Foot & ankle international
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Comparative Study
Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint.
In a 5-year period (1996-2001), the authors performed supramalleolar osteotomies for the correction of distal tibial mechanical malalignment of at least 10 degrees with concomitant pain and with or without radiographic evidence of arthritic changes. The method was also applied as an alternative to other common procedures for the treatment of a small group of patients with degenerative changes of the ankle joint without previous traumatic event and with minimal or moderately altered alignment. There were 12 patients (13 feet) with an average follow-up of 33.6 months. ⋯ In the presence of deformity, the average tibial-ankle surface angles in both the coronal and the sagittal planes were significantly improved. The radiographic degenerative changes in the ankle joint showed no evidence of progression. The choice of technique did not influence the clinical or radiographic outcome or the healing time of the osteotomy.
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Posteromedial talar facet fracture (PMTFF) is a rare injury, sparsely reported in the literature. This article proposes that PMTFF is often left undiagnosed by orthopaedic surgeons and suggests the routine application of advanced radiographic studies (i.e., CT scan) in the recognition of PMTFF. It also evaluates nonoperative management of PMTFF. ⋯ Diagnosis of PMTFF necessitates a heightened clinical suspicion, especially when a medial subtalar joint dislocation is present. Proper imaging studies, such as coronal CT scan, should be performed after any subtalar dislocation. Timely treatment, in the form of open reduction and internal fixation for large fragments involving the articular surface or surgical excision for smaller fragments, is recommended in order to restore proper anatomy and function of the subtalar joint. This study verifies the significant morbidity associated with an undiagnosed or nonoperatively treated PMTFF.
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Comparative Study
Position of the distal fibular fragment in pronation and supination ankle fractures: a CT evaluation.
Although classically the fibula has been reported to be in external rotation after supination-external rotation (SER) or pronation-external rotation (PER) ankle fractures, a previous CT study demonstrated that what had traditionally been interpreted as external rotation of the distal fibular fracture fragment is actually internal rotation of the proximal fibular fragment. The purpose of this study was to evaluate a series of CT scans in patients who have suffered type IV SER or PER ankle fractures to assess the rotational deformity of the fibular fragment. ⋯ Our study demonstrated that the distal fibular fragment in both SER and PER fractures is externally rotated relative to both the contralateral normal side and compared to the proximal fibular fragment.
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Dedicated orthopaedic residency training in the musculoskeletal discipline of foot and ankle is an important contribution to the development of a well-rounded orthopaedic surgeon. Current residency training guidelines are vague and do not require specific experience or proficiency in this discipline. ⋯ Current residency training in the United States does not universally require a commitment to foot and ankle education. A large number of residency programs do not have a faculty member committed to foot and ankle education, and almost one-third have no time specifically allocated to foot and ankle education.
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Malunion after a malleolar fracture can include a displaced posterior malleolus with associated posterolateral subluxation of the talus. Corrective osteotomy including the posterior malleolus was performed in four patients. Joint congruity was obtained in every case. ⋯ The symptoms were attributed to the damage of the cartilage and soft-tissues both from the initial injury and from weightbearing on the incongruous joint. Discrete, non-progressive osteophytes were seen in all patients. Delay in reconstruction did not preclude a good result, although early reoperation is felt to be preferable.