Endoscopic Screw Removal, Debridement of the Peroneal Tendons and Subtalar Joint and Lateral Calcaneal Ostectomy for Management of Chronic Heel Pain after Calcaneal Fracture.

Calcaneal fracture is one of the most common foot and ankle fractures, but the best treatment of this fracture is still under debate. No matter the treatment strategy of this intra-articular calcaneal fracture, early and late complications frequently occur. In order to treat these complications, combination of various ostectomy, osteotomy, and arthrodesis techniques have been proposed to re-establish the calcaneal height, restore the talocalcaneal relationship, and create a stable, plantigrade foot. In contrast to this approach of addressing all the deformities, another feasible approach is concentrating on those aspects that are the most clinically pressing.10, 11, 12, 13, 14, 15 Different arthroscopic and endoscopic approaches focused on the patient's symptoms and not the correction of the talocalcaneal relationship or restoration of the height or length of the calcaneus have been proposed to deal with late complications of calcaneal fractures. The purpose of this technical note is to describe the details of endoscopic screw removal, debridement of the peroneal tendons, and subtalar joint and lateral calcaneal ostectomy for management of chronic heel pain after calcaneal fracture. It has the advantage of dealing with various sources of lateral heel pain after calcaneal fracture, including the subtalar joint, peroneal tendons, lateral calcaneal cortical bulge and screws.

Endoscopic Superior Peroneal Retinaculum Reconstruction Using Q-FIX MINI Suture Anchor.

Post-traumatic peroneal tendon subluxation or dislocation is most commonly caused by injury to the superior peroneal retinaculum. Classic open surgeries usually require extensive soft-tissue dissection and have potential risks of peritendinous fibrous adhesions, sural nerve injury, limited range of movement, recurrent or persistent peroneal tendon instability, and tendon irritation. The purpose of this Technical Note is to describe the details of endoscopic superior peroneal retinaculum reconstruction using Q-FIX MINI suture anchor. This endoscopic approach has the advantages of minimally invasive surgery, including better cosmesis, less soft-tissue dissection, less postoperative pain, less peritendinous fibrosis, and less subjective tightness at peroneal tendons. Insertion of the Q-FIX MINI suture anchor can be performed inside a drill guide, and trapping of the surrounding soft tissue can be avoided.

Arthroscopic Deltoid Ligament Reconstruction in Rotational Ankle Instability.

Chronic lateral ankle instability is a common orthopaedic problem. The continuous stress applied by the lateral instability may affect the superficial deltoid ligament. The combination of lateral ankle instability and injury to the most anterior fascicles of the deltoid ligament contributes to rotational ankle instability. The purpose of this Technical Note is to describe the details of arthroscopic deltoid ligament reconstruction in rotational ankle instability. This minimally invasive approach allows other associated lesions to be detected and managed arthroscopically.

Modified Endoscopic Distal Soft Tissue Procedure With Medial Metatarsosesamoid Ligament and Intermetatarsal Ligament Augmentation.

Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position.

Modified Endoscopic Distal Soft Tissue Procedure (mEDSTP) and Arthroscopic Lapidus Arthrodesis for Correction of Severe Hallux Valgus.

Hallux valgus is one of the most common forefoot deformities faced by foot and ankle surgeons. Symptomatic deformity usually needs surgical correction. Endoscopic techniques of hallux valgus correction have been reported that are based on the same principle of the classic distal soft tissue procedure. Recently, the technique has been modified to include reconstruction of the medial metatarsosesamoid ligament and augmentation of the intermetatarsal ligament. In severe deformity or the presence of hypermobility or painful degeneration of the first tarsometatarsal joint, Lapidus arthrodesis of the joint is indicated. Arthroscopic Lapidus arthrodesis has been reported to reduce the complications associated with open procedure, including first metatarsal shortening, metatarsal elevatus, and nonunion. In this technical note, the technical details of a combined modified endoscopic distal soft tissue procedure and arthroscopic Lapidus arthrodesis is described. This is a minimally invasive approach for correction of severe hallux valgus deformity, especially that associated with ligamentous laxity.

Arthroscopically Assisted Reduction and Fixation of Deltoid Ligament Avulsion Fracture From Medial Malleolus.

Ankle fractures are one of the most common orthopaedic injuries. The surgical principle is to restore anatomy and stability of the ankle mortise. Repositioning of the talus under the tibia with normalization of the medial clear space is mandatory for a good outcome. Deltoid ligament injuries can present as an avulsion fracture of the medial malleolus. The purpose of this Technical Note is to describe the details of arthroscopically assisted reduction and fixation of deltoid ligament avulsion fracture from medial malleolus. This can restore the medial stability of the ankle.

Management of Bone Cyst of Talar Body by Endoscopic Curettage, Nanofracture, and Bone Graft Substitute.

Large bone cyst of the talar body is frequently associated with an osteochondral lesion. The talar bone cyst can be an incidental radiologic finding. However, when the talus is extensively destroyed, there is a risk of pathologic fracture and damage to the articular cartilage, leading to persistent swelling and pain of the subtalar joint and ankle joint. Open debridement and bone grafting frequently requires extensive soft-tissue dissection or even different types of malleolar osteotomy for proper access to the lesion. The purpose of this Technical Note is to describes the technique of endoscopic curettage, nanofracture, and filling the cyst with injectable bone graft substitute. This minimally invasive approach has minimal disruption of the normal cartilage surface.

Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases.

Chronic subdural haematoma (CSDH) is a common neurosurgical condition and is more prevalent in the ageing population. Studies have suggested that placement of subdural drains after burr-hole drainage was associated with lower recurrence rates. However, a considerable proportion of surgeons remained unconvinced of the effectiveness of drain placement and concerns exist with the potential complications this additional manoeuvre entails such as infection or bleeding. The aim of the present study is to evaluate the impact of subdural drain on CSDH recurrence and its safety. This is a multicentre observational study. Data of consecutive patients with burr-hole drainage performed for CSDH in three hospitals in Hong Kong during a four-year period from January 2008 to December 2011 were prospectively collected and retrospectively analysed. The primary outcome was symptomatic recurrence requiring re-operation. Secondary outcomes included the modified Rankin scales (mRS), morbidity and mortality at six months. A total of 302 patients were identified. The recurrence rate was 8.72% (13/149) with drain placement versus 16.3% (25/153) with no drain (Odds Ratio=0.489, 95%CI 0.240-0.998; p=0.0463). Local wound infection, subdural empyema, acute subdural haematoma and other complications had no significant difference. Six-month mRS, 30-day mortality and six-month mortality were comparable in both groups. In conclusion, the use of subdural drain significantly reduced recurrence with no significant increase in complications.