A Novel Indication for 3D-Printed Titanium Total Talus Replacements in Isolated Talar Tumors.

Background: Intraosseous talar tumors are rare and usually require complex surgery such as tibiocalcaneal fusion with allograft, resulting in a poor functional outcome. Total talus replacement (TTR) has been primarily described predominantly after trauma for talar avascular necrosis in the absence of peri-talar arthrosis. We present our small initial case series of this novel indication for a TTR to treat a localized talus tumor with no associated osteoarthritis.

Cortico-cancellous osseointegration into additively manufactured titanium implants using a load-bearing femoral ovine model.

Titanium-based implants can be used to fill voids in bone reconstruction surgery. Through additive manufacturing (AM), it is possible to produce titanium implants with osteoconductive properties such as high porosity and low stiffness. AM facilitates a level of design flexibility and personalization that is not feasible with traditional techniques.

Counting the lifetime cost of obesity: Analysis based on national England data.

Aim: Obesity has a significant impact on all-cause mortality rate and overall health care resource use (HCRU). These outcomes are also strongly linked to age, sex and local deprivation of the population. We aimed to establish the lifetime costs of obesity by demographic group/geographic area using published mortality rates and HCRU use for integrated care boards (ICB) in England in the context of costs of therapeutic intervention.

Surgical treatment of chronic achilles tendon rupture: An anatomical consideration of various autograft options.

Background: Acute Achilles tendon rupture is a common injury and when missed leads to the development of a chronic Achilles tendon rupture. Studies suggest surgical treatment (either repair or reconstruction) for most patients with a chronic Achilles rupture due to the functional deficit caused by the lack of an intact Achilles tendon. Numerous autograft options such as the flexor hallucis longus, hamstrings, peroneal and quadriceps tendon have been used to reconstruct the Achilles tendon, either as a tendon transfer or as an interposition graft.

A new classification for Freiberg's disease.

Introduction: Freiberg's osteochondrosis is an uncommon cause of foot pain. Following a national survey circulated by the British Foot and Ankle Society it was found that no classification is used to guide surgical treatment. This study aimed to create a simple, reproducible CT based classification to preoperatively plan whether an osteotomy is required.

Treatment of Severe Avascular Necrosis of the Talus Using a Novel Keystone-Shaped 3D-Printed Titanium Truss Implant.

Background: Avascular necrosis (AVN) of the talus most commonly occurs secondary to trauma. Significant bone loss and collapse in severe talar AVN remains an operative challenge. Tibiotalocalcaneal arthrodesis (TTC) using femoral head allograft is at risk of collapse and subsidence.

The lateral transligamentous approach to the talar dome.

Introduction: Anatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated 43% talar body access with a single incision and without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach.

An Approach to Managing Midfoot Charcot Deformities.

We present an approach to managing complex deformities in Charcot neuroarthropathy that typically present around the midfoot. This approach follows a stepwise progression from prevention, early detection, nonoperative through to operative management. It centers on multidisciplinary care with input from diabetologists, orthotists, plaster technicians, physiotherapists, orthopedic, vascular, and/or plastic surgeons.

The effect of computerised tomography on operative planning in posterior malleolus ankle fractures.

Background: The aim of this project was to analyse whether a CT influences surgical planning in ankle fracture involving the posterior malleolus.

Methods: Twenty consecutive patients with fractures involving the posterior malleolus were retrospectively selected and had their plain radiographs and CT scan anonymised. Initially, radiographs alone were presented to nine trauma surgeons to formulate a surgical plan individually.

Outcome following use of the Achillon jig for the repair of acutely ruptured Achilles tendons.

We report a series of 143 patients who underwent limited open Achilles tendon repair using the Achillon device at a mean follow-up of 25 months. All patients attending our institution with a diagnosis of acute Achilles tendon rupture were considered for operative repair using the Achillon jig unless they declined surgery or met the exclusion criteria. Following surgery patients were contacted and asked to complete an Achilles Tendon Rupture Score (ATRS).

Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia.

Background: As in all fields of surgery, advances in orthopaedic surgery develop toward less invasive surgical techniques. The advantages of smaller incisions include minimal soft tissue dissection allowing procedures to be performed as outpatient surgery. There is the assumption that this leads to a quicker recovery time permitting an earlier return to work.

Talus avulsion fractures: are they accurately diagnosed?

Dorsal talus avulsion fractures occurring along the supination line of the foot can cause pain and discomfort. Examination of the foot and ankle using the Ottawa ankle rules does not include examination of the talus, an injury here is easily missed causing concern to the patient. This is a retrospective study carried out in a major trauma centre to look at the assessment and diagnosis of all patients with a dorsal talus and navicular avulsion fractures over a one year period.

The treatment of iatrogenic hallux varus.

Though uncommon, iatrogenic hallux varus is most often the result of overresection of the medial eminence, overtranslation of an osteotomy, overrelease of the lateral soft tissues, or overtightening of the medial tissues. It is not always symptomatic, as the degree of deformity can be well tolerated. For soft-tissue reconstructions, releases have little role to play unless minor deformity is detected early on and the longevity of tendon transfer and tenodesis remains unknown.

Assessment of a three-grade classification of complications in total ankle replacement.

Background: Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritis of the ankle. A 3-grade classification of complications to assist in prediction of early implant failure has been proposed. We have compared the experience of a tertiary referral center in the United Kingdom to the proposed system.

Acute quadriceps tendon rupture: a pragmatic approach to diagnostic imaging.

Introduction: Quadriceps tendon ruptures are uncommon injuries, occurring most frequently in males over 40 years and associated with obesity, renal failure and steroids. Literature states that ultrasonography and magnetic resonance imaging have a role in diagnosis. We discuss the contrasting advantages and disadvantages of each imaging modality and establish their diagnostic value.

Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique.

Background: The TightRope® is a relatively new device designed to stabilize ankle syndesmotic injuries. There are no studies evaluating the clinical effectiveness of this technique and few reports addressing complications and potential modifications to the surgical technique reported in this article.

Materials And Methods: A retrospective review of 102 cases of traumatic ankle syndesmotic stabilization using the TightRope device is presented.

Absence of the flexor digitorum longus tendon: an MRI study.

Flexor digitorum longus (FDL) is the primary flexor of the lateral four toes. It is a reliable source of tendon for transfer surgery. We present a case whereby a patient who required a reconstruction for adult acquired flatfoot deformity using FDL as a dynamic structure for transfer was found to have an absent FDL tendon at the time of operation, necessitating the use of flexor hallucis longus (FHL) instead.

Complex primary arthrodesis of the first metatarsophalangeal joint after bone loss.

Background: Complications associated with a failed Keller procedure or joint replacement include bone loss and shortening of the first ray. We treated failed Keller resection arthroplasty and joint replacement arthroplasty cases with metatarsophalangeal joint arthrodesis, using an interpositional tricortical autograft from the iliac crest and a low-profile titanium plate.

Methods: This was a retrospective case note review of the patients treated by four consultant surgeons in a university teaching hospital.

Interpretation of the scarf osteotomy by 10 surgeons.

Background: The study compared three-dimensional (3D) changes in geometry of the first metatarsal following scarf osteotomy performed on standardised Sawbone® models by consultant foot and ankle surgeons. The study considered the inter-surgeon variances in interpretation and performance of the scarf osteotomy with respect to intra-surgeon variances.

Methods: The analysis used an accurate digitising system to measure and record points on the Sawbone® models in 3D space.

The importance of magnetic resonance imaging in a symptomatic "bipartite" os peroneum: a case report.

Although well reported in the literature, fractures of the os peroneum are uncommon and can be difficult to differentiate from symptomatic multipartite sesamoids. The location of the os peroneum within the tendon of peroneus longus can make it difficult to excise without compromising or sacrificing the tendon, and, subsequently, necessitating reconstruction or tenodesis to peroneus brevis. In this article, we describe the case of an adult female who presented with a fractured os peroneum that radiographically appeared bipartite, and necessitated excision with reconstruction of the peroneus longus.

Flexor digitorum longus tendon exposure for flatfoot reconstruction: A comparison of two methods in a cadaveric model.

Background: A novel method for harvesting the flexor digitorum longus (FDL) tendon has been described via a plantar approach based on a surface coordinate. The aim of this investigation is to provide a comparison with the traditional medial midfoot dissection for tendon harvest.

Methods: The FDL tendon was exposed in 10 cadaveric feet via a limited plantar approach and also medially as far as could be accessed via the knot of Henry.

Simultaneous bilateral Achilles tendon ruptures associated with statin medication despite regular rock climbing exercise.

Introduction: Ruptures of the Achilles tendon are common however simultaneous ruptures occur less frequently. Eccentric loading exercise programmes have been used to successfully treat Achilles tendinopathy.

Case Report: We report a case of simultaneous bilateral Achilles tendon rupture in a patient predisposed to rupture due to longstanding raised serum lipoprotein and recently introduced therapeutic statin medication.