Anterior Ankle Arthroscopy: Advantage of a Preoperative Ultrasound Mapping to Prevent Neurovascular Complications.

PURPOSE: The aim of this study is to verify the usefulness of ultrasound-assisted mapping of the vascular and neurological structures in the anterior compartment of the ankle just before an anterior arthroscopic procedure to reduce these kinds of complications. METHODS: Various complications can be present in anterior arthroscopy of the ankle. The structures most prone to iatrogenic damage are vessels and nerves. They are macroscopically visible and palpable in a little more than 50% of cases, but arterial ramifications are not visible because they are located deeper. RESULTS: The authors have investigated how to reduce potential iatrogenic damage to the complex and variable neuro-vascular network of the anterior aspect of the ankle. They have completed the classic routine marking of the bony and tendinous structures with an ultrasound mapping of the neurovascular structures. CONCLUSIONS: The authors concluded that ultrasound-assisted mapping is a non-invasive, fast, and safe procedure that can help to reduce potential iatrogenic damage when performing anterior arthroscopic surgery.

Can Clinical and Surgical Parameters Be Combined to Predict How Long It Will Take a Tibia Fracture to Heal? A Prospective Multicentre Observational Study: The FRACTING Study.

BACKGROUND: Healing of tibia fractures occurs over a wide time range of months, with a number of risk factors contributing to prolonged healing. In this prospective, multicentre, observational study, we investigated the capability of FRACTING (tibia FRACTure prediction healING days) score, calculated soon after tibia fracture treatment, to predict healing time. METHODS: The study included 363 patients. Information on patient health, fracture morphology, and surgical treatment adopted were combined to calculate the FRACTING score. Fractures were considered healed when the patient was able to fully weight-bear without pain. RESULTS: 319 fractures (88%) healed within 12 months from treatment. Forty-four fractures healed after 12 months or underwent a second surgery. FRACTING score positively correlated with days to healing: r = 0.63 (p < 0.0001). Average score value was 7.3 ± 2.5; ROC analysis showed strong reliability of the score in separating patients healing before versus after 6 months: AUC = 0.823. CONCLUSIONS: This study shows that the FRACTING score can be employed both to predict months needed for fracture healing and to identify immediately after treatment patients at risk of prolonged healing. In patients with high score values, new pharmacological and nonpharmacological treatments to enhance osteogenesis could be tested selectively, which may finally result in reduced disability time and health cost savings.

Posterior arthroscopic approach to the ankle: an anatomic study.

PURPOSE: The purpose of this study is to verify the safety of a new technique for a posterior arthroscopic approach to the ankle. This technique was recently described in literature. The technique uses a modified posteromedial portal, a different way of introducing the instruments into the portal, and the tendon of the flexor hallucis longus (FHL) as a landmark to work in the posterior compartment. TYPE OF STUDY: Anatomic study. METHODS: The technique was performed on 10 (4 fresh and 6 fresh-frozen) below-knee amputation specimens, which were then dissected. The instruments were left in place, and anatomic dissections were performed to determine the relationship to the surrounding neurovascular structures. Then the instruments were removed, and the distance of the neurovascular structures from the posteromedial portal was recorded. Another medial portal, 1 cm more proximal, was also created to measure the distance of this latter portal from the nervous structures. RESULTS: None of the anatomic dissections showed injuries to the neurovascular bundle either during penetration of the instruments or during procedures in the posterior compartment laterally to the tendon of the FHL. This latter is the landmark to prevent damage to the more medially located nerves and vessels. The new posteromedial portal is located, on average, 13.3 mm (range, 11 to 17 mm) from the posterior tibial nerve, 14.7 mm (range, 8 to 20) from the calcaneal branch (which may be single or multiple, and may vary as needed the height of bifurcation from the posterior tibial nerve), and 17.3 mm (range, 15 to 21 mm) from the posterior tibial artery. A posteromedial portal located 1 cm more proximally is on average 2.9 mm closer to the nervous structures. CONCLUSIONS: Based on these anatomic data, there appears to be relatively little risk to the surrounding neurovascular structures with this new technique. Therefore, this technique appears to be relatively safe in the treatment of intra-articular and extra-articular pathology.