Posttraumatic Ankle Research Articles

ANKLE ARTHRODESIS USING TTC (TIBIOTALOCALCANEAL) NAIL IN THE TREATMENT OF NEGLECTED TRIMALLEOLAR FRACTURES OF ANKLE WITH EARLY ARTHRITIS; CASE REPORT

Introduction: Patients rst consult traditional healers and it is when the signs persist that they consult the surgeon for a swollen and painful ankle. Initially we always performed anatomical repairs with osteosynthesis, but the majority of patients still complained of pain and disability. We therefore performed an arthrodesis on neglected post-traumatic ankles. The objective of our study was to describe the result of arthrodesis ankle using TTC (tibiotalocalcaneal) nail on a neglected post-traumatic ankle and to propose a therapeutic indication in the face of any neglected ankle fracture. This was a case of 38/m with 3 months old neglected trimalleolar ankle fr Material and Method: acture with early arthritis treated with ankle arthrodesis using ttc nail. Follow up taken over 3 months by serial x-rays and clinical evaluation. The average follow-up was 3 months and our results were satisfactory radiologically and Results: clinically. Discussion: Arthrodesis with ttc nail appears here as an important alternative in the treatment of neglected ankle fractures with early changes of arthritis

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Talar Arthroscopic Reduction and Internal Fixation (TARIF): A Novel All-Inside Soft-Tissue-Preserving Technique.

Arthroscopic Ankle Arthrodesis in Post-Traumatic Ankle Arthritis with Compromised Soft Tissue: A Case Report

Abstract Introduction: The most common surgical treatment for end-stage ankle arthritis remains ankle arthrodesis. Dealing with the site of an incision in the ankle with poor soft tissue condition poses a challenge. The procedure of choice in cases of poor soft tissue condition around the ankle following an open ankle fracture remains questionable. This report presents a case of post-traumatic ankle arthritis with compromised soft tissue status. The patient was managed with arthroscopic ankle arthrodesis, taking into account the condition of the soft tissue. Case Report: A 25-year-old presented with advanced arthritis in the right ankle and compromised soft tissue condition. Arthroscopic ankle arthrodesis was performed, taking into account the poor soft tissue condition, where the soft tissue healing after the incision is expected to be poor, and sutures of the arthroscopic portal site were removed at the two-week follow-up, after adequate healing of the surgical site. Conclusion: Arthroscopic ankle arthrodesis is a preferred procedure for post-traumatic ankle arthritis with compromised soft tissue. However, in cases of ankle arthritis associated with gross deformity requiring ankle arthrodesis and additional deformity correction, open ankle arthrodesis may be superior to arthroscopic ankle arthrodesis.

Ankle joint contact force profiles differ between those with and without chronic ankle instability during walking

BackgroundIndividuals with chronic ankle instability (CAI) exhibit aberrant gait biomechanics relative to uninjured controls. Altered gait biomechanics likely contribute aberrant joint loading and subsequent early onset ankle joint degeneration. Joint (i.e. cartilage) loading cannot be directly measured without invasive procedures but can be estimated via joint contact forces (JCF) generated from musculoskeletal modeling. However, no investigation has quantified JCF in those with CAI during walking despite the link between ligamentous injury and ankle post-traumatic ankle osteoarthritis. Research questionDo patients with CAI exhibit altered ankle compressive and shear JCF profiles during the stance phase of walking compared to those without CAI? MethodsTen individuals with CAI and 10 individuals without a history of ankle sprain completed a gait assessment at their self-selected speed on an instrumented treadmill. Musculoskeletal modeling was applied to estimate ankle JCF variables within a generic model. Variables included the peak, impulse, and loading rates for compressive, anteroposterior shear, and mediolateral shear JCF. ResultsThose with CAI had significantly different JCF forces, relative to uninjured controls, in all directions. More specifically, lower compressive peak and impulse values were noted while higher anteroposterior shearing forces (1 st peak, impulse, loading late) were observed in those with CAI. Those with CAI also demonstrated higher mediolateral shearing forces (1 st peak and impulse). SignificanceOur finding suggests that those with CAI exhibit different ankle joint loading patterns than uninjured controls. Directionality of the identified differences depends on the axis of movement.

Tarsal Coalition is Not Necessarily Associated with a Flatfoot Deformity: A Cohort of Clinically Misdiagnosed Cases and Alignment Features in 41 Feet

Category: Hindfoot; Ankle; Midfoot/Forefoot Introduction/Purpose: Tarsal coalition has been historically reported to be associated with a flatfoot deformity. There are however case reports demonstrating that it can be found in cavovarus and clubfoot deformities. The goal of this study was to retrospectively review all weightbearing CT (WBCT) scans that were taken in one medical center, to investigate the clinically diagnosed as well as missed cases of tarsal coalition, and to determine the hindfoot alignment and arch height features of each case. Methods: 800 WBCT scans were reviewed separately by two senior fellowship trained foot and ankle surgeons. The structure of the hindfoot and midfoot was carefully examined in all three views to screen for different types of tarsal coalition. For cases that were diagnosed with tarsal coalition on WBCT, the medical charts were then reviewed to determine the original clinical diagnoses. Hindfoot alignment and arch height features of the midfoot were subsequently evaluated on WBCT scans. Results: There were 41 feet that were diagnosed with tarsal coalition on WBCT (Figure 1). The clinical diagnosis of coalition was only made in 15 feet and 26 symptomatic feet were clinically missed. Among the 26 symptomatic feet diagnosed on WBCT but clinically missed, 16 had a clinical diagnosis of congenital or acquired flatfoot, 3 with subtalar arthritis, 1 with talonavicular arthritis, 1 with peroneal tendinopathy and a cavovarus foot deformity, 2 with cavovarus deformity and midfoot arthritis, 2 with posttraumatic ankle arthritis, and 1 with subtalar impingement. A valgus hindfoot was found in 19 feet, a neutral hindfoot in 18, and a varus hindfoot in 4 feet. In the midfoot, 38 feet had a positive (>=1) distal medial cuneiform/fifth metatarsal arch height index, and 3 feet had a negative index (<1); all 41 feet had a positive proximal cuneiform/cuboid height index (>=1). Conclusion: One should be aware that patients with tarsal coalition do not always present with a flatfoot and hindfoot valgus, since many can have a variety of hindfoot and midfoot alignment features. In cases presenting with history of trauma, degenerative arthritis, as well as a cavovarus or clubfoot deformity, tarsal coalition can easily be clinically overlooked.

Supramalleolar osteotomy for the treatment of ankle osteoarthritis leads to favourable outcomes and low complication rates at mid-term follow-up: a systematic review.

The purpose of this systematic review was to evaluate both the clinical and radiographic outcomes following supramalleolar osteotomy (SMO) in patients with ankle osteoarthritis, and to analyse the level of evidence (LOE) and quality of evidence(QOE) of the included studies. A systematic review of the MEDLINE, EMBASE, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following SMO for the treatment of ankle osteoarthritis were included and assessed. The level and quality of evidence of the included studies were also evaluated. Twenty-four studies with 1160 patients (1182 ankles) were included. Overall, 78.8% patients presented with post-traumatic ankle osteoarthritis. The weighted mean AOFAS score improved from 52.6 ± 9.7 (range 33.8-78.4) preoperatively to 78.1 ± 5.7 postoperatively at weighted mean follow-up of 50.4 ±18.6months (range 24.5-99.0). The most frequently utilised radiographic parameter was the tibial anterior surface angle, which improved from a preoperative weighted mean of 86.3° ± 5.6° (range 76.0°-102.0°) to a postoperative weighted mean of 89.9° ± 3.7° (range 84.9°-99.6°). The complication rate was 5.1% with non-union as the most commonly reported complication (1.6%). Secondary procedures were carried out in 28.2% of patients, the most common of which was implant and hardware removal (17.6%). The failure rate was 6.8%. Two studies were LOE II, 3 studies were LOE III, and 19 studies were LOE IV. The mean Modified Coleman Methodology Score was 59.3 ± 6.6 and the mean MINORS criteria score of all the included studies was 9.5 ± 3.7. This systematic review demonstrates good clinical and radiological outcomes, together with a low failure rate at mid-term follow-up following supramalleolar osteotomy in patients with ankle osteoarthritis. However, a moderate reoperation rate (28.2%) was reported. A low failure rate (6.8%) was reported, which must be interpreted in light of the shortcomings of the design of the included studies and a relatively short follow-up period. In addition, there is a low level and quality of evidence in the current literature with inconsistent reporting of data which underscores the need for further higher quality research to be conducted. Our review highlights that SMO may be an effective and safe procedure in the setting of early-to-intermediate-stage ankle osteoarthritis. IV.

Case report: A rare case of pure tibio-talar dislocation without malleolar clamp fracture in a young athlete: Long-term functional results and recent reviews of the literature.

Introduction and importanceAnkle dislocation without fracture is an extremely rare injury, requires high-energy trauma, up to 1995, only 73 cases were reported in the literature and 154 cases up to 2017. It is therefore a post-traumatic ankle disease growing in parallel with the increase in road-traffic accidents requiring the study of incriminated factors such as hypoplasia of the medial malleolus.Case presentationThe authors report the case of a young patient, a football player, who presented with a pure, closed dislocation of his ankle following a road-traffic accident. Management consisted of immediate reduction, followed by immobilization in plaster for 1 month,Clinical discussionThe short, medium and long term clinical and radiological results are excellent with no evidence of ankle instability or osteoarthritis.ConclusionAnkle dislocation without associated fracture is an extremely rare injury. The posteromedial dislocation represents the most described variety in the literature. Early management, short-term immobilization, adapted and early rehabilitation seem to be associated with good long-term functional results.

Atelocollagen-Induced Chondrogenesis Versus Microfracture Alone for Osteochondral Lesions of the Talus: Surgical Technique and a 1-Year Clinical Outcome Study.

Osteochondral lesions of the talus (OLTs) are a common cause of post-traumatic ankle pain and disability. Atelocollagen-induced chondrogenesis (ACIC) aims to encourage the development of hyaline cartilage, which is biomechanically superior to fibrocartilage. This single-center, retrospective database study assessed patients who underwent arthroscopic microfracture with or without atelocollagen scaffold augmentation for OLT. Between 2010 and 2019, 87 patients underwent microfracture only and 31 patients underwent ACIC. Propensity score matching was used to match the ACIC group in a 1:2 ratio to a corresponding microfracture-only group using logistic regression. American Orthopaedic Foot & Ankle Society (AOFAS) scores, 100-mm Visual Analog Scale (VAS), Short Form-36 (SF-36), and satisfaction were assessed at preoperative, 3-, 6-, and 12-month intervals. There were no differences in baseline characteristics between groups after matching (P > .05). Both groups had similar improvements to VAS, AOFAS, and SF-36 scores up to 12 months (P > .05). Both groups had significant 1-year improvements to physical functioning, physical limitations in usual role activities, pain, and social functioning domains, but the ACIC group additionally had significant improvements to general health, vitality, and mental health. Patients in the ACIC group were also more satisfied than the microfracture group at all time points. Patients with OLTs who underwent ACIC reported superior satisfaction and improvements to quality of life, although clinical outcomes were similar to those who underwent microfracture alone at 1 year.Level of Evidence: Level III: Cohort study.

Paper 94: Diagnostic Accuracy of Weightbearing CT in Detecting Chronic Subtle Syndesmotic Instability: A Prospective Comparative Study

Objectives:Subtle syndesmotic instability (SSI) is a difficult albeit important diagnosis to make, as undiagnosed instability frequently leads to posttraumatic ankle arthritis. Stressed conventional radiographs, ultrasonography, bilateral comparative conventional computed tomography (CT) and magnetic resonance imaging (MRI) serve as important diagnostic tools, however, the current diagnostic gold-standard is arthroscopic assessment, an invasive surgical method. The advent of weight-bearing computed tomography (WBCT) is considered to be an important additional diagnostic tool for improved non-invasive SSI diagnosis, particularly by utilizing distal tibiofibular syndesmotic (DTFS) area and volume measurements. However, to date, no studies have assessed WBCT diagnostic accuracy for chronic SSI. The purpose of this study was to prospectively evaluate the diagnostic accuracy of WBCT area and volumetric measurements in patients with suspected chronic SSI, when compared to the gold-standard arthroscopic assessment.Methods:In this IRB-approved prospective comparative study, 11 patients with suspected SSI were enrolled from July 2019 to December 2020. Patients were assessed preoperatively by bilateral standing WBCT. Raw 3D WBCT was automatically segmented by dedicated software. WBCT measurements included semi-automatic DTFS area (1cm proximally to tibial dome apex) and DTFS volumes (1, 3 and 5cm proximally to tibial dome apex). Threshold values for WBCT abnormality were defined based on currently available data (area>105mm2 and volumes>796mm3, >3062 mm3, and >6733 mm3 for 1, 3 and 5cm, respectively). Subjects underwent surgical treatment including DTFS instability arthroscopic assessment, defined as positive when a 3mm diameter sphere could enter the syndesmotic incisura. Confirmed unstable cases were treated with open reduction/internal fixation. WBCT measurements sensitivity, specificity, positive and negative predictive values (PPV/NPV) and accuracy were calculated using confirmed arthroscopic instability as diagnostic gold standard. Paired t-tests/Wilcoxon analysis was used to compare measurements. P-values<0.05 were considered significant.Results:When compared to non-injured sides, DTFS area and volumes were significantly higher in injured ankles at 1cm (667 vs 554mm3) and 3cm (2331 vs 2038mm3). Medial gutter volumes were also increased in injured sides (398 vs 370 mm3). DTFS volumes at 5cm and lateral gutter volumes were not different. Nine of eleven patients had confirmed arthroscopic DTFS instability. Considering WBCT area measurements, 4/11 patients were found to be positive (>105mm2), including 3 true positives (+WBCT/+Arthroscopy), 1 false positive (+WBCT/-Arthroscopy), 6 false negatives (-WBCT/+Arthroscopy), and 1 true negative (-WBCT/-Arthroscopy), leading to a 33.3% sensitivity, 50%, specificity, 75% PPV 75%, 14.3% NPV and 36% accuracy. When analysing WBCT DTFS volumes (1cm), 3/11 patients were found positive (>796mm3), depicting 3 true positives, 0 false positives, 2 true negatives and 6 false negatives, with resultant diagnostic accuracy of: 33.3% sensitivity, 100% specificity, 100% PPV, 25% NPV 25%, and 45% accuracy.Conclusions:This is the first study to prospectively assess the diagnostic accuracy of WBCT area and volume measurements in detecting chronic SSI and to compare it to the arthroscopic diagnostic gold standard. When compared to uninjured side, DTFS area and volumetric measurements were significantly increased in injured sides of patients with suspected SSI, including medial gutter volumes, consistent with associated deltoid ligament instability. However, interestingly, we observed a diagnostic accuracy for WBCT area and volumetric measurements to be lower than initially expected. Further incorporation of additional patients, as well as introduction of an external rotational stress can potentially optimize the WBCT diagnostic accuracy for chronic SSI.

Micro-vascular reconstruction of complex post traumatic ankle and foot defects with free anterolateral thigh flap: single centre experience

Background: Ankle and foot reconstruction is challenging for plastic surgeon due to paucity of local soft tissue and poor blood supply. Anterolateral thigh (ALT) free flap become popular reconstructive option where microsurgical expertise available.Methods: Retrospective study of 26 patients of complex post traumatic ankle and foot defect underwent free anterolateral thigh free flap reconstruction during 2 years duration.Results: ALT free flap provides satisfactory reconstructive option with only 8% flap loss in our study and minimal donor site morbidity. Flap thinning required in 19% patients on long term for adequate shoe fitting.Conclusions: ALT free flap provide like with like tissue replacement for foot and ankle reconstruction with supple skin cover for subsequent surgeries if required.

Profile and Frequency of One Hundred Ankle Osteoarthritis Cases in an Indonesian Tertiary Hospital

Osteoarthritis is one of the most common cases in orthopedics and traumatology clinic. Ankle osteoarthritis is less common than osteoarthritis of hip and knee. Limited data and literature resulted in suboptimal treatment strategy. The purpose of this study was to describe the profile and frequency of ankle osteoarthritis at Dr. Hasan Sadikin General Hospital Bandung, a tertiary referral hospital in Indonesia. A cross-sectional descriptive observational study was conducted on all patients diagnosed with ankle osteoarthritis enrolled in the medical record database at Dr. Hasan Sadikin General Hospital Bandung, Indonesia in November 2020–November 2021. Results showed that the majority of the patients were female (52%), aged ≥60 years old (44%), graduated from senior high school education (56%), and housewives (30%). The 100 patients were proportionally distributed with most of them were categorized as suffering from secondary osteoarthritis with post-trauma predominance. From the perspective of body mass index, 85% patients were classified as above normal. As many as 76% of patients presented to the hospital in an advanced stage. With the high rate of posttraumatic ankle osteoarthritis, concerns should be given more to the ankle trauma management, as well as to the population with high body mass index. Increased health promotion for general population and health care providers is also needed to reduce the tendency of late presentation at the health care facility.

Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritis

BackgroundAnkle distraction arthroplasty and supramalleolar osteotomy were both options for post-traumatic varus ankle arthritis (VAA), but their comparative effectiveness was scarcely reported. This study aimed to compare the outcomes of two operative methods for treatment of Takakura-Tanaka stage 3 post-traumatic VAA.MethodsThis was a retrospective study, comprising 73 consecutive patients who presented with Takakura-Tanaka stage 3 post-traumatic VAA treated by either ankle distraction arthroplasty (n = 32) or supramalleolar osteotomy (n = 41) from January 2016 to December 2019. All patients had a minimum 24-month follow-up assessments. The outcome measures were visual analog scale (VAS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function.ResultsAt an average of 32 months (range, 24–52 months) follow-up, significant improvement was observed for VAS, AOFAS, range of motion (ROM) and most radiographic parameters (except for TAS and TLS for ankle distraction arthroplasty group) compared to preoperative baselines (p < 0.05) for both groups. However, both groups did not differ significantly in terms of VAS or AOFAS, excellent and good rate (78.1% versus 85.4%, p = 0.422), overall rate of postoperative complications (28.1% vs. 17.1%, p = 0.257), or various radiographic parameters (e.g. tibial anterior surface angle, talar tilt angle and tibial lateral surface angle) (all p > 0.05). The ankle distraction arthroplasty group had a better postoperative ankle motion than did the supramalleolar osteotomy group, in terms of plantarflexion (37.8 ± 4.2 vs. 30.4 ± 3.6, p = 0.006), dorsiflexion (36.5 ± 6.4 vs. 28.3 ± 5.5, p = 0.004), varus (32.1 ± 4.5 vs. 27.1 ± 3.1, p = 0.017) and valgus (28.4 ± 3.7 vs. 25.2 ± 2.8, p = 0.046).ConclusionsBoth operative treatments are effective for Takakura-Tanaka stage 3 post-traumatic VAA. In practice, individualized treatment option tailored to the ankle condition and patients’ specific need should be considered.Level of evidence: III, retrospective comparative series.

The effect of BMI on long-term outcomes after operatively treated ankle fractures: a study\xa0with up to 16 years of follow-up

BackgroundAnkle fractures are a common injury and the main cause of post-traumatic ankle arthritis. The prevalence of obesity is increasing worldwide, and this population is known to have poorer short and midterm outcomes after ankle fractures. Our objective is to assess long-term patient-reported outcomes in patients with operatively treated ankle fractures, and the effect of BMI on these results using the new and validated patient-reported outcome questionnaire, the Manchester Oxford foot and ankle questionnaire (MOXFQ).MethodsWe performed a retrospective review of all ankle fractures treated operatively in a ten-year period from 2002–2012. The MOXFQ and SF-12 were sent to all patients and were obtained, on average, 11.1 years after surgery (range 5.3–16.2 years).ResultsTwo thousand fifty-five ankle fractures were reviewed, of which 478 (34%) patients completed the questionnaires. The mean age was 48.1 ± 15.5 years, 52% were men and the mean BMI was 26.1 ± 4.5 kg/m2. Of the 478, 47% were of normal weight, 36% were overweight, and 17% were obese. Overall, 2.1% were type A, 69.9% B, and 24.9% type C fractures. There were no significant differences in the type of fracture between the BMI groups. Comparing obese and non-obese patients, there were large differences in MOXFQ pain (33 ± 29 vs. 18.7 ± 22.1, effect size 0.55), and function scores (27.3 ± 29 vs. 12.5 ± 21.1, effect size 0.58). No differences in complications and reoperations rates were observed. The BMI value at surgery correlated more strongly with the MOXFQ pain score than the BMI at follow-up (Spearman’s Rho 0.283 vs. 0.185, respectively).ConclusionThese findings reveal that obese patients have significant worse long-term outcomes, namely increased pain, poorer function, and greater impairment in everyday life after an operatively treated ankle fracture. Moreover, pain and function linearly declined with increasing BMI. Our findings appear to indicate that increased BMI at surgery is an important contributor to adverse outcome in the operative management of rotational ankle fractures.Level of evidenceIII.

Functional Outcomes after Modified Blair’s Procedure for Ankle Arthritis Secondary to Hawkins Type III Talus Injuries: A Retrospective Cohort Study

Introduction: The management of ankle arthritis secondary to traumatic talar injuries remains challenging, given the complexity of the majority of cases and the presentation of patients with avascular necrosis of the talus. While several treatment options have come up, the arthrodesis of the tibiotalar joint, as first described by Blair in 1943, remains a useful modality, especially in resource-limited settings. However, few studies have reported the functional outcome after the modified Blair’s procedure. This study sought to describe the functional outcomes after the modified Blair’s procedure for ankle arthritis secondary to Hawkins type III talus injuries. Methods: This retrospective cohort study was performed in a tertiary care center in northern India, which enrolled all patients with posttraumatic ankle arthritis due to Hawkins type III talus injuries who had received modified Blair’s ankle arthrodesis from January 2018 to January 2021. The primary outcomes were scores on the Visual Analog Scale (VAS) for pain and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, which had been recorded both before treatment and 1-year postoperatively, and were compared through a paired t-test. Results: A total of 11 patients were included. Bony fusion occurred in a mean ± standard deviation duration of 21.73 ± 1.90 weeks. AOFAS score improved preoperatively from 41.45 ± 6.56 to 80.09 ± 5.09 at 1-year postoperatively (mean difference: 38.64, 95% confidence interval [CI]: 34.24–43.03, P &lt; 0.001). VAS score for pain improved from 6.27 ± 1.10 preoperatively to 0.73 ± 0.78 1-year postoperatively (mean difference: 5.54, 95% CI: 4.85–6.24, P &lt; 0.001). Conclusions: Modified Blair’s procedure has the potential to provide patients of posttraumatic ankle arthritis with significant pain relief and excellent functional outcomes. The remaining subtalar and talonavicular motion allows patients to have satisfactory walking ability without considerable difficulty.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle Arthritis; Ankle; TraumaIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and a substantial burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma. However, it is currently unknown what types of injuries of the foot and ankle most commonly lead to end-stage arthritis. Therefore, the purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over 20 years. We hypothesized that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over 20 years. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy), and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at the time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibiotalar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), Charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The primary etiology for AO is secondary due to trauma. A history of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines to diminish disease impact on the population and health care system.

Хирургическая тактика при лечении пациентов с последствиями внутрисуставных повреждений дистального отдела костей голени (обзор литературы)

Background Management of patients with sequelae of intra-articular fractures of the distal tibia continues to be a substantial clinical challenge in orthopaedic trauma due to the high incidence, poor outcomes and high disability rate. The objective was to review Russian and international experience in repair of intra-articular ankle fractures and explore contemporary trends in treatment strategies. Material and methods The literature search was produced using medical electronic databases of eLibrary, PubMed, Medline, SpringerLink between 2000 and 2020 and keywords: cruzarthrosis, arthrodesis, total ankle arthroplasty, arthroscopy, distal tibia, ankle joint, joint replacement, intra-articular fractures of distal tibial. Results The article presents an insight into the problem of malunited and nonunited ankle fractures, ankle contractures and deformities, post-traumatic ankle arthritis. Major surgical techniques used to address sequelae of ankle fractures include correcting osteotomy, arthroscopy, distraction arthroplasty, arthrodesis, total ankle arthroplasty with the advantages and disadvantages with each of the practices. Discussion The surgical option would depend on the time of injury, condition of soft and bone tissue, malalignment and severity of ankle arthritis. Joint saving procedures of correcting osteotomy, arthroscopy or distraction arthroplasty can be applied at early stages of the disease, and arthrodesis or total ankle arthroplasty are secured for terminal stages of ankle arthritis. Benefits of total ankle arthroplasty include preservation and improvement of ankle mobility, a short inpatient period. Ankle fusion is associated with less complication rate and low costs. Conclusion There is an obvious need for a uniform treatment algorithm with specific indications and contraindications to each surgical option.

Ankle Arthrodesis in the Treatment of Neglected Ankle Fractures

Introduction: Neglected ankle fractures are common in our regions. Patients first consult traditional healers and it is when the signs persist that they consult the surgeon for a swollen and painful ankle. Initially we always performed anatomical repairs with osteosynthesis, but the majority of patients still complained of pain and disability. We wondered whether a primary arthrodesis would not be indicated in old ankle fractures to avoid disabling pain for patients. We therefore performed a series of arthrodesis on neglected post-traumatic ankles. The objective of our study was to describe the results of arthrodesis on an old post-traumatic ankle and to propose a therapeutic indication in the face of any neglected ankle fracture. Material and Method: This was a prospective study over 8 years between December 2012 and November 2020, involving 36 cases of neglected ankle fractures treated by arthrodesis using Meary’s technique. We used AOFAS (American Orthopedic Foot and Ankle Score) preoperatively and postoperatively for an objective assessment. Results: The average follow-up was 4.2 years and our results were satisfactory (94.4%) with an average AOFAS score ranging from 27.8 preoperatively to 76.7 postoperatively. The fusion rate was 97.2%. Discussion: Arthrodesis appears here as an important alternative in the treatment of neglected ankle fractures with significant trophic disorders.

Ankle Arthritis Etiology Predicts Patterns of Gait Dysfunction: A Prospective Multivariate Gait Analysis

Category:Ankle; Ankle Arthritis; Basic Sciences/Biologics; HindfootIntroduction/Purpose:Preoperative factors influencing functional disability imparted on the patient by ankle arthritis have not previously been assessed with gait analysis. The purpose of this study was to assess the influence of ankle arthritis etiology and deformity, measured radiographically, on gait performance in a dedicated gait lab utilizing a multisegment foot model. With three calcaneal and four metatarsal markers in addition to standard lower extremity markers, the modified Helen Haynes model allows for the evaluation of range of motion (ROM) within the 'ankle-hindfoot segment.' The primary hypothesis was that three- dimensional ankle-hindfoot segment ROM would be more restricted in patients with post-traumatic ankle arthritis than other etiologies. The secondary hypothesis was that temporospatial and kinetic measures would not vary by etiology.Methods:A longitudinal cohort of 183 patients with end-stage ankle arthritis were prospectively enrolled from 2008-2018. Mean age was 61, BMI 29, and 56% were male. Four etiologic groups were defined: Post-fracture (100), arthritis caused by planovalgus foot deformity (23), chronic instability associated with cavovarus (32), and miscellaneous (28), comprised of inflammatory (7), idiopathic (6), instability without deformity (5), septic (2), and avascular necrosis (3) as causes. The four-segment Milwaukee foot model was used in a dedicated gait lab with a 12-camera motion capture system. Gait data was collected over a minimum 20 gait cycles across a 10-meter walkway. Kinetic data was simultaneously collected with two force plates embedded in the walkway operating at 1 MHz. AP and lateral tibiotalar angles, lateral talus-first metatarsal angles, calcaneal pitch, and tibiotalar ratio were measured. Multivariate regression analyzed the effect of etiology and radiographic measures on gait function, controlling for age, gender, and BMI.Results:The primary hypothesis was confirmed. Sagittal plane ankle-hindfoot segment ROM was lower in post-traumatic and higher in valgus patients compared to other etiological groups (P<0.0001) (Figure 1). Sagittal plane ankle-hindfoot segment ROM restriction relative to the contralateral limb was also more severe in the post-traumatic group than others (P=0.0005). Valgus AP tibiotalar angles were associated with greater sagittal plane ankle-hindfoot ROM (P=0.0016). The secondary hypothesis was disproven. Post-traumatic patients ambulate with greater maximum ankle moment than other groups (P=0.0043). Valgus patients ambulate with a comparatively longer step length (P<0.0001). Significant reductions in affected limb walking speed (P<0.0001), step length (P<0.0001), and maximum ankle moment (P=0.036), as well as increases in double limb (P=0.0007) and total support percentage (P<0.0001) were found among the miscellaneous etiology group.Conclusion:Of the four groups, patients with post-traumatic ankle arthritis ambulated with the greatest ankle and hindfoot stiffness, but also the greatest ankle moment. Patients with valgus ankle arthritis had the greatest ROM through the ankle and hindfoot and the longest step length. In addition to diminished ROM, patients in the miscellaneous group had the lowest cadence, symmetry, and torque of gait. The etiology of severe ankle arthritis can predict the pattern of gait dysfunction, which, in turn, may inform choices of surgical reconstruction.

Reliability of Manually Segmenting T1ρ Magnetic Resonance Sequences of Talar Articular Cartilage.

Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg,T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. Descriptive observational study. Laboratory. Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03]y, 170.00 [7.93]cm, 71.03 [14.97]kg) participated. None. Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). For T1ρ relaxation time, intraobserver (ICC = .994-.997, RMSCV = 1.31%-1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975-.980, RMSCV = 3.88%-4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.

What are the Injures that Lead to Post-Traumatic Ankle Osteoarthritis? A Long-Term Retrospective Analysis of 533 Patients

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Ankle osteoarthritis (AO) is an incapacitating condition for patients and an important burden for medical assistance. It is well known that the vast majority of AO occurs as a sequela of previous trauma, however, it is currently unknown what types of injuries of the foot and ankle most commonly lead end-stage arthritis. The purpose of this study was to investigate the etiology of end-stage ankle osteoarthritis in all patients who underwent ankle fusion or replacement at a tertiary care center over a 20-year period. Our hypothesis was that the most common injury patterns would correspond to low-energy lesions.Methods:The electronic medical record was queried using current procedural terminology (CPT) codes for ankle fusion or ankle replacement to identify all patients who underwent either of these procedures at a single tertiary academic center over a 20-year period. Etiologies were broadly grouped as Pilon/Plafond fracture, ankle fracture, talus fracture, tibia fracture, single or recurrent sprains, infection/septic joint, systemic disorder (Charcot arthropathy, rheumatoid arthritis, hemophilic arthropathy) and idiopathic/primary osteoarthritis. Each fracture pattern was then subclassified using commonly accepted classification systems by two independent observers in addition to the grade of arthritis at time of fusion or replacement. Reliability among readers was assessed by Kleiss kappa. Normative data were analyzed by ANOVA and comparison among groups and methods by Student's T- test.Results:A total of 533 patients were included in this study. The initial injury patterns were broadly classified as: pilon/plafond (65), ankle (173), sprains (110), talus (17), tibia (22), tibio-talar dislocation without fracture (1). Other identified etiologies included rheumatoid arthritis (18), charcot arthropathy (11), progressive collapsing foot deformity (21), septic arthritis (5), and cavovarus (6). The average time interval between the initial injury and definitive treatment for end-stage arthritis was 558 days. Ankle fractures classified as 44C1 (14,1%), 44B3 (10.6%), 44B2 (9.3%) followed by pilon 43C3 (6.5%) and 43C1 (4.1%) were the most prevalent subclassification found in the fractures group.Conclusion:The main etiology for AO is secondary, due to trauma. History of ankle sprains and instability was found in 20.6%. Fractures corresponded to 54,6% of our cohort, ankle fractures producing most of these lesions. When considering the subtype of injury, ankle fractures with a 44C1 and a 44B3 classification were the more frequent presentation. These findings could support the argument that complex low-energy rotational traumas do not carry a benign course. Comprehension of the AO etiology scenario may guide prevention policies and specific primary treatment guidelines with the objective of diminishing disease impact on population and health care system.