Average AOFAS Score Research Articles

Ankle Mortise Instability in Multiple Hereditary Exostoses

Category:Ankle, Ankle Arthritis, Pediatric Foot and AnkleIntroduction/Purpose:Ankle valgus has been reported in 50% of patients with multiple hereditary exostoses (MHE) and, untreated, results in early arthrosis. Widening of the ankle mortise has also been reported; however, there has been a lack of data regarding its natural history and management. Alterations of mortise anatomy result in poor functional outcomes and accelerated arthrosis of the ankle. The aim of our study was to report the characteristics and outcomes of mortise widening in a group of patients with MHE.Methods:A total of 13 patients with MHE and mortise widening (16 ankles) were identified. Age, sex, BMI, laterality, origin of osteochondroma, pain, instability, clinical deformity, operative data, and complications were recorded. Mortise (M), Talocrural angle (TC), and Tibiotalar angle (TT) measurements were collected on preoperative and last follow up radiographs. The majority of patients underwent medial distal tibia hemiepiphysiodesis. Post-surgical AOFAS and SF36 scores were collected.Results:Preoperatively, no patient complained of instability, however, 9/16 ankles were painful and 14/16 were clinically in valgus. Patients underwent surgery at an age of 11.8 years (9.7-15). Radiographic and clinical follow up were 2.6 years (0.2-7.3) and 6 years (1.5-11.7), respectively. There were no significant differences between pre/postoperative M, TC, TT angles. Operative patients improved mean M (5.17 to 4.63 mm) and TT (8.71 to 4.54 degrees), neither angle reached normal values. TC (fibular length) was within normal limits (82.2 to 84.8). Questionnaires were obtained for 8/16 ankles, at a mean age of 19 years (13-25.1). The average AOFAS score was 66.7 out of 100. Patients scored 8.6/10 for alignment, 32/40 for pain, 25.6/50 for function. SF-36 scores were excellent.Conclusion:The improvement in M and TT was modest and their values remained outside the normal limits. TC angle was within normal limits but displayed an overall fibular shortening and thus, decreased lateral buttress with potential for talar shift. This was reflected in the mean functional and overall AOFAS score. However, our patients are functionally compensating as evidenced by SF36 scores. More studies are needed to optimize the management of MHE patients with ankle malalignment. Earlier valgus correction and possible addition of fibular lengthening to simultaneously address mortise widening may need to be considered to prevent early ankle arthritis.

Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique

Category:Midfoot/Forefoot, Sports, TraumaIntroduction/Purpose:Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique.Methods:Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up.Results:At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button.Conclusion:The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

Supracutaneous plating in tibial metadiaphyseal fractures with compromised soft tissue using LCP as an external fixator

Introduction: Tibial meta-diaphysealfractures are challenging injuries because of subcutaneous anteromedial surface of bone and frequent soft tissue complications. Ideal management requires stable fixation with minimal soft tissue handling. Locking compression plate (LCP) applied as an external fixator fulfills these criteria and can be an important tool in the armamentarium of an orthopaedic surgeon. Objective of the study is to evaluate the result of this technique. Methods: 23 patients with meta-diaphyseal fractures of tibia with compromised soft tissue treated by this technique were evaluated retrospectively interms of union, maintenance of reduction, complications and final outcome using KSS (Knee society scoring) for proximal fractures and AOFAS (AO Ankle and Foot scoring) for distal fractures. Average follow up duration was 9.4 months (6-14 months). Results: There were fifteen males, eight females with fourteen open fractures and nine cases of closed fractures with tscherne grade 2 or 3 soft tissue injury. Five fractures were in proximal tibia and eighteen were in distal tibia, all fractures united with an average of 21.7 weeks period maintaining acceptable reduction. There were 3 cases of infection, one deep and two superficial treated successfully by debridement and antibiotics. Average knee society scores were 74 and 78.6 for open and close proximal metadiaphyseal fractures respectively. Average AOFAS scores were 81.9 and 84 for open and close distal tibial metadiaphyseal fractures respectively. Conclusion: we found this technique to be more biological, simple to do surgery, effective in maintaining reduction till union, more patient friendly in comparison to traditional large, bulkyfixators and with minimal complications.

Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach

Introduction: Displaced intra-articular calcaneal fractures (DIACF) represent a challenging and controversial issue in traumatology. Conservative treatment has been recommended to avoid surgical problems and complications. The final result, however, is often a painful malunioun of the calcaneus with peroneal impingement. Surgical treatment is gaining acceptance since it offers a chance to restore bone anatomy improving function as long as complications are avoided.Material and method: We reviewed a series of 59 DIACF treated by a single surgeon during a 9 years period. A clinical and radiological follow-up was obtained in 44 cases (74,6%) (average of 5,5 years; range 2–9). There were 29 males and 15 females with an average age of 54 years (range 25–74). Patients were operated through an extended l-shaped lateral approach and fixation was achieved with lag screws and plate. Outcome measures method included the AOFAS score, the Maryland Foot Score, the Foot Function Index and the SF-36.Results: The average AOFAS score was 80,5 points. The result was excellent in 18 cases (40,9%), good in 14 cases (31,8%), fair in 10 cases (22,7%) and poor in 2 (4,6%). The mean score for pain was 33,5/40 points, for function 40/50 and for alignment 7/10. Pain was absent in 17 cases (38%), 19 patients (43%) had no functional limitations and 11 (25%) could walk on uneven ground without difficulties. The average FFI score was 25/100 points. The average MFS score was 89/100 points. Subtalar motion was reduced. Reconstruction of the calcaneus was anatomic in 20 cases (45,5%) with an improved clinical outcome. Eight patients (17%) had minor wound healing complications. Three patients (6,8%) required a subtalar arthrodesis after the procedure.Conclusions: Ostheosytesis through an extended lateral approach restored bone morphology with a reasonable complications rate. The clinical results were good but a normal function and complete subtalar motion were rarely achieved.

Outcome after surgical treatment of calcaneal fractures

After controversial discussions in the literature about therapy regimens for calcaneal fractures, aretrospective study of patients operatively treated in a maximum care trauma center was conducted. Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures. Between 2005 and 2013 a total of 90patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis. A total of 48patients with 55fractures were retrospectively investigated. The assessment with respect to posttraumatic arthrosis was made radiologically and Böhler's and Gissane's angles were also determined. Clinically AOFAS and SF-36 scores were documented. The results were statistically tested with respect to possible risk factors. A total of 9patients (18.8%) were found with complications necessitating operative revision, with 8patients requiring subtalar arthrodesis and 1 patient with a deep wound infection. Nicotine abuse and along interval between trauma and reconstructive surgery were identified as factors that influenced the development of wound healing problems. The average AOFAS score was 68points and the SF-36 was 58.86 points. Apoor result in the scores was caused by the development of symptomatic arthritis and the type of insurance. In this cohort factors, such as age and complexity of fractures were not correlated with a poor result. In this patient collective nicotine abuse and along interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.

Retrospective Chart Review of the Internal Brace Ligament Augmentation Repair in Conjunction with Open Broström Surgery in Ankle patients

Category: Arthroscopy, Sports Introduction/Purpose: The Broström is the most commonly used Lateral ligament repair for chronic instability, but there is growing evidence that a fairly large percentage will stretch out with time, resulting in recurrent instability. Due to the nature of the repair, rehabilitation is fairly slow, so as not to compromise the tissue during the maturation stage. Currently, the Internal Brace Ligament Augmentation Repair is an accepted augmentation method for management of a Broström procedure. However, to our knowledge, no formally collected outcome data on the procedure has been reported. Hypotheses Augmentation of the Broström repair with an Internal Brace would 1)allow accelerated rehabilitation and return to activity, 2)Will aid in long-term stability of the repair without a tendency to stretch out. Methods: Patients with lateral ankle instability repaired with a Broström and Internal Brace Augmentation were prospectively evaluated one-time post-operatively between 6 and 24 months. Patients with concomitant procedures other than debridement were excluded. Outcome measures included demographics; surgical time; AOFAS, FAAM, satisfaction, VAS scores; ROM, Raise Test, and calf strength compared to the contralateral limb; return to sports, and adverse events. Fifty five (55) patients were analyzed from two sites. The cohort includes 20 males and 35 females. 96% of the patients were non-smoking with an average BMI 27.7 ± 5.3 (range 20.6 to 43.8). Median age was 35 years (18 to 62 years). Six of the cases were revisions. Interestingly, 55% of the injuries resulted from severe sprains to the involved ankle from normal activities of daily living (ADL), while 45% were a result of sports injuries. The mean follow up time was 13.5 ± 6.5 months (range 6-27 months). Results: Average surgical time was 36±9 minutes (range 16-60minutes). The average postoperative VAS and Satisfaction scores were 0.9±1.5 and 9.1±2.0, respectively. The mean return to sports was 86 days (range 44-181). Average AOFAS score was 93.9±10.4. Thirty (55%) patients reported an ideal max score of 100. For the FAAM, current level of function in sports activities score was 90+ in 76% of subjects. Forty five (81%) patients were brace free with return to sport. The objective calf strength examination (actual girth measured) proved not significantly different from the contralateral limb; 38.9±4.5 cm and 38.7±4.4 cm (p=0.866). 89% had a negative anterior drawer. Ankle dorsiflexion comparisons were 9.4±2.8 cm (operative side) and 10.6±3.4 cm (contralateral); and ankle plantarflexion comparison (goniometer) 45.7±12.1degrees (operative side) and 45.9±12.7degrees (contralateral). Neither comparison showed a difference. Conclusion: The overall complication rate was < 3% without any reported adverse events. The results of the outcome measures and objective measurements suggest the Internal Brace Augmentation of Broström procedure is safe and efficacious.

Outcomes of Lisfranc Injuries Treated with Joint Preserving Fixation

Category: Midfoot/Forefoot Introduction/Purpose: Open reduction and internal fixation with transarticular screws to stabilize Lisfranc injuries may increase the risk of arthritis or affect outcomes. Extra-articular or bridge plating to stabilize these injuries avoids this articular damage. This study analyzes the functional outcomes and complications in patients who underwent this type of joint preserving fixation for Lisfranc injuries. Methods: A retrospective review of all patients treated for a Lisfranc injury at a level 1 trauma center from July 2008 to October 2015 was conducted. Patients over 18 years of age who were not incarcerated and did not have any concomitant procedures in the lower extremities were included. Patient electronic medical records were reviewed. Outcomes were analyzed with AOFAS scores. Results: There were 16 patients included in the study with an average follow up time of 57 months (15 - 102 months). Average AOFAS score was 79 (SD 16) and time to return to regular activities was 35 weeks (SD 25 weeks). Seven patients (44%) had their hardware removed during the follow up period. There was 1 complication which comprised of a screw backing out and needing to be removed. Conclusion: In the present case series, joint preserving fixation for Lisfranc injuries offered similar AOFAS scores as those reported for ORIF with transarticular screws, but with a decreased rate of hardware removal and need for mid-foot fusion.

Pilon fractures: A new classification system based on CT-scan

Actually, pilon fractures are classified according to AO and Ruedi Allgower classification systems based on X-rays. These classifications are less reproducible and do not provide necessary information for proper surgical planning. Aim of the study is to (1) propose a new classification system based on CT scan; (2) to check the prognostic value of this classification and (3) to evaluate its reliability and (4) reproducibility.We retrospectively reviewed 71 cases of pilon fracture. All fractures were classified according to AO, Ruedi Allgower and new proposed classification system by 5 surgeons. Clinical and radiographic evaluation were performed at a mean follow-up of 36 months. Cohen’s K value was calculated in order to evaluate the interobserver and intraobserver agreement.Sixty-four of 71 fractures healed. Average AOFAS score was 91,7±7,8 in the Type I of new classification proposed, 87,7±7,8 in the Type II, 82±18,6 in type III, and 67,2±20,9 in type IV. Using the AO classification system the average K weighted value among the five reviewers was 0,51; using Ruedi Allgower classification it was 0,50 and using the new classification system it was 0,88 (p<0.0005).This study demonstrated that the new classification system is prognostic, reliable and reproducible. Moreover it provides a new treatment-oriented classification for this challenging fracture which affect the quality of life of the patients more than chronic diseases like diabetes and coronaropathy or pelvic fractures.

Staged management of missed lisfranc injuries: A report of short-term results

Objective To analyze the clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with the old Lisfranc injuries. Methods Fifty patients (16 feet) with Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4.8month (3 to 8 month). In first stage an external fixator was applied across the Lisfranc joint and distraction was done at 1 milliliter per day to 2 milliliter per day. In the second staged the ORIF (open reduction and internal fixation) was doneand we were able to reduce all the fractures and dislocations. Extra-Articular screws and staple fixation were used for fixation. We compared categorical variables using Fisher’s exact test and continuous variables using paired t-test or Wilcoxon signed-rank test. Results All patients were followed up 1 to 3 years (mean 2.2 years) in the clinic. The visual analogue scale score averaged 3.1 points at the final follow-up, the average AOFAS scores for these patients were 55.8 points (range, 43 to 98 points), with a significant increase than before surgery (P=0.001). The mean duration between two surgeries was 3.2 weeks (range 2.5-4.5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up, 2 patients had lost reduction. Posttraumatic osteoarthritis was observed in 5 patients, and all of them were scheduled for arthrodesis because of persistent pain. Conclusions The study have displayed that staged reduction and Extra-Articular fixation should be considered for old Lisfranc injuries with a good reduction, the firm stability, low risk of intraoperative fracture.The short-term effectiveness is good, but the long-term effectiveness needs further follow-up. Key words: Missed lisfranc injury; Staged management; Extra-articular fixation; Fractures; Treatment outcome; Joint

POSSIBILITIES OF THE MINIMALLY INVASIVE SURGERY IN THE TREATMENT OF SEVERE FOREFOOT DEFORMITIES IN THE RHEUMATOID ARTHRITIS PATIENTS

Introduction. Approximately 90% of the rheumatoid arthritis patients present with foot symptoms. Rheumatoid foot is characterized by toe dislocations and chronic wounds due to the corticosteroid treatment. In case of surgical intervention metatarsophalangeal joints excision arthroplasty remains the standard. To perform second through fifth metatarsal head resection extensive transverse plantar or longitudinal dorsal incisions are routinely used. The rate of the wound-healing problems after rheumatoid foot surgeries is 23-45%. The purpose of this study was to demonstrate the possibilities and advantages of the rheumatoid arthritis patients with severe forefoot deformities minimally invasive surgical treatment and to develop mini-invasive approach for central metatarsal heads resection. Material and methods. By the example of 23 rheumatoid arthritis female patients (30 feet) surgical treatment possibilities of percutaneous techniques in severe forefoot deformities correction were demonstrated. The average age of the group was 54.5 years (range, 39 to 72). There were 24 primary surgeries and 6 repeated. Four feet had chronic wounds. Percutaneous techniques were used to correct all the forefoot deformities components but central metatarsal head resections (7 cases). To make them minimally invasive plantar approach has been developed. Surgical technique of the central metatarsal heads resection using proposed approach was presented. Decision-making algorithm for choosing appropriate surgical technique (to perform first metatarsophalangeal arthrodesis with central metatarsal heads resection or joint-preserving surgery) was proposed, including functional test, performed under fluoroscopic control and tricks for the dislocated fifth toe reduction. Results. The mean follow-up was 12 months (range, 3 to 52). The average hospital stay was 1.23 days. No infectious or wound-healing problems were noted. Chronic wounds have healed in four weeks after surgery. Overall, patients were satisfied with the result of the 12 surgical interventions and satisfied with reservations with the result of 18 surgeries. Unsatisfactory results were not noted. Average preoperative AOFAS score was 23.7 points (range, 0 to 34); postoperative 79.2 points (range, 52 to 100), the average AOFAS score increase was 55.5 points. Conclusions. Percutaneous techniques allow correction of nearly all severe forefoot deformities components in rheumatoid arthritis patients, eliminating the need for first and fifth metatarsal head resection and significantly reducing the need for central metatarsal head resection. If central metatarsal head excision is necessary, they can be removed using minimally invasive 2-3 сm plantar approach, proposed by the author, thus reducing the risk of wound-healing complications.

Treatment of Freiberg's disease by Gauthier's dorsal cuneiform osteotomy: Retrospective study of 30 cases

IntroductionFreiberg's disease is osteonecrosis of the dorsal side of a metatarsal head. The gold-standard surgical treatment is the osteotomy procedure first described by Gauthier. HypothesisGauthier osteotomy for Freiberg's disease will restore the joint space and lead to long-term clinical improvement. A retrospective study was carried out to verify this hypothesis. Material and methodsThis study involved 30 consecutive cases treated by a single surgeon in 28 patients having a mean age of 61.2 years. These patients underwent the Gauthier osteotomy procedure with one or two dorsal staples used for fixation. Patients were reviewed 15 days, 45 days and 3 months after the procedure, and then at the last follow-up to look for any complications and determine patient satisfaction, the AOFAS score, metatarsophalangeal range of motion (ROM), sphericity of the metatarsal head, bone union and metatarsal shortening. ResultsThe average follow-up was 6.5 years±2.2. The second metatarsal was affected in 27 cases and the third metatarsal in 3 cases. Discomfort related to the staples was noted in five cases; the staples were removed in three of them. There was one case of severe stiffening (< 20° ROM). At the last follow-up, 17 cases were very satisfied, 11 were satisfied and 2 were moderately satisfied. The average AOFAS score was 83.8 points±11.8 at the last follow-up. A mean loss of 15° plantar flexion and 10° dorsiflexion was noted. Bone union and metatarsal head sphericity were achieved in all cases. The average shortening was 2mm±1.4. ConclusionsThe Gauthier osteotomy procedure results in recovery of the metatarsal head's sphericity in every case of this series, with good clinical results and low morbidity. Level of evidenceIV, retrospective series.

Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases.

The best treatment for intra-articular fractures of the calcaneus is still debated. The aims of this study were to determine whether intrafocal reduction of thalamic fractures is effective, to evaluate whether a locking nail is able to maintain reduction of the articular surface and to analyse the functional results of this original method. This prospective study assessed 69 fractures treated with a locking fracture nail in 63 cases and with primary subtalar fusion in six (Calcanail (®), FH). Articular congruity and global reduction of the calcaneus was assessed in all patients by computed tomography (CT) scan three months postoperatively. Functional results were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and all complications recorded. For the 63 fracture nails, the average AOFAS score was 85.9 at a mean final follow-up of 12 months. Only three secondary fusions were performed. For the six comminuted fractures requiring primary fusion, the average AOFAS score was 75.9 at the last follow-up. The posterior intrafocal approach for both reduction and locked nailing of intra-articular calcaneal fractures has been proven as an effective and reliable procedure.

Ankle arthrodesis from lateral transfibular approach: analysis of treatment results of 23 feet treated by the modified Mann's technique.

The aim of the study was to analyze the results of treatment by ankle arthrodesis by modified Mann's technique. The study included 23 patients, and a total of 23 feet were treated. Stabilization of arthrodesis was performed by two screws going from the sinus tarsi to the talus and tibia. Lateral part of the fibula was fixed with one or two screws to the talus and tibia. No additional medial approach to the ankle was performed. In 16 feet, arthrodesis was done due to secondary posttraumatic osteoarthritis, in five due to paralytic drop foot and in two due to osteoarthritis of unknown etiology. In 18 patients, the purpose of arthrodesis was also to correct the malalignment. The average age at operation was 46 (range 19-74) years. The average follow-up was 32 (range 12-69) months. At follow-up, the average AOFAS score was 76 points and subjective scale result 7.9 points. The correct alignment was not achieved in three feet. In one foot, fusion was not achieved and the patient needed repeated operation. The study has confirmed the effectiveness of the technique.

Management of fractures of the distal third tibia by minimally invasive plate osteosynthesis - A prospective series of 50 patients.

Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series. From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years. The mean fracture healing time was 21.4 weeks (range 16-32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%). MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension.

English

INTRODUCTION: Calcaneal fractures account for approximately 2% of all fractures and about 75 % of all calcaneal fractures are intraarticular. Although open reduction and inernal fixation of these fractures is widely recommended outcomes of these fractures remain understudied. In present study we evaluate functional outcome of joint depression calcaneal fracture treated by open reduction and calcaneal plating with minimum follow up of 1 year. MATERIAL AND METHODS: Using Essex-Lopresti radiological classification ,Twenty patients of joint depression calcaneal fractures with mean age of 35 years were treated by open reduction and calcaneal plating using extended lateral approach. Out of these, 17 were males and 3 were females. Patients were followed up for an average period of 1 year and 4 months and were evaluated by AOFAS score at final follow up. OBSERVATION AND RESULTS: Most common cause of injury was fall from height(90%).Mean duration between injury and surgery was 10 days. In post-operative period, 4 patients(20%) developed wound edge necrosis out of which 1 patient developed deep infection. During follow up, One patient(5%) developed discharging sinus and in one patient(5%) screw was broken . Mean Bohler’s angle and Gissane’s angle at final follow up were 25.13 degree and 121.8 degree respectively. At final followup, the average AOFAS score was 81.7, there were 8 excellent (40%), 8 good (40%), 3 fair (15%) and 1 poor (5%) results. CONCLUSION: Open reduction and internal fixation of joint depression type calcaneal fracture using calcaneal plate gives good to excellent functional outcome in majority of patients.Restoring Bohler’s angle as anatomically as possible and appropriate reduction of posterior joint surface by open reduction and internal fixation followed by early mobilization and delayed weight bearing is a good option in treatment of this fracture.

Effectiveness of weight-bearing lateral radiographs in evaluation of ankle malunited fractures restoration

Objective To evaluate the significance of weight-bearing lateral radiographs in evaluation of malunited frac-tures of the ankle. Methods 17 patients with malunited fractures of the ankle were treated by different reconstructive operations be-tween March 2010 and October 2012, including 9 females and 8 males, aged from 17 to 64 years. According to the Takakura classifi- cation of ankle arthritis, there were 7 patients in grade 1, 4 in grade 2 and 6 in grade 3. Simple open reduction and internal fixation were performed in 5 patients, supramalleolar tibial osteotomy in 5, lengthening osteotomy of the fibula in 2, supramalleolar tibial and fibular osteotomy in 5. Tibiofibular clear space on the anteroposterior radiograph. Medial clear space, tibiofibular clear space and tib-iofibular overlap on ankle mortise radiographs were compared preoperatively and at last follow-up. Tibial lateral surface angle （TLS）, the offset of the center of talar rotation from the tibial axis, and the displacement of tibiotalar articular surface center on weight-bear-ing lateral X-ray were also compared preoperatively and at last follow-up. AOFAS score was used to evaluate the function of the ankle. Results The duration of follow-up was 9 to 32 months. Bone healing was observed in all patients, and the average healing time was 11 to 14 weeks. Ankle joint degeneration grade had no exacerbation. The medial clear space, tibiofibular clear space and tibiofibular overlap had no significant difference between the pre and postoperative. Statistically significant change was seen postoperatively in the values of TLS （76.9°±4.1° vs 80.9°±5.2°）. The offset of the center of rotation from the tibial axis and the displacement of tibiotalar articular surface center were changed from 10.8＋2.1 mm to 2.0_＋0.5 mm and 4.5±1.5 mm to 2.2±1.0 ram, respectively. The average AOFAS score was improved from 45.7±15.9 points preoperatively to 82.0±9.9 points postoperatively. Conclusion Weight-bearing lateral radiographs can be used to judge the ankle restoration. Even if the mortise radiograph had relative good realignment, it may ap-pear obvious deformity on lateral radiographs. Good reduction of lateral radiographs requires that the mid axis of the tibia should pass through the center of talar rotation and tibiotalar articular surface be parallel on the lateral radiograph. Key words: Ankle joint; Fractures, bone; Fracture healing; Radiography; Weight-bearing

Ilizarov technique for treatment of congenital brachymetatarsia

Objective To evaluate the clinical therapeutic effectiveness of Ilizarov technique for the treatment of congenital brachymetatarsia.Methods We retrospectively analyzed the 5 patients who had been treated in our department for congenital brachymetatarsia (12 metatarsal bones in 10 feet) from January 2008 to January 2011.All of them were female,aged from 22 to 26 years (mean,24.2 years).All cases were bilaterally involved.Three of them suffered from bilateral brachymetatarsia of the first metatarsal bone,one from bilateral brachymetatarsia of the fourth metatarsal bone,and the other one from bilateral brachymetatarsia of the first and fourth metatarsal bones.Bone transport was conducted with a monolateral mini-fixator in 3 patients and with a modified semi-ring Ilizarov fixator in the other 2.Dorsal incision was used for all osteotomy before the external fixator was mounted.Bone transport began 7 days after surgery at a rate of 0.3 mm/d and was completed in 3 times.Results The 5 patients were followed up from 12 to 48 months (mean,22.0 months).The metatarsal bones were lengthened by 13.5 mm(12 to 17 mm) on average.The functions of the toe and ankle joint were normal without skin necrosis,vascular or nerve injury,tylosis of the footplate,or walking pain.The lengthened segments were mineralized well,with an average lengthening index of 48 d/cm(45 to 53 d/cm) and average time of external fixation of 64.8 days.At the last follow-up,the average AOFAS score was 92.2 points (90 to 95 points).Conclusions Although the Ilizarov technique necessitates a patient's prolonged fixation with an external fixator in the treatment of congenital brachymetatarsia,it has advantages of simplicity,minimal invasion,and satisfactory correction of brachymetatarsia.Consequently it is a good treatment for this disease. Key words: Lower extremity deformities,congenital; Ankle joint; Clubfoot; Ilizarov technique

Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes

In the past few decades, the incidence of Achilles tendon rupture has increased in parallel with increased sports participation. Although the optimal treatment remains controversial, there is a trend towards surgical treatment in athletes. Surgical repair of ruptured Achilles tendon in athlete results in good functional and objective recovery, irrespective of the type of surgery performed. Subsidiarily, are the results different between percutaneous surgery (PS) and standard open surgery (OS)? This was a cross-sectional study of 31 patients who presented with a ruptured Achilles tendon that occurred during sports participation. Percutaneous surgery was performed in 16 patients and open surgery in 15 patients between 2005 and 2009. The objective recovery status was evaluated by open chain goniometry, measurement of leg muscle atrophy and assessment of isokinetic strength. The functional analysis was based on the delay, level of sports upon return, AOFAS and VAS for pain. Our series of Achilles tendon rupture patients consisted of 88% men and 12% women, with an average age of 38 years. In 71% of cases, the rupture occurred during eccentric loading. After a follow-up of 15 months, the muscle atrophy was 13 mm after PS and 24 mm after OS (P=0.01). A strength deficit of 19% in the plantar flexors was found in the two groups. No patient experienced a rerupture. The return to sports occurred at 130 days after PS and 178 days after OS (P=0.005). The average AOFAS score was 94 and the VAS was 0.5. There were no differences in ankle range of motion between the two groups. The majority (77%) of patients had returned to their preinjury level of sports activity. The return to activities of daily living was slower in our study than in studies based in Anglo-Saxon countries; this can be explained by the different sick leave coverage systems. Percutaneous surgery resulted in a faster return to sports (about 130 days) and less muscle atrophy than open surgery. Our results for return to sports and return to preinjury levels were similar to published results for athletes and were independent of the type of surgery performed. The AOFAS score was comparable to published studies. We found no difference in muscle strength between the two surgery groups 15 months after the procedure. Apart from venous thrombosis typically described after lower-limb immobilization, secondary postoperative complications mostly consisted of sural paresthesia, which had resolved at the 15-month postoperative follow-up evaluation. The results of surgical treatment for ruptured Achilles tendon are good overall. By combining the simplicity of conservative treatment and the reliability of standard surgical treatment, percutaneous surgery is the treatment of choice to achieve excellent results. The return to sports occurred earlier, the muscle atrophy was less and the functional score was better in our patients treated by percutaneous surgery. Level IV.

Tibiocalcaneal arthrodesis using an Ilizarov fixator

ObjectiveTo evaluate the results of arthrodesis with Ilizarov fixator with tibiocalcaneana. MethodsWe studied 12 patients with a mean age of 35 years, and 9 (75%) men and 3 (25%) women, underwent arthrodesis tibiocalcaneana. The diagnosis in the preoperative talus infection. We used a modified surgical technique Reckling (6 patients) and the Ilizarov technique, modified by Catagni (6 patients). Patients were evaluated by the AOFAS scale research and patient satisfaction. ResultsUnion was achieved in 100% of cases. The mean time to healing was 6 months (range 4-12 months) and mean duration of external fixator removal was 9 months (range 4-13 months). Stretching was performed in 6 patients with an average of 4cm. The follow-up with Vancomycin lasted around 6 months. The average AOFAS score was 72.5 points (range 57 to 89 points). All patients were satisfied with the result. ConclusionDespite the small number of cases, arthrodesis tibiocalcaneana seemed to be a good solution for cases of complex pathologies of the talus, such as infection, resulting in bone healing, pain relief and patient satisfaction.

Artrodese tibiocalcaneana usando fixador de Ilizarov

ObjectiveTo evaluate the results of arthrodesis with Ilizarov fixator with tibiocalcaneana. MethodsWe studied 12 patients with a mean age of 35 years, and 09 (75%) men and 03 (25%) women, underwent arthrodesis tibiocalcaneana. The diagnosis in the preoperative talus infection. We used a modified surgical technique Reckling (06 patients) and the Ilizarov technique, modified by Catagni (06 patients). Patients were evaluated by the AOFAS scale research and patient satisfaction. ResultsUnion was achieved in 100% of cases. The mean time to healing was 06 months (range 04-12 months) and mean duration of external fixator removal was 09 months (range 04-13 months). Stretching was performed in 06 patients with an average of 04cm. The follow-up with Vancomycin lasted around 06 months. The average AOFAS score was 72.5 points (range 57 to 89 points). All patients were satisfied with the result. ConclusionDespite the small number of cases, arthrodesis tibiocalcaneana seemed to be a good solution for cases of complex pathologies of the talus, such as infection, resulting in bone healing, pain relief and patient satisfaction.