AOFAS Score Research Articles

Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability: Case Series

Category:Arthroscopy; SportsIntroduction/Purpose:The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Maintenance of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability.Methods:This is a retrospective study with patients diagnosed with multidirectional instability, submitted to an ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the VAS and the AOFAS Score at a mean of 14.8 months (5-27 months) in follow-up.Results:A total of 30 ankles (29 patients) were included in the study. AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean (p=0.001) and was followed by significant improvement in the mean VAS (6.83; CI 0.37 to 0.95; CI 0.31). The majority of patients had associated procedures (53.3%) and a low complication rate was found (16.6%).Conclusion:Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique can improve the clinical outcomes of these patients.

Ultrasound-guided hyaluronic acid injection for the treatment of insertional Achilles tendinopathy: A prospective case series

BackgroundHeel pain is a common condition and often involves the Achilles tendon and is classified as insertional or non-insertional. Several operative and non-operative treatments have been described, but there is no consensus on the most effective therapy. The aim of this study is to evaluate a case series of patients with insertional Achilles tendinopathy refractory to conservative treatment submitted to a single-dose ultrasound-guided injection of hyaluronic acid (40 mg/2.0 mL). MethodsWe prospectively included 25 patients (29 feet) who underwent a single ultrasound-guided injection of hyaluronic acid after conservative treatment failure. Clinical outcomes such as pain (using the Visual Analog Scale – VAS), function (using the American Orthopedic Foot & Ankle Society – AOFAS score), personal satisfaction, and complications were evaluated. Statistical analysis was performed using the R software. ResultsMost patients were female (80%) and there was a right-side predominance (55%). The median VAS was 8 points [range 4–10] at baseline, decreasing to 3 points [range 0–8] at the six-month follow-up, with statistical significance (p < .001). The median AOFAS score was 71 points [range 38–87] at baseline, increasing to 90 points [range 48–100] at the six-month follow-up (p < .001). The personal satisfaction level was 69%, and 48% of patients considered the result excellent. There were no Achilles tendon ruptures, infections, or allergic reactions post injection. ConclusionSingle-dose injection of hyaluronic acid is a safe treatment option, improving function and reducing pain for six months in patients with insertional Achilles tendinopathy after conservative treatment failure. Level of evidenceIV, case series.

Approach to Displaced Intra-Articular Calcaneus Fractures After Attempted Suicide Among Patients With Psychiatric Disorders: Nonsurgical or Surgical?

Displaced intra-articular calcaneus fracture is one of the injurious events in psychiatric patients after high-jump suicide attempts. These patients are reported to have poorer compliance and worse postoperative outcomes compared to those with no psychiatric condition. We aimed to compare nonsurgical and surgical treatment with respect to functional and radiological outcomes and complications in this patient. We evaluated medical records of 42 psychiatric patients who had displaced intra-articular calcaneal fractures after high-jump suicide attempt. 20 (54%) of these were treated nonsurgically and further 17 patients (46%) received surgical intervention. We compared to nonsurgical and surgical approaches statistically. The mean follow-up period were 30.4 ± 8.02 months and 31.8 ± 7.5 months in the nonsurgical and surgical groups, respectively. Böhler's angle was significantly higher in the surgical group (30.4 ± 6.4) than that in the nonsurgical group (16.1 ± 3.7) (p=.001). AOFAS scores and supination levels were significantly higher in the surgical group than that in the nonsurgical group (p ≤ .05). During the follow-up period, one patient from the surgical group re-attempted high-jump suicide and died, and another one caused the subtalar joint to re-collapse after full weightbearing on the first postoperative day. Surgical treatment of displaced intra-articular calcaneal fractures following a high-jump suicide attempt in psychiatric patients may not cause increased complication rates. However, behavioral manifestations of the psychiatric disorder might be associated with several complications. Should any surgical intervention be decided, minimal invasive approach would be the appropriate choice.

Short leg cast versus orthotic removable support for the management of pseudo-Jones avulsion fracture: A systematic review and meta-analysis

BackgroundThe fifth metatarsal base avulsion fracture (i.e., Pseudo-Jones fracture) is one of the most common foot fractures. The management of pseudo-Jones fractures could be carried out surgically or conservatively. This systematic review and meta-analysis aimed to provide an update about the efficacy of orthotic removable support compared to short-leg casting for individuals with pseudo-Jones fracture. MethodsWe searched Embase, Medline, and Cochrane Central register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) that compared the clinical outcomes of orthotic removable support and short-leg cast for adult individuals with a fifth metatarsal base avulsion fracture. We used 95% as a confidence level and P <0.05 as a threshold. The standardized mean difference (SMD) was used for the continuous outcomes, and the risk ratio (RR) was used for the dichotomous outcomes. ResultsA total of 6 RCTs incorporating 403 individuals out were deemed eligible. There was no significant difference between orthotic removable support and short-leg casting regarding AOFAS score (standardized mean difference (SMD)= 0.31, 95% CI -0.17 to 0.8), pain on VAS score (SMD= -0.08, 95% CI -0.39 to 0.22), VAS-FA score (SMD= 0.22, 95% CI -0.19 to 0.62) EQ-5D VAS score, and non-union rate (RR=0.37, 95% CI 0.05 to 2.74). ConclusionThe current meta-analysis reveals that there is no difference between orthotic removable support and short-leg casting for the conservative management of individuals sustaining pseudo-Jones fracture.

Ankle Height Preservation with the Hind Foot Nail and Iliac Crest Bone Blocks in Patients with Sequelae of Partial or Complete Talus Bone Loss.

Introduction:The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection.Materials and methods:Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest.Results:All patients were followed-up for an average of 17.6 months (range 12.0 – 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united.Conclusions:The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.

Posttraumatic Osteoarthritis. Effective Combination of Non-steroidal Anti-inflammatory Drugs and SYSADOA

Osteoarthritis (OA) is the most frequent joint desease and is the leading cause of the functional loss and disability among older patients. The heterogeneity of OA determines the absence of a 100% effective therapeutic strategy for all patients. In addition, this heterogeneity may be the main reason for the failure of clinical trials of therapeutic agents designed to restore cartilage. The SYSADOA group of drugs, in particular – glucasamine and chondroitin, is among the most studied compounds, have a good safety profile and showed proven efficacy in the early stages of osteoarthritis. The use of these drugs in combination with non-steroidal anti-inflammatory drugs (NSAIDs) is widespread in the world and is included in the recommendations of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis – ESCEO. The objective: to assess the clinical efficacy and safety of the combination of diclofenac potassium 50 mg, chondroitini sulfatis 400 mg and glucosamini sulfatis 500 mg; chondroitini sulfatis 400 mg and glucosamini sulfatis 500 mg in treatment of patients with knee and ankle post-traumatic osteoarthritis in the early stages (I–II according to Kelgren and Lawrence). Materials and methods. The study was designed as a randomized comparative prospective placebo-controlled in parallel groups. The level of evidence for this study is II-B. Patients of the main group N1 underwent surgical treatment for joint trauma and had a radiographically and clinically confirmed diagnosis: post-traumatic osteoarthritis stage I-II (according to Kelgren and Lawrence) of the ankle (N1.1=15) and knee (N1.2=15) joints. Time from injury and surgery was 14.3±2.3 months. Patients from main group received combination of diclofenac potassium, chondroitini sulfatis and glucosamini sulfatis for 10 days at the begining of the treatment course, and followed with combination of chondroitin and glucosamin for 3 months further. The comparison group included similar patients in terms of the number, gender, age and the nature of OA (N2.1=15; N2.2=15), these patients were prescribed diclofenac potassium 50 mg 2 times a day (for the first 10 days of treatment), and further followed with placebo (for the next 3 months). All enrolled patients also were prescribed basic non-pharmacological treatment, which included body weight control, physical therapy, mechanotherapy, exercises, together with orthopedic devices to unload and stabilize the affected joint. The results of treatment were assessed clinically at 3 months and 6 months after the start of treatment using VAS, functional state of the ankle (according to AOFAS) and knee (according to Lysholm scale); on each visit information about adverse reactions was collected. Results. After 3 months, the intensity of pain according to VAS in the N1.1 group was 24.8±2.1 points, and in the N2.1 group 29.2±3.2 (p&lt;0.05). After 6 months, the VAS results were accordingly 15.1±3.4 vs 26.7±0.9 (p&lt;0.01). The functional capacity of the ankle joint, evaluated by AOFAS, after 3 months in N1.1 group achieved 81.7±4.3 and 68.4±5.6 points in N2.1 group (p&lt;0.01). At 6 months, the AOFAS score was 93.9±3.8 vs 79.4±4.1 (p&lt;0.05). After 3 months VAS score in patients with early stages of knee OA (group N1.2 and N2.2) was 21.2±1.9 vs 28.3±3.1 mm (p&lt;0.05); after 6 months – 14.7±1.4 vs 23.9±2.8 mm (p&lt;0.01). The level of functional activity after 3 months of treatment according to the Lysholm scale achieved 86.8±2.9 points versus 68.4±5.6 points (p&lt;0.05) and after 6 months - continued to grow and got to 97.4±1.2 vs 86.2±2.9 points (p&lt;0.01). There were no statistical differences in number and intensity of the adverse events in the studied groups (p&gt;0.5). Conclusions. In the early stages of post-traumatic osteoarthritis of the knee and ankle joints (I–II according to Kelgren and Lawrence), a 3-month course of treatment with combination of NSAID and SYSADOA (diclofenac with chondroitin and glucosamin), followed by further treatment with SYSADOA (chondroitin and glucosamine) demonstrated superior efficacy compared to the placebo/standard treatment with the same level of safety.

A comparative study of functional and radiological outcome in the management of distal tibia fractures treated by intra medullary nailing and minimally invasive locking plate

Aim: To compare functional and radiological outcome in the management of distal tibia fractures treated by intra medullary nailing and minimally invasive locking plate. Material and Method: This perspective observational study was undertaken in the Department of Orthopaedic Surgery of SRMS-IMS, Bareilly for a period of 18 months from November 2019 to April 2021 among patients with DISTAL TIBIAL FRACTURE. According to the hospital record, 30 patients of similar condition were treated by intra medullary nailing or minimally invasive locking plate last year. The study participants were split into two groups: those who received intramedullary interlock nailing (Group 1) and those who received a minimally invasive locking plate (Group 2). All patients who underwent intramedullary nailing or minimally invasive plating were evaluated using the American Orthopaedics Foot and Ankle Society score. Results: Mean duration of surgery (in min) was 64.19±7.91 and 72.36±6.23 in group 1 and 2 respectively. After 6 months, excellent radiological union was revealed among 50% and 56.25% of the subjects in group 1 and 2 respectively. When AOFAS score was compared using chi square test among group 1 and group 2 at 3 and 6 months, it was found to be statistically insignificant as p>0.05 in our study. Conclusion: Intramedullary nailing in distal tibial fractures allows for early mobilisation and is a simpler, less expensive and less complication-prone procedure. In cases where the fracture is very close to the ankle mortise and is associated with a greater rate of wound complications, plating is preferred.

LCP as supracutaneous plate vs IMLN tibia for open grade 1 and Ⅱ distal tibial fractures. A comparison study (RCT) on Functional outcome between a conventional method and a Novel technique

Introduction Orthopaedics is an ever evolving branch. Especially for fractures that have controversies in management options, recent advances are being done. Open distal tibial fractures belong to these groups of difficult, yet very common injuries. As the necessity is the mother of invention, for such a common injury a common plate-LCP was used supracutaneously for better biological fixation and shorter duration of surgery. We have compared the results of IMLN nailing vs supracutaneous plating for open distal tibial fractures. Material and methods The patients who had Gustilo and Anderson type 1 and 2 # of distal tibia were enrolled in this study. They were randomized into 2 groups. In one group (IMLN) intramedullary locking nail and in another group Supracutaneous plating was done (SCP). Duration of clicnal and radiological union was calculated. Functional outcome in both groups was measured in AOFSAS score, Knee Society Score (KSS),Lower extremity functional scoring (LEFS) and Ketenjian and Shelton Criteria modified by Yokoyama. Any complications were charted. Results 100 % fracture union was seen in both cases. Intra operative blood loss was 165 ml and was more in IMLN group than SCP group (100) ml. LEFS at 1 year was 90 in SCP group whereas it was 80 in IMLN group. AOFAS score was similar in both groups showing good functional outcome around ankle joint. Knee society score was statistically better in SCP group (82) whereas in IMLN group it was 70. Incidence of infection and surgical duration was similar in both groups.Due to need for removal in some cases duration of stay was more in IMLN. Conclusion Patients in SCP Group had lesser incidence of persistent pain or other chronic symptoms and were happier (better LEFS score, better Yokahama scoring) than their counterparts with interlocking nail. Using locking plate in a supracutaneous mode is a very simple, easy, rapid, reliable and effective method for management of open tibial fractures in adults, especially in terms of patient satisfaction and can be considered as an effective alternative to nailing in selected patients.

Complex approach to the conservative treatment of hallux rigidus

Introduction. Hallux rigidus (HR) is a common source of forefoot pain, which leads to progressive loss of range of motion in the first metatarsophalangeal (MTP1) joint and pathologically affects biomechanics of the whole lower limb. HR is characterized by degeneration of the articular surfaces of MTP1 joint with the formation of bone growths, cysts and erosions, osteochondral defects and loose bodies. The frequency of occurrence of HR is 1 in 40 adults older than 50 years, and this localization of osteoarthritis is the most common among all joints of the foot. The aim of this article is to improve the results of conservative treatment of HR through the use of physical rehabilitation methods, such as manual therapy, therapeutic exercises and foot orthotics.Materials and methods. This study included retrospective cases of 24 patients (28 feet), who underwent a single course of conservative treatment of HR at the European Clinic for Sports Traumatology and Orthopedics (ECSTO) of the European Medical Center (EMC) since January 2014 to December 2018. The patients’ mean age was 51 years (range, 41 to 69 years). Median time between the beginning of treatment and final examination was 26 months (interquartile range from 17 to 36 months). Patient satisfaction, VAS pain scale, AOFAS and FAAM questionnaires and MTP1 dorsiflexion were evaluated in this study.Results. According to AOFAS scale, we obtained 18% (5/28) of excellent, 78% (22/28) of good, 4% (1/28) of fair and no poor results. Median AOFAS score significantly increased from 58.5 points before treatment to 87.0 points on the final examination (p&lt;0.05). Median FAAM daily activity subscale showed 98% of functional outcome with median subjective score of 95%, median FAAM sports score was 97% and median subjective sports score rate was 90%. Patient’s satisfaction at the final examination was “excellent” in 57% (16/28), “good” in 39% (11/28), “fair” in 4% (1/28) of cases and no poor results were obtained. Median VAS pain scale decreased from 5 points before treatment to 1 point at the final examination (p&lt;0.05). Median angle of the MTP1 dorsiflexion significantly increased from 23° before treatment to 30° on the final examination (p&lt;0.05).Conclusion. Described approach of the conservative treatment of HR is an effective method of treatment of early stages of the disease with high patient satisfaction rate and functional outcome.

Clinical and functional outcomes of tarsal coalition resection to correct rigid flat foot

Objective: This study used the AOFAS score to assess the clinical functional results of patients who underwent tarsal coalition resection. Methods: This was a retrospective case series of patients who underwent tarsal coalition resection to correct rigid flat foot. Clinical and functional assessment was performed with the AOFAS score before and 6 months after surgical treatment. Descriptive analysis was performed for 7 patients (11 operated feet) using measurements of position and dispersion (mean, standard deviation, minimum, median and maximum value) for continuous variables and frequency tables (absolute and relative) for categorical variables. Results: The mean patient age was 10 years, 7 months, and the majority (71.43%) were male. The most affected joint was the calcaneonavicular. The right side was affected in 54.55% of the cases. The most frequent type of coalition was osseous (81.82% of the cases). The mean pre- and postoperative AOFAS scores were 32.7 and 70.2 points, respectively, which was a significant increase. Conclusion: The increased scores after coalition resection was considered the main change between the two assessments. Thus, it can be concluded that in rigid flat feet without severe hind- or forefoot deformities for which conservative treatment failed, bar resection should be the surgical procedure of choice. Level of Evidence IV; Therapeutic Studies; Case Series.

Clinico-radiological Results of Distal Chevron Osteotomy without Lateral Soft Tissue Release in Mild to Moderate Hallux Valgus Deformity.

The study was done to evaluate short term clinico-radiological results of distal chevron oste-otomy without lateral soft tissue release in mild to moderate hallux valgus. This was a prospective study consisting of a total of 35 cases with mild to moderate hallux valgus deformity. All these patients were treated by distal chevron osteotomy without lateral soft tissue release. In our study, the average value of hallux angle preoperatively was 32° (range, 24°-40°) and at final follow-up it was 14° (range, 8°-31°). The average reduction was 18°. The average intermetatarsal angle showed mean reduction of 5.3° at the final follow-up. Average range of motion of the first metatarsophalyngeal joint preoperatively and at final follow-up showed a small reduction of 5 degrees. The average preoperative AOFAS score was 49, which improved by 35 points to 84 at the final follow-up. 11.42% of the patients in the study group had a recurrence. 1. Based on our experience with distal chevron osteotomy without lateral soft tissue release, we found the procedure easy to perform with good procedural outcomes. 2. The possible complications of lateral soft tissue release are avoided.

Functional Outcome of Chronic Anterior Cruciate Ligament Rupture Reconstruction Using Peroneus Longus Tendon Graft According to AOFAS and IKDC Score: A Case Series

Introduction: The anterior cruciate ligament (ACL) is a crucial ligament structure of the knee that plays a significant role in knee joint stability and competitive sports performance. In order to reestablish knee stability, ACL reconstruction (ACLR) in the presence of rupture has been recognized as the most common surgical management procedure. Case: This study reported six cases of chronic ACL rupture reconstruction using peroneus longus tendon graft. All patients underwent an arthroscopic ACL repair procedure in Sanglah Hospital Bali. In terms of functional outcome, all patients were assessed using the scoring of AOFAS for the ankle and IKDC for the knee. Result: The functional outcomes of the IKDC and AOFAS score were good from all six patients who already underwent ACL reconstruction using peroneus longus graft with a minimum follow-up of one year. Discussion: Chronic ACL ruptures were successfully treated using the peroneus longus tendon graft. Intraoperatively, there were no significant problems from the harvested peroneus longus tendon graft and ACL reconstruction with the graft. All patients showed no complications, including the local infection following the operation. Rehabilitation procedure post-ACL reconstruction was performed at the Rehabilitation Unit in Sanglah General Hospital. Conclusion: Peroneus longus tendon graft is considered a suitable choice of graft for ACL reconstruction. It presented satisfactory results, effectiveness, and safety based on the AOFAS and IKDC scores.

THE OPERATIVE TREATMENT OUTCOMES OF CHRONIC HINDFOOT PAIN WITH POSTERIOR ANKLE ENDOSCOPY

Objectives: The purpose of this study was to assess the outcome of hindfoot endoscopy and to show the availability of this technique by short- to mid-term outcomes on 27 consecutive patients.&#x0D; Methods: A case series of 27 patients, mean age 19-63(mean37.6) ,15 man and 12 woman, diagnosed and treated for chronic hindfoot pain were included for the study between 2010-2016 All these patients were initially treated conservatively. If conservative treatment is insufficient to alleviate symptoms, posterior ankle endoscopy is performed. Patient data included age, gender, the location and the pattern of foot, follow-up, the time delay from symptom onset to operation, surgeries, the length of hospitalization, the pain scores (AOFAS, VAS), time to return to work, and complications.&#x0D; Results: The indications for 27 patients were posterior ankle impingement syndrome (n:8), isolated flexor hallucis longus (FHL) tenosynovitis (n:7),loose body (n:2),subtalar joint arthrosis (n:3),achyl tendinitis (n:1) and peritendinitis(n:6). Symptom duration until operation was 6-22 months (mean 13.2 months). The patients who underwent arthroscopic surgery resumed to their work a mean time of 2-6 months (mean 2.5 months) after the surgery. All patients returned to their previous lives without any limitation or recurrence. Mean follow-up 46.5 months (21-96 months). AOFAS score was preoperative 44-63 (mean 51.4) and postoperative was 92-100 (mean 96.37). The VAS score was preop 5-8 (mean 6.4) and postop 0-2 (mean 0.62). One patient had a partial arterial injury that was repaired, and four patients had mild joint stiffness.&#x0D; Conclusion: Functional and clinical evaluations following hindfoot endoscopy revealed that all patients were very satisfied. Thus, posterior ankle endoscopy is an effective, elegant and rewarding treatment method in the case of continuing chronic hindfoot pain after failed non-surgical treatment modalities.

Interdigital vs Transarticular Lateral Release With Scarf Osteotomy.

We compare the clinical and radiographic outcomes of the interdigital approach vs the medial transarticular approach for lateral release combined with scarf osteotomy. Seventy-seven feet with moderate to severe hallux valgus underwent scarf osteotomy and lateral soft tissue release, using an interdigital approach (n = 36) vs medial transarticular approach (n = 41). The clinical measurements (range of motion, American Orthopaedic Foot & Ankle Society [AOFAS] score) and radiographic data were evaluated preoperatively and at final follow-up (93-124 months postoperatively). Additionally, the numeric pain rating scale and Foot and Ankle Outcome score [FAOS] were assessed postoperatively. The AOFAS score improved from 60 (q1 = 54, q3 = 70) to 93 (q1 = 85, q3 = 98) in the transarticular group, and from 59 (q1 = 50, q3 = 64) to 95 (q1 = 85, q3 = 100) in the interdigital group. The hallux valgus angle improved from 35.7±6.5 degrees to 15.5±7.6 degrees in the transarticular group, and from 36.0±6.8 degrees to 12.9±13.0 degrees in the interdigital group. The intermetatarsal angle improved from 16.5±2.5 degrees to 6.5±2.7 degrees within the transarticular group and from 17.2±2.5 degrees to 7.3±4.3 degrees in the interdigital group. None of the clinical or radiographic parameters showed any significant differences between the treatment groups. Comparison of outcomes between the interdigital approach and the transarticular approach for lateral soft-tissue release with scarf osteotomy are equally successful. The transarticular approach can thus be considered safe and effective, with the additional benefits of just one scar as opposed to 2. Level III, therapeutic.

Acute Fixation Vs Casting in Treatment of Fracture Base of Fifth Metatarsal Comparative Study

Background: The understanding of the anatomy of the proximal portion of the fifth metatarsal is essential as it explains the injury process and cures of various kinds of fifth metatarsal fractures that influence the appropriate treatment decision. Work objective: Comparison of clinical and radiographic outcomes among conservation therapy and acute surgical therapy of the fifth-metatarsal fracture base. Methods and patients: Twenty patients have been treated with percutaneous fixation with a 4,0 mm cannula screw and 20 have been conservatively treated with a lower knee cast. The length of the injury to hospital admission varied from 1 to 3 days with an average of 2 days between September 2020 and May 2021. The average follow-up time was six months (range from 5 to 7 months). Findings: Our results revealed that for zone 2 and zone 3 the acute fixation is superior than casting with respect to the union time and the AOFAS score. Conclusion: Early screw fixing is a safe and efficient therapeutic technique for acute fifth metatarsal base fractures, particularly zones 2 and 3. Early operational therapy leads to before clinical union and enables patients to return to regular daily activities rather than to cast therapy, leading to a high delayed union rate.

Fascial Manipulation Technique in the Conservative Management of Morton's Syndrome: A Pilot Study.

Background and Objective: Morton’s syndrome (MS) is a common cause of neuropathic chronic forefoot pain, characterised by the development of a swelling of the common digital plantar nerve, whose aetiology is not fully known. There is currently no gold standard of treatment; nonoperative management commonly involves manual therapies, orthoses therapy and infiltrative techniques, while surgery is indicated after failure of conservative measures. The present preliminary study prospectively evaluates patients affected by MS treated by Fascial Manipulation technique (FM), a noninvasive manual therapy, focused on the release of the deep fascia, reducing its stiffness. Materials and Methods: Patients with clinical and sonographic diagnosis of MS with at least a 4-month history of neuropathic symptoms underwent a cycle of three weekly FM sessions. Clinical follow-up, including VAS and AOFAS scores, was performed 21 days (T1) and 3 months (T2) after treatment. Results: Nine patients, among 28 recruited initially, completed the manual therapy sessions and relative follow-up points. This noninvasive pain treatment led to significant improvement of VAS (p = 0.0034) and AOFAS scores (p = 0.0240) at the first follow-up (T1). At 3-month follow-up (T2), both scores decreased slightly, remaining however superior to the pre-treatment values. Only VAS was still significant (p = 0.0184). Conclusions: Despite the small size of the case series, this pilot study is unique in supporting Fascial Manipulation in the nonoperative treatment of MS. Further studies are needed with a large cohort of gender balanced patients to confirm the encouraging results obtained.

A prospective study of distal tibial fracture fixation with anatomical osteosyntheses using minimally invasive percutaneous plate osteosynthesis technique

Introduction: Our objective was to evaluate clinical results and functional outcomes of extraarticular distal tibia fracture treated using anatomical osteosyntheses by minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Materials and Methods: 30 patients of closed distal tibial extraarticular fractures operated by MIPPO technique from November 2018 to October 2019 with age from 20 to 60 years with or without fibula fracture upto 5 cm proximal to distal tibiofibular syndesmotic joint were included in the study. Clinical and radiological assessment for fracture union were performed at 3 weeks,12 weeks and 24 weeks interval and results were analysed by using AOFAS Ankle-Hind foot scale. Results: Thirty patients were followed for 6 months with mean fracture healing time was 16 weeks (12-60 weeks). 14 patients had excellent results with AOFAS score with two patients (6.7%) had delayed union and one patient (3.3%) developed superficial infection but fractures united completely. Conclusion: Minimally invasive percutaneous plate osteosynthesis technique is an effective method of treatment for distal tibial fractures, it provides good, stable fixation with minimal complications.

Outcomes of oblique supramalleolar osteotomy without fibular osteotomy for congruent- and incongruent-type medial ankle arthritis

BackgroundAlthough high talar tilt and ankle mortise incongruence are risk factors for supramalleolar osteotomy (SMO), no study on lateral talofibular joint congruence exists. We aimed to evaluate the outcomes of oblique SMO without fibular osteotomy for medial ankle arthritis and compare them according to the lateral talofibular joint congruity. MethodsForty-eight ankles were retrospectively reviewed and divided according to preoperative talofibular joint congruity (congruent, 22 [45.8%] vs. incongruent, 26 [54.2%]). ResultsThe mean VAS score, AOFAS score, and modified Takakura stage were significantly improved. No significant differences were noted in clinical outcomes, but the mean postoperative tibiotalar angle and difference between the upper and lower talofibular gaps were significantly different in both groups (p = 0.004 and p = 0.009, respectively). The mean Takakura stage at 1 and 2 years after surgery was higher in the incongruent group (p = 0.013, p = 0.012). ConclusionThis procedure was effective against early- to mid-stage medial ankle arthritis. Radiographic arthritic grade changed according to the talofibular joint congruity.

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

IntroductionOsteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity.The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France).Material and methodsIn this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle.ResultsAt a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint.ConclusionThis study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.

Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

PurposeThe study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date.MethodsThis is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups.ResultsA total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters.ConclusionDouble arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.