilitative period following ATR. Both injured and contralateral limbs from 10 subjects (1 female, BMI: 27.2 ± 3.9 kg/m2; age: 46 ± 10 years) with acute, unilateral ATR were assessed at 8, 12, and 16 weeks after percutaneous surgical repair. To characterize the component tissues of the muscle-tendon unit, resting medial gastrocnemius muscle thickness, fascicle length, and pennation angle were determined from ultrasound images with the ankle in both maximal plantarflexion and dorsiflexion. The ankle range of motion (ROM) was determined using motion capture; combined ultrasound and motion capture determined the relative displacement of the musculotendinous junction (MTJ) of the AT with the medial gastrocnemius. The ATR-injured gastrocnemius muscle consistently exhibited lower thickness, regardless of time point and ankle angle. Maximal ankle plantarflexion angles and corresponding fascicle lengths were lower on the injured ankle compared to the contralateral throughout rehabilitation. When normalized to the overall ankle ROM, both injured fascicles and MTJ displacement exhibited a comparably lower change in length when the ankle was passively rotated. These results indicate that when both ankles are passively exposed to the same ROM following ATR surgery, both ipsilateral Achilles tendon and gastrocnemius muscle fascicles exhibit limited lengthening compared to the contralateral MTU tissues. This appears to be consistent throughout the rehabilitation of gait, suggesting that current post-operative rehabilitative exercises do not appear to induce muscle adaptations in the affected MTU.

Alterations in structure of the muscle-tendon unit and gait pattern after percutaneous repair of Achilles tendon rupture with the Dresden instrument.

BACKGROUND: Functional deficits after Achilles tendon (AT) ruptures are observed. The relationship between musculotendinous structural alterations and functional outcome is not clear. METHODS: Kinematic analyses (level walking, stair climbing), patient-reported outcome measures (PROMs), calf atrophy (maximum calf circumference (MCC)), and AT length were evaluated in patients after percutaneous AT repair with the Dresden instrument (n=20min. FOLLOW-UP: 24 months). RESULTS: Patients achieved good results in PROMs. However, MCC decreased significantly and AT length increased significantly postoperatively. Side-to-side MCC differences over 2cm resulted in significantly lower PROMs. AT lengthening correlated with increased dorsiflexion and decreased plantarflexion. CONCLUSION: Calf atrophy and AT lengthening after minimally invasive AT repair resulted in inferior ankle kinematics and PROMs.

Functional outcome and complication rate after percutaneous suture of fresh Achilles tendon ruptures with the Dresden instrument.

BACKGROUND: The aim of this study was to evaluate the outcome of patients with a rupture of the Achilles tendon (ATR) treated percutaneously with the Dresden instrument in the hands of surgeons others than its inventors. MATERIALS AND METHODS: 118 patients (FU rate: 77.1%) with an acute ATR treated with the Dresden instrument were retrospectively evaluated. The following data were evaluated: pain intensity, functional limitation, Hannover score, Achilles tendon total rupture score (ATRS), AOFAS ankle-hindfoot score, Tegner activity score, complications, maximum calf circumference (MCC) on both sides, and the Matles test for tendon lengthening. The effect of the time point of the surgery after trauma was examined. RESULTS: Hannover scores and ATRSs were good; AOFAS scores were excellent. Almost all patients returned to sporting activities postoperatively, and 66.1% were able to return to their previous level. The Tegner activity score revealed a slight posttraumatic decrease (p = 0.009) in the level of physical activity overall (pre-injury: 5.37 ± 0.15; postoperatively: 4.77 ± 0.15). The re-rupture rate was 2%. No sural nerve lesions and no infections were reported. Even after 3 years, there was still a difference in MCC that was correlated with inferior clinical score and AT lengthening. Patients treated within the first 2 days after ATR showed inferior clinical outcomes in terms of AOFAS score, ATRS, and functional limitations. CONCLUSIONS: Percutaneous ATR suture with the Dresden instrument is a safe and reliable method. Low complication and re-rupture rates, good clinical results, and a high rate of return to play support this fact. The time point of the operation may influence the outcome.

Short-term functional assessment of gait, plantarflexor strength, and tendon properties after Achilles tendon rupture.

BACKGROUND: Although early functional rehabilitation (EFR) has been suggested to yield rapid functional recovery after Achilles tendon rupture (ATR) compared to conventional rehabilitation (CR), most quantitative assessments occur long after rehabilitation has been completed. Few data exist regarding the short-term functional gains during the healing period post-ATR. It remains unclear if EFR allows for an objectively faster return to function. The aim of this study was to examine EFR's effect on gait, plantarflexor strength, and tendon properties in early post-operative follow-ups. METHODS: Fourteen patients received either EFR (n = 6) or CR (n = 8) after percutaneous ATR repair. Functional gait analysis, maximal voluntary isometric contractions (MVICs), and Achilles tendon properties were assessed at 8 and 12 weeks post-op. RESULTS: Comparison of EFR against CR yielded no statistically significant differences in ankle kinematics or kinetics, Achilles tendon properties or MVICs on the injured (INJ) ankle at either time point. During gait, only CR patients demonstrated significantly lower plantarflexion moments on INJ at 8 weeks (0.817 ±â€¯0.151 N·m/kg vs. 1.172 ±â€¯0.177 N·m/kg, p = 0.002). All patients exhibited deficits in plantarflexor moment at 8 weeks and eversion moment at 12 weeks on INJ during gait that had effect sizes of note when compared to CON. SIGNIFICANCE: ATR patients, regardless of rehabilitation, exhibit deficits in gait, AT properties, and single-limb strength at 8 weeks. Though AT properties and single-limb plantarflexor isometric strength remain at a deficit at 12 weeks, bipedal plantarflexion moments are comparable between INJ and CON. Though effect size calculations suggested clinically significant differences, clear benefits of EFR compared to CR were not found.

Different Achilles Tendon Pathologies Show Distinct Histological and Molecular Characteristics.

Reasons for the development of chronic tendon pathologies are still under debate and more basic knowledge is needed about the different diseases. The aim of the present study was therefore to characterize different acute and chronic Achilles tendon disorders. Achilles tendon samples from patients with chronic tendinopathy (n = 7), chronic ruptures (n = 6), acute ruptures (n = 13), and intact tendons (n = 4) were analyzed. The histological score investigating pathological changes was significantly increased in tendinopathy and chronic ruptures compared to acute ruptures. Inflammatory infiltration was detected by immunohistochemistry in all tendon pathology groups, but was significantly lower in tendinopathy compared to chronic ruptures. Quantitative real-time PCR (qRT-PCR) analysis revealed significantly altered expression of genes related to collagens and matrix modeling/remodeling (matrix metalloproteinases, tissue inhibitors of metalloproteinases) in tendinopathy and chronic ruptures compared to intact tendons and/or acute ruptures. In all three tendon pathology groups markers of inflammation (interleukin (IL) 1ß, tumor necrosis factor α, IL6, IL10, IL33, soluble ST2, transforming growth factor ß1, cyclooxygenase 2), inflammatory cells (cluster of differentaition (CD) 3, CD68, CD80, CD206), fat metabolism (fatty acid binding protein 4, peroxisome proliferator-activated receptor γ, CCAAT/enhancer-binding protein α, adiponectin), and innervation (protein gene product 9.5, growth associated protein 43, macrophage migration inhibitory factor) were detectable, but only in acute ruptures significantly regulated compared to intact tendons. The study gives an insight into structural and molecular changes of pathological processes in tendons and might be used to identify targets for future therapy of tendon pathologies.

Time-Dependent Alterations of MMPs, TIMPs and Tendon Structure in Human Achilles Tendons after Acute Rupture.

A balance between matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) is required to maintain tendon homeostasis. Variation in this balance over time might impact on the success of tendon healing. This study aimed to analyze structural changes and the expression profile of MMPs and TIMPs in human Achilles tendons at different time-points after rupture. Biopsies from 37 patients with acute Achilles tendon rupture were taken at surgery and grouped according to time after rupture: early (2-4 days), middle (5-6 days), and late (≥7 days), and intact Achilles tendons served as control. The histological score increased from the early to the late time-point after rupture, indicating the progression towards a more degenerative status. In comparison to intact tendons, qRT-PCR analysis revealed a significantly increased expression of MMP-1, -2, -13, TIMP-1, COL1A1, and COL3A1 in ruptured tendons, whereas TIMP-3 decreased. Comparing the changes over time post rupture, the expression of MMP-9, -13, and COL1A1 significantly increased, whereas MMP-3 and -10 expression decreased. TIMP expression was not significantly altered over time. MMP staining by immunohistochemistry was positive in the ruptured tendons exemplarily analyzed from early and late time-points. The study demonstrates a pivotal contribution of all investigated MMPs and TIMP-1, but a minor role of TIMP-2, -3, and -4, in the early human tendon healing process.

Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

Heterotopic ossification after total ankle replacement: The role of prosthesis alignment.

BACKGROUND: The aetiology of heterotopic ossifications (HO) after total ankle arthroplasty (TAR) remains controversial. The aim of the study was to evaluate the prevalence and localisation of HO and the effect of alignment. METHODS: 88 TARs with a series of radiological controls and follow-up of 36 months were evaluated. Frontal and sagittal alignment parameters (alfa and beta angle defined by Hintermann) and tibial coverage were evaluated. RESULTS: The prevalence and grading of HO increased over time, mostly in the posterior gutter. Varus alignment correlated with HO increase in the ventral and lateral gutters the first year. A dorsally located rotational centre correlated with total HO growth and HO in the posterior gutter. These correlations were not detected after 3 years, as HO were seen in all prostheses, regardless of alignment. CONCLUSIONS: HO grow over time with a prevalence up to 100% after 3 years. TAR alignment correlates with gutter-specific HO formation within the first year.

Fracture severity of distal radius fractures treated with locking plating correlates with limitations in ulnar abduction and inferior health-related quality of life.

INTRODUCTION/BACKGROUND: The operative treatment of distal radius fractures has significantly increased after the introduction of locking plates. The aim of the present study was the evaluation of health-related quality of life, functional and radiological outcome of patients with distal radius fractures treated with the locking compression plate (LCP). MATERIALS AND METHODS: In the present study 128 patients (130 fractures) that were operatively treated with the LCP (2.4 mm/3.5 mm, Synthes(®)) were retrospectively evaluated. Mean follow-up was 22.7 months (SD 10.6). The fractures were radiographically evaluated (radial inclination, palmar tilt, ulnar variance) pre-, postoperatively and at the last follow-up visit. Range of motion (ROM) was documented. Grip strength was assessed with the use of a JAMAR dynamometer. The score for disabilities of the arm, shoulder and hand (DASH) and the Gartland-Werley score (GWS) were evaluated. Health-associated quality of life was assessed with use of SF-36 Health Survey. RESULTS: Postoperative reduction was excellent; at the last follow-up visit only minimal reduction loss was observed. Except for pronation, a statistically significant decrease of ROM was present; in most cases that was not disturbing for the patients. The injured side achieved 83.9% of grip strength of the intact side. Mean DASH was 18.9 and mean GWS was 3.5. Health-associated quality of life was generally not compromised. However, limitations in ulnar abduction correlated with inferior quality of life. Fracture severity correlated with inferior quality of life, despite the absence of correlation with the functional and radiological outcome. Complication rate was low. CONCLUSIONS: Fracture severity seems to affect ulnar abduction and therefore patient quality of life, despite almost anatomical reduction; the objective and subjective scores were in most cases excellent. Modern everyday activities, such as keyboard typing, could be associated with the present results.

Periprosthetic fractures in total ankle replacement: classification system and treatment algorithm.

BACKGROUND: Despite progress in implant design and surgical technique, the reported number of periprosthetic ankle fractures following total ankle joint replacement continues to increase. A treatment-oriented classification of these fractures has not yet been reported. The purpose of this study was to evaluate the prevalence, cause, and location of periprosthetic fractures and the stability of the associated prosthetic components after total ankle replacement and to develop a method of classification. METHODS: Data regarding 503 total ankle replacements with a mean follow-up of 14.7 months were reviewed. The prevalence, location, and possible cause of the fractures as well as prosthesis stability were analyzed and a systematic method of classification based on these factors was developed. RESULTS: Twenty-one patients (4.2%) with a periprosthetic fracture were identified. The fracture was intraoperative (Type 1) in eleven patients (2.2%) and postoperative in the remaining ten (2.0%). Two of the latter fractures were traumatic (Type 2) and eight were stress fractures (Type 3). Two-thirds (fourteen) of the twenty-one fractures occurred in the medial malleolus. CONCLUSIONS: The prevalence of periprosthetic fractures following primary total ankle replacement was relatively low. We propose a classification system for these fractures that is based on more than 500 cases. We believe that this classification can facilitate therapeutic decision-making, as it allows for differential analysis of the cause and guides the choice among operative and nonoperative treatment options.

Peripheral talar fractures.

Peripheral fractures of the talus are uncommon and often overlooked. CT scanning has become the imaging modality of choice and is necessary for decision making on treatment. Displaced peripheral fractures have to be managed with open reduction and internal fixation. Precise anatomical reduction is necessary to achieve a good result. A rigid internal fixation with interfragmentary lag screws is the method of choice in almost all fractures, which allows early postoperative mobilization. The outcome is related to the degree of the chondral lesion and the degree of instability of the subtalar joint, but it may be poor due to the treatment. Early diagnosis and proper treatment achieve the best possible results and prevent long-term complications. Typical complications of the fracture are nonunion and malalignment with slight subtalar instability or osseous overgrowth with secondary impingement and posttraumatic subtalar arthritis.