Lateral Impingement Research Articles

Functional and Radiological Outcome after Internal Fixation of Intra-articular Calcaneal Fractures.

Calcaneal fractures are rare injuries constituting 2% of all fractures. Fractures of calcaneum correspond to nearly 60-75% of the tarsal bone fractures. The calcaneum is the most commonly fractured tarsal bone 90% occur in males between 21 and 45 years of age. The calcaneal fracture may be extra-articular (sparing the subtalar joint) and intra-articular involving the subtalar joint. Intra-articular fractures account for approximately 75% of calcaneal fractures and have been associated with poor functional outcomes. In this study, we aim to assess the functional outcome of internal fixation in displaced intra-articular calcaneal fractures. A prospective interventional study was conducted on patients with only intra-articular calcaneal fractures admitted to Chettinad Hospital and Research Institute, Kelambakkam during the period from May 1, 2022, to February 29, 2024, and a total of 32 patients were considered. The functional outcome was assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scoring System. The average age of the patients in our study was 39 years of which all were male. Fall from height is the most common mode of injury. The right calcaneum is more commonly involved than the left. The mean duration of hospital stay was around 10 days. The fracture classification was based on the sanders and Essex-Lopresti classification of which 17 patients were sanders type 3 and 13 patients were sanders type 2 and 1 patient was sanders type 4. The mean time for radiological union is 12 weeks. The Bohler's angle and Gissane's angle preoperatively 16.16 ± 8.87 and 121.48 ± 7.47 restored to near normal values after fixation 27.77 ± 6.02 and 113.485 ± 44, respectively. Heel height and heel width restored to near normal values of (pre-operative heel height - 24.74 ± 3.71 and heel width - 39.97 ± 4.11 and post-operative heel height - 31.55 ± 3.38 and heel width - 34.0 ± 3.1), respectively. The most common complications were wound-related complications (superficial wound infection - 9.7%, deep wound infection - 3.2%, and wound margin necrosis and wound dehiscence 6.4%) and the most common late complications were complex regional pain syndrome - 9.7% and subfibular lateral impingement with peroneal tendinitis - 6.5%. AOFAS grading of functional outcome had shown good to excellent results in 83.8% (26 patients) of the cases. The mean AOFAS score was 83.39 in our study. The present study shows that open reduction and internal fixation give superior radiographic results as shown by the restoration of Bohler's and Gissane's angle and height and width of the calcaneus to near normal values, indicating anatomical restoration of calcaneal shape. The functional outcome by AOFAS score showed good to excellent results in most of the patients with minimal wound complications.

Patients With Lateral and Anterolateral Cam Morphology Have Greater Deformities Versus Typical Anterolateral Deformity Alone but No Differences in Postoperative Outcomes: A Propensity-Matched Analysis at Minimum 5-Year Follow-Up

To compare pre- and postoperative findings between patients undergoing hip arthroscopy for femoroacetabular impingement syndrome with lateral impingement versus those without lateral impingement METHODS: Patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between 2012 and 2017 with minimum 5-year follow-up were included. Alpha angle (AA) was measured on preoperative anteroposterior (AP) and 90° Dunn radiographs. Patients with AA >60° on Dunn view but not AP view (no lateral impingement) were propensity matched by sex, age, and body mass index in a 1:3 ratio to patients with AA >60° on both views (lateral impingement). Demographic characteristics, radiographic and intraoperative findings, reoperation rates, and patient-reported outcomes (PROs) were compared between groups. Categorical variables were compared using the Fisher exact testing and continuous variable using 2-tailed Student t tests. Sixty patients with lateral impingement (65.0% female, age:35.3 ± 13.0 years) were matched to 180 patients without lateral impingement (65.0% female, age: 34.7 ± 12.5 years, P ≥ .279). Patients with lateral impingement had larger preoperative AAs on both Dunn (71.0° ± 8.8° vs 67.6° ± 6.1°, P=.001) and AP radiographs (79.0° ± 12.1° vs 48.2° ± 6.5°, P < .001). However, there were no differences in postoperative AAs on either view (Dunn: 39.0° ± 6.1° vs 40.5° ± 5.3°, AP: 45.8° ± 9.0° vs 44.9° ± 7.0°, P ≥ .074). Labral tears began more superiorly in patients with lateral impingement (12:00 ± 0:49 vs 12:17 ± 0:41, P= .030), and they demonstrated greater rates of acetabular and femoral cartilage damage (P= .030 for both); however, there were no differences in PROs or reoperation rates between the groups at 5-year follow-up. Although cam deformities located laterally and anterolaterally are larger than those located anterolaterally alone, both can be resected adequately, resulting in similar postoperative radiographic measurements, PROs, and survivorship. Level III, retrospective cohort study.

Midterm Outcomes of the Salto Talaris Total Ankle Arthroplasty

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) has become an accepted alternative to ankle arthrodesis for end-stage ankle arthritis and has seen significantly increased utilization in the past decade1. The Salto Talaris total ankle prosthesis has shown excellent short-term and mid-term survivorship results since its FDA approval in the U.S. in 20062,3. At a minimum of five-year follow-up, the currently reported midterm survivorship has ranged from 93.3% to 100% with equally satisfactory clinical outcomes as evidenced in short-term outcome studies4–8. The purpose of this study is to report the outcomes of one of the largest cohort of patients who underwent a Salto Talaris total ankle arthroplasty with a minimum of five-year follow-up. Methods: 103 Salto Talaris TAA patients with 5-view weight-bearing series of radiographs and minimum follow-up time of 5 years since index surgery were included. Age at time of surgery, gender, body mass index, diagnosis, diabetes status, and tobacco use were collected through chart review. Radiographic imaging was assessed at the most recent follow-up for evidence of radiolucency and osteolysis as previously described9. Range of motion was assessed on plantarflexion and dorsiflexion views on sagittal radiographs as previously described10. The Foot and Ankle Ability Measure (FAAM) and Visual Analog Scale for pain (VAS) scores were obtained at the most recent follow up visit and compared with preoperative scores. Baseline characteristics were compared between groups using Wilcoxon rank-sum test for continuous data or Fisher exact test for discrete data. Survivorship probability was calculated using a Kaplan-Meier analysis for revisions and reoperations. Revisions were defined as exchange or removal of metal component. Results: The survivorship for revision surgery was 93.2% (95% CI [89.8,98.8]). 5 out of the 7 patients requiring revision surgery experienced talar subsidence, 1 patient experienced an infection, and 1 patient experienced lateral impingement. The survivorship for reoperation was 90.2% (95% CI [83.4-95.4]). 5 out of the 10 patients requiring reoperation experienced pain from impingement, 2 experienced periprosthetic fractures, 1 experienced infection, and 2 experienced osteolytic cysts. At last follow- up, the FAAM-ADL, FAAM-Sport, and VAS pain scores were improved from preoperatively. The average range of motion at last follow-up was 31.6 degrees. On the AP view, radiolucency and osteolysis were most frequently detected in zones 3 and 4, while on the lateral view they were most frequently seen in zones 2 and 6. Conclusion: Patients undergoing Salto Talaris prosthesis showed improvements in patient-reported outcomes with satisfactory survival rates.

Revision of total ankle arthroplasty: Survival and medium-term functional results

BackgroundThe objective of this study was to analyze the results and survivorship of total ankle arthroplasty (TAA) revision surgery with standard (Salto Talaris®) or revision (Salto Talaris XT®) implants. MethodsBetween January 2005 and December 2017, all patients undergoing TAA revision at our hospital were included. Indications for revision, type of surgery performed, improvement in function assessed with the AOFAS score, occurrence of complications and implant survival at last follow-up were analyzed. ResultsIn the end, 25 TAA patients who had undergone revision (11 unipolar, 14 bipolar) were included. The mean follow-up time was 5.1 ± 1.9 years. At the last follow-up, function was improved compared to the preoperative AOFAS score (51.3 ± 17.5 vs. 83.5 ± 10.1; p < .001), but not plantar flexion (17.5 ± 5.7 vs. 15.4 ± 7.1; p = 0.28) or dorsal flexion (7 ± 5.6 vs. 8.3 ± 4.9; p = 0.3). Complications occurred in six patients (24 %) that led to reoperation: three infections, one lateral impingement, one implant malposition, and one hindfoot alignment disorder. At the last follow-up, implant survival was 96 %, but the probability of survival without reoperation was 78.7 ± 8.5 % at 4 years. ConclusionTAA revision by arthroplasty is feasible, produces good functional results in the medium term, but has a high risk of complications. The challenge of revision TAA is managing the loss of bone stock and anchoring the new implants.

Intramedullary Femur Nailing in Intertrochanteric Fractures: Postoperatively Do Helical Blades Migrate More Than Lag Screws? A Randomized Controlled Trial.

This was a prospective, randomized controlled trial to test functional outcomes between a single lag screw and helical blade nails in the treatment of intertrochanteric fractures. 72 patients with intertrochanteric fractures between March 2019 to November 2020 were randomized into two groups and treated with a lag screw or a helical blade nail. Intraoperative parameters such as operative time, blood loss, and radiation exposure were calculated. Postoperatively, tip apex distance, neck length, neck-shaft angle, lateral impingement of implant, union rate, and the functional outcomes were measured at the end of 6month follow-up period. There was a significant decrease in tip apex distance (p = 0.03) and neck length(p-0.04) with significant lateral impingement of the implant (p = 0.04) in the helical blade group compared to the lag screw group. The functional outcome calculated using the modified Harris Hip score & Parker and Palmer mobility score, at the end of 6months, had no significant difference between the two groups. Both lag screw and helical blade devices can be used to successfully treat these fractures, although there is greater medial migration in the helical blade as compared to the lag screw.

Quantifying graft impingement in anterior cruciate ligament reconstruction

BackgroundAnterior cruciate ligament reconstructions (ACLR) fail at a rate of 10–15%, with graft impingement often a cause. In this study we investigate the prevalence and causes of impingement seen during ACLR surgery. MethodsWe reviewed consecutive primary ACLR from 2012-2018. Graft impingement was estimated intraoperatively by placing the arthroscope through the tibial tunnel and passively extending the knee, observing how much was obscured by the lateral femoral condyle from an anterior and lateral direction. Preoperative MRI scans were used to measure the intercondylar notch; Notch Width Index (NWI) and Notch Depth Index (NDI). Positioning of the tunnels was determined on postoperative radiographs. ResultsThere were 283 ACLRs performed with 33 failures diagnosed on MRI (11.7%). 257 patients had complete imaging and follow up (91%). The mean age was 28 (±9) years and mean follow-up 5.3 (±1.8) years. The mean NWI was 0.26(±0.03), and NDI was 0.49(±0.06). The tibial tunnel aperture was located 42(±6) % of the way from anterior-posterior and 39(±6) % from medial-lateral. Impingement requiring a notchplasty was observed in 80% of cases, with lateral impingement more prominent. ConclusionsThe amount of impingement did not correlate with tunnel position, which was located within the recommended area. There was a weak negative correlation between NWI and lateral impingement (rs = −0.16, p = 0.01), and NDI and anterior impingement (rs = −0.12, p = 0.04), therefore a smaller notch is associated with greater impingement. Despite optimal tunnel positioning, impingement still occurs in a significant number of cases therefore notchplasty should always be considered to keep revision rates low.

Distal Tibiofibular Syndesmotic Widening in Progressive Collapsing Foot Deformity.

Lateral overload in progressive collapsing foot deformity (PCFD) takes place as hindfoot valgus, peritalar subluxation, and valgus instability of the ankle increase. Fibular strain due to chronic lateral impingement may lead to distraction forces over the distal tibiofibular syndesmosis (DTFS). This study aimed to assess and correlate the severity of the foot and ankle offset (FAO) as a marker of progressive PCFD with the amount of DTFS widening and to compare it to controls. In this case-control study, 62 symptomatic patients with PCFD and 29 controls who underwent standing weightbearing computed tomography (WBCT) examination were included. Two fellowship-trained blinded orthopedic foot and ankle surgeons performed FAO (%) and DTFS area measurements (mm2). DTFS was assessed semiautomatically on axial-plane WBCT images, 1 cm proximal to the apex of the tibial plafond. Values were compared between patients with PCFD and controls, and Spearman correlation between FAO and DTFS area measurements was assessed. P values of less than .05 were considered significant. Patients with PCFD demonstrated significantly increased FAO and DTFS measurements in comparison to controls. A mean difference of 6.9% (P < .001) in FAO and 10.4 mm2 (P = .026) in DTFS was observed. A significant but weak correlation was identified between the variables, with a Þ of 0.22 (P = .03). A partition predictive model demonstrated that DTFS area measurements were highest when FAO values were between 7% and 9.3%, with mean (SD) values of 92.7 (22.4) mm2. To our knowledge, this was the first study to assess syndesmotic widening in patients with PCFD. We found patients with PCFD to demonstrate increased DTFS area measurements compared to controls, with a mean difference of approximately 10 mm2. A significantly weak positive correlation was found between FAO and DTFS area measurements, with the highest syndesmotic widening occurring when FAO values were between 7% and 9.3%. Our study findings suggest that chronic lateral impingement in patients with PCFD can result in a negative biomechanical impact on syndesmotic alignment, with increased DTFS stress and subsequent widening. Level III, retrospective comparative study.

Dickinsonia discovered in India and late Ediacaran biogeography

The discovery of Dickinsonia in India allows assessment of biogeographic provinces and plate tectonic reconstructions for the late Ediacaran. The fossils were found in the roof of Auditorium Cave at Bhimbetka Rock Shelters, a UNESCO World Heritage Site for Paleolithic and Mesolithic cave art, near Bhopal, Madhya Pradesh. The fossils are identical with Dickinsonia tenuis from the Ediacara Member of the Rawnsley Quartzite in South Australia, and like them also show deformation due to lateral impingement, arcuate pieces missing, and alignment. They are within the late Ediacaran, Maihar Sandstone of the Bhander Group, in red sandstones formed in coastal plain paleoenvironments, including eolian, tsunamite, and intertidal bedforms. This new occurrence confirms assembly of Gondwanaland by 550 Ma, but not reconstructions adjusted for true polar wander. Cloudina and other small shelly marine fossils were low latitude, but vendobionts such as Dickinsonia were at temperate to subtropical latitudes.

Is Lateral Impingement a Good Predictor of Peritalar Subluxation in Patients with Adult Acquired Flatfoot Deformity?

Category:Ankle Arthritis; Ankle; Hindfoot; OtherIntroduction/Purpose: Sinus tarsi and Subfibular impingement are considered the main causes of lateral foot pain in patients with Adult Acquired Flatfoot Deformity (AAFD). They are considered important markers in the spectrum of progressive peritalar subluxation (PTS) in patients with AAFD. Recent literature has also highlighted the use of the Middle Facet of the subtalar joint as a more accurate indicator of PTS. The objective of this study was to assess the relationship between lateral impingement and middle facet PTS. Our hypotheses were that patients with sinus tarsi and subfibular impingement would demonstrate more severe PTS than patients with no impingement, and that subfibular impingement would represent a better indicator of pronounced deformity when compared to sinus tarsi impingement.Methods: In this retrospective comparative Cohort Study, we included 110 AAFD patients that underwent standing weightbearing CT (WBCT) as a standard baseline assessment of their foot deformity. The presence or absence of sinus tarsi and subfibular impingements, as well as the incongruence angle and percentage of subluxation of the middle facet of the subtalar joint, were manually measured on multiplanar reconstruction (MPR) WBCT images by a blinded fellowship-trained foot and ankle surgeon. Descriptive statistics were used to describe the rate of sinus tarsi and subfibular impingement as well as mean values for middle facet incongruence angle and subluxation. Wilcoxon test was used to compare the values of PTS at the middle facet in patients with or without sins tarsi and subfibular impingement. A partition prediction model was used to assess the values of middle facet PTS that would foresee a higher risk for lateral impingement. P-values <0.05 were considered significant.Results: Seventy-five percent (n=82) of the AAFD patients had sinus tarsi impingement and 64% (n=70) of the AAFD patients had subfibular impingement. The mean value and 95% CI for middle facet incongruence angle and subluxation percentage were respectively 10.5o (CI, 8.7 to 12.2o) and 28.7% (CI, 23.5 to 33.9%). Middle facet subluxation was significantly higher in patients with sinus tarsi and subfibular impingement by respectively 22.6% and 23.9%, both p-values <0.0001. No similar significant differences were observed on incongruence angle measurements. The partition model demonstrated that the middle facet subluxation percentage was the best predictor of both sinus tarsi (R2=0.15) and subfibular impingements (R2=0.17), with 24.9% subluxation representing an important threshold for higher risk of sinus tarsi (90% incidence) and subfibular impingements (84% incidence).Conclusion: Our results showed significantly increased middle facet subluxation in AAFD patients with sinus tarsi and subfibular impingement. Subfibular impingement was less frequent and associated with more pronounced deformity than sinus tarsi impingement. Measurements of the percentage of subluxation of the middle facet were also found to be the best predictor of impingement, with 29.4% representing an important threshold value above which the risks for both sinus tarsi and subfibular impingement were significantly higher. With that in mind, we would recommend close assessment and follow-up of the amount of middle facet subluxation in the decision-making for the treatment of AAFD patients.

Subtalar Fusion for Correction of Forefoot Abduction in Stage II Adult-Acquired Flatfoot Deformity.

Correction of talonavicular uncoverage (TNU) in adult-acquired flatfoot deformities (AAFD) can be a challenge. Lateral column lengthening (LCL) traditionally is utilized to address this. The primary study objective is examining stage II AAFD patients and determining if correction can be achieved with subtalar fusion (STF) comparable to LCL. Following institutional review board approval, retrospective chart review performed identifying patients meeting criteria for stage IIB AAFD who underwent either STF with concomitant flatfoot procedures (but not LCL) to correct TNU, or who underwent LCL as part of their flatfoot reconstruction. Patients indicated for STF had one or more of the following: higher body mass index (BMI), were older, had greater deformity, lateral impingement pain, intraoperative spring ligament hyperlaxity. Patients without 1-year follow-up or compete records were excluded. All other patients were included. A total of 27 isolated STFs identified, along with 143 who underwent LCL. Pre-/postoperative radiographic parameters obtained as well as PROMIS (Patient-Reported Outcomes Measurement Information System) and FAOS (Foot and Ankle Outcome Score) scores. Radiographic and patient reported outcomes both preoperatively and at 1-year follow-up evaluated for both groups. STF patients were older (P < .05), with higher BMIs (P < .004). STF had significantly worse TNU (P < .001) than LCL patients, and average change in STF TNU was larger than LCL change postoperatively (P = .006), after adjusting for age, BMI, gender. PROMIS STF improvement reached statistical significance in Physical Function (P 0.011), for FAOS Pain (P 0.025) and Function (P = 0.04). STF can be used in appropriately indicated patients to correct flatfoot deformity without compromising radiographic or clinical, correcting not only hindfoot valgus, but also talonavicular uncoverage (TNU) and corresponding medial arch collapse. Level III: Retrospective chart review comparison study (case control).

Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture.

To observe the clinical outcome of the sinus tarsi approach in the operative treatment of intra-articular calcaneal fractures.Forty-nine intra-articular calcaneal fractures in 45 patients were managed surgically with sinus tarsi approach. The anatomical plate and compression bolts were applied in 14 feet. The anatomical plate and screws were applied in 35 feet. Maryland foot score system was used to evaluate the function of the hindfoot at the followup.The reduction of the posterior facet was graded as nearly anatomical (less than 2 mm articular displacement) in 46 feet (93.9%). The width, height, and Böhler angle were significantly improved in all patients (P < .01). After a mean follow-up period of 18.7 months (14.5–29 months), the Maryland foot scores were: 34 feet scored 90–100 points (excellent), 6 feet scored 80–90 points (good), 6 feet scored 70–80 points (fair), and 3 feet scored 60–70 points (poor). Incision-edge necrosis occurred in 2 cases. One case suffered from incomplete medial plantar nerve injury. One case suffered from heel pad branch of the tibial nerve injury. Six cases suffered from sural nerve injury, and 4 cases sustained a lateral wound dehiscence due to a hematoma. No case suffered from lateral impingement syndrome. Up to now, no patient had to accept subtalar arthrodesis.Sinus tarsi approach provides good exposure to the subtalar joint. Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with low risk of wound-healing complications.

A study of intra articular calcaneal fractures treated with minimally invasive cannulated screw fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective study to assess the functional outcome of patients with displaced intra-articular calcaneal fractures treated with percutaneous reduction, cannulated screw fixation.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Ultimately, 14 patients with a DIACFs, underwent. percutaneous reduction, cannulated screw fixation. Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A total of 46 adult patients were assessed in our study. Twenty patients did not meet the inclusion criteria and were excluded. Twelve patients were excluded due to severe medical ailments (2 patients) and non-adherence to the treatment plan (10 patients). Therefore, 14 patients with an average age of 42.5 years old (range, 20 to 72 years) including 10 men and 4 women participated in the study. All patients were followed-up for 12 months averagely (range, 11 to 18 months). Complete articular reduction is achieved in 8 patients, 6 patients had articular depression of posterior facet, 3 patients had heel widening and lateral impingement. There was no wound complications in any of the patients, 2 patients developed sub talar arthritis at 2 years of follow up. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Surgical treatment of intra articular calcaneal fractures remains challenging task. Minimally invasive reductions remain good option to minimize wound complications. Cannulated cancellous screw fixation is good option for intra articular calcaneal fracture.&lt;/span&gt;&lt;/p&gt;

Le conflit latéral de l’acromion

The lateral subacromial impingement is based on the assumption that the lateral acromion is the causal constitutional factor of the subacromial pathology and consequently of the rotator cuff tears. The lateral acromion provides to the deltoid a predominant ascending force as soon as its overhang is important. The rotator cuff suffers, the humeral head tends to rise and the coraco-acromial arch receives higher stresses, causing morphological changes and especially a traction enthesophyte. Thus, with age as well as with professional constraints, the acromion lengthens and curves. This is the acquired part of the problem, responding to the initial extrinsic theory of the subacromial impingement. The contact between the coraco-acromial arch and the rotator cuff, which is normally physiological, then becomes symptomatic. The acromion can be responsible for the aggression to the cuff and especially to the supra-spinatus tendon. This latter is the most exposed to the pressure against the acromial coraco-acromial arch when the humeral head is going up. This original concept of lateral impingement of the acromion shuffles the indications of acromioplasty, as well as the technical modalities of its realization as it was recommended until now.

IMPINGEMENT-SYNDROME OF PERONEUS BREVIS TENDON AFTER CALCANEAL FRACTURES (MORPHOLOGICAL ASPECTS)

Background. One of the main causes of pain in patients with consequences of calcaneal fractures is the lateral impingement syndrome. This term means lateral displacement of outer calcaneal wall at the moment of fracture, narrowing of anatomical space under the lateral malleolus and compression of soft tissues in this region, including tendons of short and long peroneal muscles. This leads to chronic traumatization of tendons, alteration of their normal tracking and development of tendinitis and tenosynovitis. At this moment there are no articles in foreign or Russian literature describing how prolonged traumatization influences the internal structure of the tendons. The purpose of this study was to evaluate the morphological changes in structure of peroneus brevis tendon after different duration of compression between outer wall of calcaneus and the tip of the lateral malleolus in patients with calcaneal malunion.Materials and methods. Fifteen patients with calcaneal malunion and lateral impingement syndrome were treated operatively between 2016 and 2017. To confirm the lateral impingement syndrome, the authors performed clinical examination and AP x-rays of ankle joint. Two peroneus brevis tendon specimens were obtained intraoperatively in each of 15 patients: one specimen from compressed and one from non-compressed area. Obtained specimens were histologically examined according to standard protocol.Results. Microscopically all specimens showed separation of collagen bundles with loose connective tissue degeneration, increase of vascularization and inflammation. The degree of these changes differed according to the compression duration. This allowed us to analyze the dynamics of these changes.Conclusion. The morphological changes in structure of peroneus brevis tendon during the compression between outer wall of calcaneus and the tip of the lateral malleolus correspond with dynamics of common pathologic reactions. Early stages showed signs of mechanical damage of bundles and inflammation. In prolonged impingement the intensity of inflammation decreases, but the connective tissue degeneration of the tendon continues with lipoid infiltration.

Radiographic Outcomes of Osteosynthesis Using Proximal Femoral Nail Antirotation (PFNA) System in Intertrochanteric Femoral Fracture: Has PFNA II Solved All the Problems?

PurposeWe evaluated the geometric discrepancies between the proximal femur in Koreans and two types of proximal femoral nail using plain radiographs.Materials and MethodsA total of 100 consecutive patients (38 treated with proximal femoral nail antirotation [PFNA], 62 PFNA II) with intertrochanteric fracture were retrospectively identified. The minimum follow up period was 32 months. The geometric analysis of the proximal femur was performed using preoperative true hip antero-posterior radiographs of the unaffected side, and the data were compared with the PFNA and PFNA II dimensions. Postoperative assessments were performed using postoperative radiographs for the proximal protruding length of nail tip, quality of reduction, implant position and the presence of lateral cortical impingement.ResultsThe geometric dimensions of the proximal femur were different between the two proximal femoral nail types. No impingement was detected in patients treated with PFNA II, whereas 13 cases of lateral impingement were observed in patients treated with PFNA. A significant association was observed between the short proximal femur and the presence of lateral cortical impingement (P=0.032) and between impingement and intraoperative reduction loss (P=0.012). Proximal protrusion of the nail tip was seen in 71 patients and no difference was observed between two groups.ConclusionOur study demonstrates that the flat lateral surface of PFNA II can avoid lateral cortical impingement, which provide better fixation for intertrochanteric fracture. However, there was still a problem associated with longer proximal end of PFNA II compared with the proximal femoral length in Korean.

Ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage

To analyze clinical efficiency and intraoperative considerations of ankle arthroscopy for ankle impingement syndrome through anterior and posterior passage. From April 2011 to April 2015, the clinical data of 17 patients diagnosed as ankle impingement syndrome were performed arthroscopy, including 12 males and 5 females, with an average age of 32.4 years (ranging from 22 to 47). Ankle arthroscopy cleaning were carried out according to clinical symptoms and radiological imaging, crashed part were cleaned too. Non steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate were used as conventional postoperatively treatment. AOFAS score and Ogilvie-Harris score were used to assess preoperative situation and postoperative situation. Intra-operative conditions showed 8 cases with anterior lateral impingement syndromes, 2 cases with anterior medial impingement syndromes, 2 cases with posterior impingement syndromes and 3 cases combined with anterior and posterior impingement syndromes. Distal bundle of anterior tibiofibular ligament, anterior talusfibular ligament and synovial tissue and scar tissue were cleared up during operation. Four patients were combined with concomitant articular cartilage injury, and damage area were about 1 mm×3 mm to 1.5 mm×4 mm. Microfracture treatment were performed by 1.2 mm diameter Kirschner wire. All patients were followed up from 8 to 24 months with an average of 14.3 months. AOFAS score increased from 62.3±5.20 preoperatively to 87.6±5.40 postoperatively, Ogilvie-Harris ankle score increased from 6.70±0.98 preoperatively to 12.80±1.21 postoperatively. No neurovascular damage, wound infection or wound healing problem occurred. Ankle swelling were appeared with different degrees, but disappeared at 4 to 8 weeks postoperatively. For ankle impingement syndrome patients, ankle arthroscopy through anterior with posterior passage could effectively clear up bone and soft tissue impingement. Postoperatively non-steroidal anti-inflammatory drugs and intra-articular injection of sodium hyaluronate could effectively relieve ankle pain and swollen and achieve good therapeutic effect.

Minimally-invasive treatment of calcaneal fractures: A review of the literature and our experience

The optimal treatment of calcaneal fractures (CF) is currently controversial and is still under debate. It is well established that conservative treatment of these fractures is associated with poor results. Several surgical techniques are described in the literature; however, there is no consensus on which of these is more effective. The main goals of surgery are to restore the subtalar joint congruence, and calcaneal width, height, shape and alignment, thus avoiding medial and lateral impingement and enabling the patient to resume a normal lifestyle. ORIF is the most popular technique for these fractures, but it is associated with high rates of wound complications, hardware failure and infections. Several minimally‐invasive techniques have been developed recently for the treatment of CF, with the common aim to be as simple, effective and inexpensive as possible and to reduce surgical times, complications and length of hospital stay.

Isolated subtalar arthrodesis after fractures of the calcaneus

Background Involvement of the subtalar joint in fracture calcaneus may give rise to chronic pain and permanent functional impairment. This can be produced by subtalar incongruity with calcaneofibular abutment and/or impingement of the tendon, nerve, or other soft tissue. Patients and methods Twenty patients (16 males and four females) underwent subtalar arthrodesis for the treatment of subtalar arthrosis after calcaneal fracture. All patients were initially treated conservatively; the mean time for fusion operation was 20 months (range: 12–36 months). The indications for operation were severe pain and disability in an incongruent subtalar joint with lateral impingement after failed conservative treatment. The fusion was fixed by using cannulated screws in all cases. Results All patients studied at the time of follow-up had a solidly fused subtalar arthrodesis. Two cases had a superficial wound infection and were treated with antibiotics. The mean postoperative period of recovery after which the patient could return to work or daily activities was 9 months (range: 6–12 months). In 16 (80%) patients, there was some residual pain; only four (20%) had no complaints. The result assessments with respect to the American Orthopedic Foot and Ankle Society score showed four (20%) patients with excellent score, good in 10 (50%), fair in four (20%), and poor in two (10%). There was no correlation between the type of accident, the weight of the patient, the recovery period, and the outcome of the American Orthopedic Foot and Ankle Society. Conclusion Isolated subtalar arthrodesis with screw fixation is an effective surgical intervention with significant clinical improvements in some patients with post-traumatic arthrosis of the subtalar joint.

Sex-Based Differences in the Clinical Presentation of Patients With Symptomatic Hip Labral Tears

Background: An increasing body of literature describes the clinical presentation and demographics of patients with hip labral tears. The differences in pelvic structure and joint laxity between sexes have been described; however, no study has evaluated differences in the clinical presentation of patients with symptomatic labral tears between sexes. Purpose: To describe the differences between sexes in demographics, clinical history, physical examination, and intraoperative findings in patients with symptomatic labral tears. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected between February 2008 and February 2013 on 1401 patients who had symptomatic labral tears and underwent arthroscopic surgery. Hips with previous pathologic disorders were excluded. Data on demographics and clinical history were gathered, and a physical examination was performed. Preoperative pain was estimated on the visual analog scale (VAS), and 4 hip-specific patient-reported outcomes (PROs) were administered to evaluate functional status. Intraoperative findings were recorded. Results: A total of 654 patients met our inclusion/exclusion criteria, with 320 males and 334 females. The median age for males was 38.3 years (range, 15.0-69.6 years) and for females 40.4 years (range, 13.1-66.8 years). Male patients had a higher incidence of acute injury than females (39.6% vs 27.6%, respectively; P < .05) and a higher incidence of workers’ compensation status (14.1% vs 4.5%, respectively; P < .05). Females had increased range of motion compared with males, which was statistically significant for all range of motion measurements (P < .05). The anterior impingement test was positive in 94.4% of females and 92.9% of males, the flexion/abduction/external rotation test was positive in 59.5% of females and 61.5% of males, and the lateral impingement test was positive in 55.0% of females and 59.2% of males, but there was no statistically significant difference between sexes in any of the tests. Pain with palpation over the greater trochanter was positive in 22.0% of males and 36.9% of females (P < .0001). Females had lower PROs; however, VAS scores were similar. Conclusion: Male and female patients differ in their hip structure, biomechanics, and operative findings of symptomatic labral tears. However, they do not differ substantially in clinical presentation, except that males are more likely to report an acute injury and females are more likely to be evaluated with increased range of motion.

Radiographic, Histologic, and Arthroscopic Findings in Amorphous Calcifications of the Hip Labrum

The purpose of this study was to evaluate the clinical, radiographic, histologic, and intraoperative findings of an amorphous calcification involving the acetabular labrum. From October 2008 to April 2013, all patients who underwent arthroscopic hip surgery for symptomatic intra-articular hip disorders and were found to have the characteristic calcific deposit involving the acetabular labrum were included. These patients were reviewed retrospectively on prospectively collected data. Radiographs were retrospectively evaluated for morphologic features of impingement and characteristics of labral calcification. Sixteen patients were identified as having amorphous calcification at the time of arthroscopy. There were 15 women and 1 man. Mean age was 37.3 years (range, 30 to 50 years). Symptoms were present for a mean of 9.3 months (range, 3 to 48 months). All patients reported anterior groin pain. Fifteen (94%) patients had positive anterior impingement and 9 (56%) had positive results for lateral impingement. Calcifications measured on average 3.2 mm (range, 1.9 mm to 5.6 mm), and 14 had a clear separation from the rim with increased opacity compared with neighboring trabecular bone. Intraoperatively, the characteristic amorphous calcium deposit was located in the anterosuperior labrum, with the deposit found to be accessible from the capsule-labral recess in all cases. Allpatients had labral tears and all patients had at least one component of femoroacetabular impingement (FAI). Calcification in the anterosuperior acetabular labrum presents with a consistent patient demographic and distinct radiographic and arthroscopic presentation that is different from os acetabuli. As with os acetabuli, one should have a high suspicion for FAI when this lesion is encountered. Level IV, therapeutic case series.