Tillaux Fracture Associated with Adult Ankle Fracture Injury.

Tillaux fractures in adults are rare and, if unrecognized, can lead to ankle fracture healing complications, early progression of arthritis, and limited ankle movement caused by pain and degenerative changes. The Tillaux fracture was first described by Paul Tillaux as an external rotation injury of the ankle, involving an avulsion fracture of the distal anterolateral tibia. This fracture can be easily overlooked on plain radiographs in the adult. A high index of suspicion for this type of fracture pattern along with the use of computed tomographic scanning can help confirm the suspected diagnosis, rule out other tibial injuries, and provide more information on the best course of action. Historically, Tillaux fractures have been more common in adolescents because of the open tibial epiphyseal plate. Once the epiphyseal plate fully closes, skeletal maturity is achieved, thus making it extremely unusual for the anterior tibiofibular ligament to cause an avulsion fragment of the distal anterolateral tibia. Because of how uncommon this type of fracture is in adults, it has rarely been reported in our literature. We reviewed the literature and present a case report of this rare fracture injury.

Bone graft from the distal medial tibia in foot and ankle surgery.

UNLABELLED: Autogenous bone graft is the ideal substrate for primary and revisional foot and ankle surgery. The distal medial tibia is an easily accessible site that provides both cancellous and corticocancellous autograft. Thirty cases of distal tibial bone graft with a minimum follow-up of 1 year are presented. There was an 86% union rate, and there were no stress fractures, persistent pain, or reported nerve injuries at the donor site. An efficient and versatile technique for harvesting both cancellous bone graft and corticocancellous graft is described. The use of distal tibial bone graft eliminates the need for a second surgeon and more lengthy harvest procedure and offers sufficient autograft material for foot and ankle applications with a low rate of complications. LEVELS OF EVIDENCE: Therapeutic, Level IV.

Arthroscopic treatment of ankle osteochondral lesions.

Arthroscopic treatment of osteochondral lesions (OCLs) of the ankle is a popular first-line surgical option after conservative therapy has failed. MRI is the preferred imaging modality to evaluate OCLs and aid in surgical planning. Associated soft tissue pathology must be appreciated and addressed surgically, because associated synovitis and soft tissue impingement often contribute to symptoms. The diverse treatment modalities available via arthroscopy offer simplistic and straightforward solutions for biologically and mechanically complicated pathology. Marrow-stimulating techniques, particularly microfracture, have shown good to excellent results in most patients with small (<15 mm) acute lesions, and have a low complication rate.

Contralateral peak plantar pressures with a postoperative boot: a preliminary study.

BACKGROUND: Frequent use of walking boots in podiatric medicine often elicits patient complaints and sequelae from the imposed limb-length discrepancy. This study was designed primarily to determine whether peak plantar pressures are decreased in the contralateral foot when a moderately worn athletic shoe is worn opposite a high-calf walking boot and, if so, secondarily to determine whether a specialized surgical shoe worn on the contralateral foot can also effectively reduce this pressure. The pressure reductions were then compared to determine whether significantly greater plantar pressure reduction was provided by either the athletic shoe or the surgical shoe. METHODS: Participants without a foot abnormality walked on a treadmill in four footwear combinations: barefoot bilaterally, high-calf rocker-bottom sole (HCRB) walking boot/ barefoot, HCRB walking boot/athletic shoe, and HCRB walking boot/modified walking boot shoe. Measurements were taken with the participants wearing socks. Peak plantar calcaneal pressures were collected. RESULTS: Peak plantar pressures under the calcaneus opposite the HCRB walking boot were significantly reduced from barefoot pressures when either an athletic shoe or the modified walking boot shoe was worn. However, no significant difference was seen when comparing the reduction by the athletic shoe with that by the modified walking boot. CONCLUSIONS: Wearing an athletic shoe on the foot opposite an HCRB walking boot reduces calcaneal pressures; however, wearing a modified device with structural properties of an HCRB walking boot sole is no better than an athletic shoe at reducing peak calcaneal pressures.

High fibular fracture in association with triplane fracture: reexamining this unique pediatric fracture pattern.

A case of a high fibular fracture in association with a triplane fracture in a 12-year-old boy is presented and this unique fracture pattern examined. Whether from blunt trauma or an external rotation mechanism, it appears that trans-syndesmotic fixation is not needed to satisfactorily repair this injury. Because of the rarity of the condition, there is limited previously published information describing this particular injury, although surgeons should be aware of it and the underlying mechanism of the fracture.