Delayed Diagnosis of Syndesmotic Injury: A Treatment Algorithm.

A delay in diagnosis and management of syndesmotic injuries can result in a complex treatment challenge, leading to poorer clinical results and higher rates of unplanned, syndesmotic-related primary operations and reoperations. This article presents a simple and reproducible algorithm with case examples for the management of syndesmotic injuries with delay in diagnosis to help guide surgeons when determining the best treatment strategies for this complex injury.

Anthropometric measurements of the foot cannot predict the screw diameter for fifth metatarsal fractures intramedullary fixation.

Purpose: The present study aimed to evaluate the accuracy of anthropometric foot measurements in predicting the diameter of the intramedullary screw for fifth metatarsal fracture fixation. Secondary aim was to identify whether the fifth metatarsal intramedullary canal diameter is correlated to the fifth metatarsal length and the foot dimensions.

Methods: In 29 cadaveric feet, the maximum length of the plantar surface of the foot (PL) and the perimeter of the foot at the level of the fifth metatarsal base (PBFM) were measured using a measuring tape.

Diffuse Tenosynovial Giant Cell Tumor Encircling the First Metatarsal Bone Remodeling after Resection. A Case Report.

Introduction: The term tenosynovial giant cell tumor encompasses a group of rare soft-tissue tumors. A new classification divides the group in localized and diffuse type, depending on the involvement of the surrounding tissues. Due to the unclear origin and heterogeneity in extend of the diffuse-type giant cell tumors, there is only limited evidence on the tumor-specific treatment.

Physical Examination of Ankle Sprain and Ankle Instability: Can We Really Divide It into Low and High Ankle Sprains?

Lateral ankle ligament sprains and syndesmotic injuries are two different entities. However, they may be combined under the same spectrum depending on the arch of violence during the injury. Currently, the clinical examination has a limited value in the differential diagnosis between an acute anterior talofibular ligament rupture and a syndesmotic high ankle sprain.

Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda's process resection in patients with posterior ankle impingement syndrome: a prospective comparative study.

Objective: To evaluate the potential differences in American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score and Foot Function Index (FFI) at 6-month and 12-month postoperative follow-up of arthroscopic treatment for posterior ankle impingement (PAIS) between os trigonum (OT) and Stieda's process (SP) patients.

Methods: Thirty consecutive patients (32 ankles) treated in our Institution for PAIS with posterior arthroscopy were prospectively enrolled in the study from December 2012 to July 2019. Indications were patients with PAIS with persistent symptoms following conservative management.

Insufficient evidence to support peroneus longus tendon over other autografts for primary anterior cruciate ligament reconstruction: a systematic review.

Importance: Graft choice for anterior cruciate ligament reconstruction (ACLR) remains a subject of interest among orthopaedic surgeons because no ideal graft has yet been found. Peroneus longus tendon (PLT) has emerged as an alternative autograft for reconstruction in kneeling populations and in simultaneous anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries.

Objective: To evaluate the current evidence on the outcome of primary ACLR with PLT autograft in adults and donor ankle morbidity, in addition to determining the average PLT graft dimensions from published studies.

Single incision, minimally invasive fasciotomy of the anterior and lateral leg compartments with decompression of the superficial peroneal nerve.

Background: There is a considerable overlap of symptoms between chronic exertional compartment syndrome (CECS) of the anterior and lateral compartments of the lower leg and entrapment neuropathy of the superficial peroneal nerve (SPN). We describe a minimally invasive, single incision surgical technique for release of both the compartments and the SPN in the same setting. The operative technique involves a minimal anterolateral approach at the level where the SPN pierces the subcutaneous fascia.

Talonavicular Dislocation-What Lies Beneath?

Background: The talonavicular joint is a rare site of dislocation. Its etiology varies and can be the result of either acute trauma or a chronic degenerative process that most commonly occurs in patients with rheumatoid arthritis or Charcot arthropathy. Our aim is to highlight the relationship between the underlying pathology of talonavicular dislocations and the final outcome in the case of operative management.

Minimal resection interposition arthroplasty of the first metatarsophalangeal joint.

Background: Interposition arthroplasty of the first metatarsophalangeal (MTP) joint is a viable alternative to fusion in patients with advanced hallux rigidus. The purpose of this study is to evaluate the midterm results of a modification of the technique.

Methods: Case series of 18 interposition arthroplasties were performed on 13 female patients with Grade III-IV hallux rigidus.

Surgical management of hallux valgus and hallux rigidus: an email survey among Swiss orthopaedic surgeons regarding their current practice.

Background: Various clinical and radiological criteria have been suggested to choose one of the numerous techniques in surgical treatment of hallux valgus and rigidus. We hypothesized that the surgeons' professional background will influence that choice depending on specialization, age, type and institution of training as well as his orthopaedic cultural orientation. Since Switzerland is characterized by regional languages (the most important being German and French), we were interested to learn if the linguistic differences had an influence on the orientation of the surgeons towards e.

Late diagnosis of a McFarland fracture: imaging and treatment.

McFarland fractures represent a type of oblique medial malleolar fracture in children that can be challenging to diagnose and treat. A 14-year-old junior league soccer player with a Salter Harris type IV McFarland fracture presented late, as the initial routine two views radiological assessment failed to reveal a clear fracture line. The addition of a mortise ankle view led to the correct diagnosis and subsequent MRI findings guided nonsurgical treatment with an excellent outcome.

Common pitfalls in syndesmotic rupture management: a clinical audit.

Background: Syndesmotic injuries occur in up to 11% of all ankle injuries. Whereas the optimal fixation of syndesmotic injuries remains controversial, pitfalls in their management can lead to poor outcomes.

Materials And Methods: This is a retrospective study of all ankle fractures operated on at a level 1 trauma center over a 7-year period.

Perioperative variations of the intracompartmental pressures of the paraspinal muscles.

Study Design: Study of the influence of thoracolumbar spinal surgery through a posterior approach to the intercompartmental pressure of the paraspinal muscles.

Objective: To create waveforms according to the pressure variations up to 24 hours postoperatively and relate these measurements to independent parameters.

Summary Of Background Data: The existence of a paraspinal anatomic compartment and a relevant compartment syndrome has been supported theoretically, proven experimentally, and confirmed in clinical cases.

Prevalence of interdigital nerve enlargements in an asymptomatic population.

Background: Morton's neuroma is a common primary diagnosis for referral to foot and ankle surgeons. On presentation, many patients have had an ultrasound reporting the presence of Morton's neuroma, which may not correlate with the clinical examination findings. The prevalence of such sonographic findings in the general population remains unknown.

Sutures versus sterile strips for closure of ankle arthroscopy portals: prospective crossover trial.

Background: Either a nylon single suture or adhesive tape in the form of Steri strip are commonly used for the closure of portals in ankle arthroscopy. The purpose of this study was to compare the two methods with regards to their safety, complications and cosmetic result.

Methods: This was a prospective cross over study of 100 patients who underwent ankle arthroscopy.

Operative management of common forefoot deformities: a representative survey of Australian orthopaedic surgeons.

Background: Hallux valgus and hallux rigidus are common conditions for which numerous operative interventions have been described in the literature. Various clinical and radiological measurements have been used to help grade severity and to guide treatment.

Materials And Methods: A survey was e-mailed to all members of the Australian Orthopaedic Association.

Solitary navicular metastasis of a pulmonary adenocarcinoma.

Unlabelled: The authors present a case of a 62-year-old male with a symptomatic isolated midfoot metastasis as the first clinical presentation of a primary pulmonary tumor. In this case of a metastatic adenocarcinoma, the lesion leading to diagnosis was located in the foot. The poor outcome and the sparse relevant literature are presented in brief.

Metatarsal bars more effective than metatarsal pads in reducing impulse on the second metatarsal head.

Background: The second metatarsal head is commonly involved in cases of metatarsalgia. As part of the conservative treatment, metatarsal bars and metatarsal pads are often prescribed.

Objective: To compare the effectiveness of metatarsal bars and metatarsal pads in reducing impulse on the second metatarsal head.

Osteoid osteoma of the posterior talar dome.

Osteoid osteoma of the foot and ankle can be challenging to diagnose. A case of an osteoid osteoma of the posterior talar dome is presented in this article. The lesion mimicked other local pathologies resulting in considerable delay in diagnosis and unnecessary therapeutic interventions.

Suction during orthopaedic surgery. How safe is the suction tip?

The use of a suction system is mandatory in most orthopaedic procedures. In the unlikely event of contamination of the system, deep wound infection could occur, jeopardising the operation. We have prospectively studied 50 patients who underwent elective and orthopaedic trauma procedures during which a suction system was used.

Late results of absorbable pin fixation in the treatment of radial head fractures.

The use of bioabsorbable pins with prolonged degradation periods for fracture fixation has raised concerns about adverse soft tissue reactions, including seromas, discharging sinuses, or osteolytic changes. We asked whether bioabsorbable pins of self-reinforced polylactic acid polymer used in radial head fractures resulted in such reactions. We retrospectively reviewed 21 patients followed a minimum of 36 months (mean, 81 months; range, 36-136 months).

Primary epithelioid hemangioendothelioma of the lumbar spine.

Background Context: Primary epitheliod hemangioendotheliomas of the lumbar spine are extremely rare tumors with an unpredictable clinical course.

Purpose: To present a case of primary lumbar epithelioid hemangioendothelioma and its treatment protocol.

Study Design/setting: A tertiary Spinal Unit.