The Effect of Lower Extremity Internal and External Rotation on the Hindfoot Alignment Moment Arm and Hindfoot Alignment Angle

Category: Ankle; Hindfoot Introduction/Purpose: The hindfoot moment arm was first described by Saltzman and el-Khoury to evaluate hindfoot varus and valgus alignment and has been well described and validated in the literature. It is commonly used by surgeons for preoperative planning of various hindfoot reconstructive procedures. The hindfoot alignment angle (the angle formed by the intersection between the tibial axis and the calcaneal axis) is another metric of measuring hindfoot alignment commonly utilized by surgeons. The purpose of this study was to determine if rotation of the hindfoot alters the hindfoot alignment moment arm and hindfoot alignment angle. We hypothesize that slight changes in internal and external rotation of the foot during x-ray positioning will have a large effect on the hindfoot moment arm and hindfoot alignment angle. Methods: We prospectively enrolled 29 patients, totaling 58 lower extremities, presenting to outpatient clinic for evaluation of a foot and ankle complaint. Patients <18 years of age, unable to perform bilateral weightbearing radiographs, or presenting for postoperative visits from recent foot and ankle surgery were excluded. Bilateral Saltzman hindfoot radiographs in neutral, 10 degrees of internal rotation, and 10 degrees of external rotation were performed. Marking lines were drawn on the standing platform to standardize rotation, with patients aligning their second ray with the lines. A fellowship-trained foot and ankle orthopaedic surgeon and an orthopaedic surgery resident individually measured the hindfoot moment arms and alignment angles. Analysis of variance (ANOVA) testing was used to assess for differences in hindfoot moment arm and hindfoot alignment angle in neutral, internal, and external rotation. Intra- and inter-observer agreement (95% limits) and intra-class correlation coefficients were calculated to assess for intra- and inter-observer reliability. Results: The cohort consisted of 11 (37.9%) males and 18 (62.1%) females, with a mean age of 48.7 (SD=14.7) years and mean body mass index (BMI) of 29.9 (SD=6.6) kg/m2. The mean hindfoot moment arms were 4.6 (SD=6.7) mm, 11.3 (SD=3.4) mm, and -5.4 (SD=6.2) mm in neutral, internal, and external rotation, respectively. The mean hindfoot alignment angles were 4.5 (SD=5.6) degrees, 18.6 (SD=6.8) degrees, and -10.9 (SD=10.6) degrees in neutral, internal, and external rotation, respectively. There was a significant difference in both the hindfoot moment arm (p<0.001) and hindfoot alignment angle (p<0.001) among rotational positions. A strong positive correlation existed between the amount of rotation and both moment arm (r=0.78; p<0.001) and alignment angle (r=0.84; p<0.001). Conclusion: There appears to be significant variability in both the hindfoot moment arm and hindfoot alignment angle with respect to rotation of the patient’s lower extremity. Orthopaedic surgeons should carefully scrutinize limb rotation when making clinical decisions based on the hindfoot moment arm or alignment angle.

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3D Biometrics for Hindfoot Alignment Using Weightbearing CT

Foot & Ankle International ◽

10.1177/1071100717690806 ◽

2017 ◽

Vol 38 (6) ◽

pp. 684-689 ◽

Cited By ~ 54

Author(s):

François Lintz ◽

Matthew Welck ◽

Alessio Bernasconi ◽

James Thornton ◽

Nicholas P. Cullen ◽

...

Keyword(s):

Normal Population ◽

Interobserver Reliability ◽

Mean Value ◽

Data Sets ◽

Anatomical Landmarks ◽

Foot And Ankle ◽

Level Of Evidence ◽

Hindfoot Alignment ◽

Significant Difference ◽

The Mean

Background: Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. Methods: In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. Results: In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was −11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups ( P < .001). The distribution of the normal population was Gaussian. The inter- and intraobserver reliability were 0.99 +/- 0.00 and 0.97 +/-0.02 Conclusions: This pilot study suggests that the FAO is an efficient tool for measuring hindfoot alignment using WBCT. Previously published research in this field has looked at WBCT by adapting 2D biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. Level of Evidence: Level III, retrospective comparative study.

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The Use of Patient-Specific 3D Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000018 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Samuel Adams ◽

Travis Dekker ◽

John Steele ◽

Kamran Hamid

Keyword(s):

Lower Extremity ◽

Deformity Correction ◽

Titanium Implants ◽

Patient Specific ◽

Allograft Bone ◽

Foot And Ankle ◽

Sf 36 ◽

3D Printed ◽

The Mean

Category: Ankle,Ankle Arthritis,Basic Sciences/Biologics,Trauma Introduction/Purpose: Large lower extremity bony defects, complex foot and ankle deformities, and high-risk arthrodesis situations can be difficult to treat. These challenging pathologies, often require a critical-sizes and/or shaped structural bone void filler which may not be available with allograft bone. The advancement of 3D printing technology has allowed for the use of custom designed implants for foot and ankle surgery. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D printed titanium implants. Methods: Seven consecutive patients who were treated with custom designed 3D printed implant cages for severe bone loss, deformity correction, and arthrodesis procedures were included in this study. A minimum of 1-year follow-up was required. No patients were lost to follow-up. Patients completed preoperative and most recent follow-up VAS for pain, FAAM, and SF-36 outcomes questionnaires. All patients had post-operative radiographs and CT scans to assess bony incorporation. Results: The mean age of these patients was 54.6 (35-73 years of age). The mean follow-up of these seven patients was 17.1 months (range 12 to 31). Radiographic fusion with cage ingrowth and integration occurred in all seven patients verified by CT scan. There was statistically significant improvement in all functional outcome score measures (VAS for pain, FAAM, and SF-36). All patients returned were satisfied with surgery. There were no failures. Case examples are demonstrated in Figure 1. Conclusion: This cohort of patients demonstrated the successful use of custom 3D printed implants to treat complex large bony defects, deformities and arthrodesis procedures of the lower extremity. These implants offer the surgeon a patient specific approach to treat both pain and deformity that is not necessarily available with allograft bone.

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Foot Alignment Profile in Injured Professional Basketball and Football Athletes

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00202 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0020

Author(s):

Cesar de Cesar Netto ◽

Alessio Bernasconi ◽

Lauren Roberts ◽

Francois Lintz ◽

Martinus Richter ◽

...

Keyword(s):

Elite Athletes ◽

American Football ◽

Foot And Ankle ◽

Hindfoot Alignment ◽

P Values ◽

Professional Basketball ◽

Horizontal Angle ◽

Longitudinal Arch ◽

Alignment Angle ◽

Foot Alignment

Category: Sports Introduction/Purpose: Adequate evaluation of foot and ankle problems in elite athletes is paramount for planning the correct treatment, predicting clinical prognosis and supporting decision making. A complete physical examination that includes the assessment of foot alignment during weightbearing is mandatory. The three-dimensional evaluation provided by weightbearing CT imaging (WBCT) represent an important diagnostic tool for foot and ankle surgeons when dealing with these extremely physically active patients. The purpose of this study was to assess different WBCT measurements of hindfoot and forefoot alignment in injured high-level football and basketball players. We hypothesized that specific patterns of hindfoot alignment and height of the longitudinal arch of the foot could be identified. Methods: In this single center retrospective comparative study, 80 professional male athletes - 47 basketball and 33 American football players from College, NBA and NFL leagues - that underwent WBCT as part of the clinical investigation for different injuries of the foot and ankle were included in the study. WBCTs images were evaluated by a blinded board-certified foot and ankle orthopedic surgeon. Multiple measurements used for assessment of hindfoot valgus and longitudinal arch height were assessed and included: foot and ankle offset (%), calcaneal offset (mm), hindfoot alignment angle (°), navicular-floor distance (mm), medial cuneiform-floor distance (mm), forefoot arch angle (°), inferior talar-superior talar angle (°), and subtalar horizontal angle (°). An unpaired Student’s t test was performed to evaluate any differences in the measurements when comparing professional basketball and football patients. P-values less than 0.05 were considered significant. Results: A summary of demographic characteristics and each measurement’s distributions and standard deviations, as well as p-values for the analysis between groups, is given in table 1. No significant differences were found between basketball and American football elite athletes when comparing the mean values of measurements evaluated (mean differences): foot and ankle offset (0.26%), calcaneal offset (0.58 mm), hindfoot alignment angle (0.73°), navicular-floor (0.35 mm) and medical cuneiform-floor distances (0.38 mm), forefoot arch angle (0.74°), inferior talar–superior talar angle (0.83°) and subtalar horizontal angle (0.1°). Conclusion: Although we did not find significant differences in foot alignment when comparing basketball and American football professional athletes, the results of our study highlight some of the important foot alignment parameters and establish distributions in an extreme but important population. Further studies correlating foot alignment with the incidence of some of the most common pathologies diagnosed in elite athletes, such as the ones reported in our study, can help in the understanding and prevention of those injuries.

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The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

Foot & Ankle International ◽

10.1177/107110070502600603 ◽

2005 ◽

Vol 26 (6) ◽

pp. 442-448 ◽

Cited By ~ 32

Author(s):

Craig I. Title ◽

Hung-Geun Jung ◽

Brent G. Parks ◽

Lew C. Schon

Keyword(s):

Biomechanical Study ◽

Posterior Tibial Tendon ◽

Peroneal Tendon ◽

Foot And Ankle ◽

Calcaneofibular Ligament ◽

Significant Difference ◽

Mean Pressure ◽

Fresh Frozen ◽

The Mean ◽

Pressure Changes

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

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Factors Affecting the Clinical Outcomes of Surgically Treated Ankle Fractures Associated with the Posterior Malleolar Fragment

Journal of the American Podiatric Medical Association ◽

10.7547/18-184 ◽

2021 ◽

Vol 111 (5) ◽

Author(s):

Mehmet Kuyumcu ◽

Emre Bilgin ◽

Hasan Bombacı

Keyword(s):

Clinical Outcomes ◽

Fragment Size ◽

Statistical Significance ◽

Ankle Fractures ◽

Foot And Ankle ◽

Ankle Osteoarthritis ◽

Posterior Malleolus ◽

Significant Difference ◽

Functional Scores ◽

The Mean

Background This study was performed to determine the factors that influence the clinical outcomes of surgically treated ankle fractures associated with the posterior malleolus (PM). Methods We evaluated 42 fractures of 42 patients. Posterior malleolus fracture size was calculated using computed tomography. Posterior malleolar fractures with a size less than 10% were left nonfixated. The decision for larger fragments was performed using fluoroscopy following the fixation of other components. If the joint was found to be congruent, the PM was left nonfixated. Otherwise, the PM was reduced and fixated. Clinical outcomes were evaluated based on Weber, Freiburg, and American Orthopaedic Foot and Ankle Society scores. Ankle osteoarthritis was determined according to the Canadian Orthopaedic Foot and Ankle Society classification. The effect of PM fixation, age, PM fragment size, waiting period before surgery, presence of ankle dislocation, and number of injured malleoli on clinical outcomes were assessed. Statistical significance was set at a value of P < .05. Results The mean patients age was 48.5 ± 14.9 years (range, 20–84 years) and the mean follow-up was 23.7 ± 8.6 months (range, 12–56 months). Fixation of the PM was performed solely in 12 patients. Postoperative displacement of the PM and articular step were less than 2 mm in all fractures. Statistically significant worse outcomes were demonstrated based on functional scores in the patients with a PM size greater than or equal to 25% (P = .042, P = .038, and P = .048, respectively) and in patients aged 60 years or older (P = .005, P = .007, and P = .018, respectively). However, there was no significant difference between functional scores and the other factors. Ankle osteoarthritis was observed at a higher rate in patients with PM size greater than or equal to 25% and in patients aged 60 years or older. Conclusions Clinical outcomes of the patients are mainly influenced by the patient's age and PM fragment size. However, if the tibiotalar joint is congruent, comparable results can be obtained in PM fixated or nonfixated patients.

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Analysis of the Hindfoot Alignment Measured in 3D After a Medializing Calcaneal Osteotomy Using a Pre- and Postoperative Weightbearing CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00032 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0003

Author(s):

Arne Burssens ◽

Alexej Barg ◽

Timothy Leenders ◽

Stefan Clockaerts ◽

Peter Burssens ◽

...

Keyword(s):

Valgus Deformity ◽

Stage Ii ◽

Tibial Rotation ◽

Flat Foot ◽

Hindfoot Alignment ◽

Software Analysis ◽

Calcaneal Osteotomy ◽

Significant Difference ◽

Significant Correction ◽

The Mean

Category: Hindfoot Introduction/Purpose: An adult acquired flat foot (AAFD) is a complex 3D deformity. A medializing calcaneal osteotomy (MCO) is a surgical procedure frequently performed to correct the valgus alignment of the hindfoot in a stage II AAFD, when conservative measurements fail. However currently little is known on its accurate influence regarding the hindfoot alignment (HA). The aim is therefore to assess the influence of a MCO on the 3D HA using computer aided software analysis of the images retrieved from a weightbearing cone beam CT (WBCT). Methods: Twelve patients with a mean age of 49,4 years (range 18-67yrs) were prospectively included in a pre-post study design. Indications for surgical correction by a MCO with a solitary translation consisted of an AAFD stage II (N=10) and a posttraumatic valgus deformity (N=2). Fixation of the osteotomy was performed by a step-plate or double screw. WBCT was obtained pre- and post-operative. Images were subsequently segmented to allow a HA calculation in 3D(HA3D) by an angle between the anatomical tibia axis and the axis connecting the computed inferior calcaneuspoint and the centroid of the talus in the coronal plane based on a Cartesian coordinatesystem(Fig 1A, C). The tibia in the HA3D was separately assessed by the anatomical tibia axis (TAx 3D) and the axis to determine the tibial rotation(TR 3D) in the axial plane by connecting the computed most outer point of the anterior and posterior tubercle of the incisura fibularis(Fig 2A, D). Results: The mean medial translation of the calcaneal osteotomy during surgery was 5.72 mm (SD = 3.9). The mean HA3D pre-operatively equaled 18.21 degrees of valgus (SD = 6.6) and post-operatively 9.31 degrees of valgus (SD = 6.18). The Paired Student’s t-test showed a significant correction of 8.89 degrees (95%CI [5.99, 11.80], P<0.001). The mean TAX 3D pre-operatively was 6.80 degrees of valgus (SD = 3.38) and post-operatively 4.11 degrees of valgus (SD = 2.77), with a significant difference of 2.69 degrees (95%CI [1.79, 3.59], P <0.001). The mean TR3D pre-operatively was -27.11 degrees (SD = 4.77) and post-operatively - 28.80 degrees (SD = 5.98) and showed a significant difference of 1.69 degrees (95%CI [0.41, 2.97], P = 0,016). Conclusion: This study shows an effective correction of the valgus hindfoot in an AAFD. It appears that the correction is not only situated in the calcaneus but also to a lesser extent in the tibia and this resulted in 15% of the achieved HA correction. The novelty is the 3D weightbearing assessment of a hindfoot correction and the shown influence on the tibia. This information could be of use to take in to account when performing a pre-operative planning of a hindfoot deformity.

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Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Classical CT

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00173 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0017 ◽

Cited By ~ 1

Author(s):

Arne Burssens ◽

Alexej Barg ◽

Laurens De Cock ◽

Jan Victor ◽

Kristian Buedts

Keyword(s):

Sequential Analysis ◽

External Rotation ◽

Lateral Displacement ◽

Computer Calculation ◽

Control Group ◽

3D Analysis ◽

Distal Fibula ◽

Fracture Group ◽

Significant Difference ◽

The Mean

Category: Ankle Introduction/Purpose: Syndesmotic lesions of the ankle have shown to be challenging injuries towards diagnosis and surgical treatment. This could be mainly attributed to the limitations of 2D imaging, which make it difficult to accurately determine the extent of the lesion and to verify if peroperatively an anatomical reduction is achieved of the distal tibiofibular congruence. The aim of this study is therefore to develop a reproducible method to quantify the displacement in a syndesmotic ankle lesion in all six degrees of freedom based on 3D imaging. Methods: Eighteen patients were retrospectively included having a unilateral syndesmotic lesion. N=12 sustained a high ankle sprain and a bilateral weightbearing conebeam CT was obtained because of positive clinical syndesmotic tests. N=6 presented with a fracture associated syndesmotic lesion and were imaged by a bilateral non-weightbearing CT. The non-affected ankle was used as a template after being mirrored and matched on the contralateral ankle containing a syndesmotic lesion (Fig 1A-B). The distal fibula was marked by computer calculation of the most outer point of the anterior tubercle, posterior tubercle and apex malleolis lateralis. The change of these points towards the unaffected fibular position was used to quantify the syndesmotic lesion (Fig 1C). A control group of seven patients (N=7) was used to analyse if these changes differed from the normal variation in tibio-fibular congruency (Fig 1D). Results: The main findings consisted of a statistical significant difference in the mean mediolateral diastasis of both the sprained group (M = 1.60 mm, SD=1.02) and the fracture group (M = 1.69 mm, SD=0.62) compared to the control group (P<.001). The mean external rotation was statistically different when comparing the sprained group (M = 4.68°, SD=2.74) and the fracture group (M = 6.97°, SD=3.02) towards the control group (P<.05). The mean antero-posterior translation was only significantly different when comparing the fracture group (M = -4.73 mm, SD=4.53) towards the sprained group (M = -0.91 mm, SD=1.26) and the control group (M = -0.26 mm, SD=1.53) (P<.05). Conclusion: This study demonstrates an effective method to quantify a unilateral syndesmotic lesion of the ankle. The pathological measurements differed from the normal distal tibio-fibular configuration in the syndesmotic complex. This sequential analysis is of use for an accurate diagnosis and a pre-operative planning to know in advance which correction needs to be achieved to have the fibula at proper length correctly rotated, and reduced into the syndesmosis with no anterior, posterior or lateral displacement.

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Radiographic Measurements on Hindfoot Alignment View in 1,128 Asymptomatic Subjects

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00166 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0016

Author(s):

Jun Young Choi ◽

Jin Soo Suh

Keyword(s):

Flat Foot ◽

Adult Type ◽

Hindfoot Alignment ◽

Mean Values ◽

Radiographic Measurements ◽

Alignment Angle ◽

The Mean ◽

Asymptomatic Subjects ◽

The Relationship ◽

Female Subjects

Category: Hindfoot Introduction/Purpose: The primary aim of this study was to calculate the mean values of three most frequently measured parameters for hindfoot alignment determination in asymptomatic subjects - hindfoot alignment angle (HAA), hindfoot alignment ratio (HAR), and hindfoot moment arm (HMA). The secondary aim was to determine the relationship between HAR and HAA or HMA using statistical methods. Methods: From January 2014 to June 2019, a total of 1128 asymptomatic subjects were enrolled in this study. With the hindfoot alignment view by Saltzman and el-Khoury, HAA, HAR, and HMA were measured to evaluate the degree of hindfoot varus or valgus deviation. All subjects were divided into subgroups according to sex and age (<45 years old vs >=45 years old). Simple linear regression was performed to draw out the regression formula between HAR and HAA or HMA. Results: The mean HAA, HAR, and HMA for all subjects were -4.07+-3.48o, 0.21+-0.15, and -6.12+-5.22 mm, respectively. By comparing subgroups, female subjects >=45 years old showed the largest valgus deviation (-7.08+-6.34o, P=0.001). To predict HAR using HAA or HMA, the regression formulas were ‘HAR= 0.366 + 0.039 × HAA’ and ‘HAR= 0.361 + 0.025 × HMA.’ Conclusion: Under HAA, HAR, and HMA evaluation, the hindfoot alignment for asymptomatic subjects was valgus deviation. Furthermore, the degree of valgus deviation was the largest in female subjects aged 45 years or older. This can be explained as the progression of adult type flat foot deformity with aging.

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Management of mal-united Pilon fractures with joint-sparing osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00527 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0052

Author(s):

Guang-rong Yu

Keyword(s):

Type Ii ◽

Foot And Ankle ◽

Aofas Score ◽

Vas Score ◽

Articular Surfaces ◽

Significant Difference ◽

The Mean ◽

American Orthopaedic ◽

Time From Injury ◽

Pilon Fractures

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.

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Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Nonweightbearing CT

Foot & Ankle International ◽

10.1177/1071100718791834 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1487-1496 ◽

Cited By ~ 15

Author(s):

Arne Burssens ◽

Hannes Vermue ◽

Alexej Barg ◽

Nicola Krähenbühl ◽

Jan Victor ◽

...

Keyword(s):

External Rotation ◽

Imaging Techniques ◽

Ankle Injuries ◽

Control Group ◽

3D Analysis ◽

Anatomical Landmarks ◽

Distal Fibula ◽

Fracture Group ◽

Significant Difference ◽

The Mean

Background: Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques. Methods: Eighteen patients with a unilateral syndesmotic lesion were included. Bilateral imaging was performed with weightbearing cone-beam computed tomography (CT) in case of a high ankle sprain (n = 12) and by nonweightbearing CT in case of a fracture-associated syndesmotic lesion (n = 6). The healthy ankle was used as a template after being mirrored and superimposed on the contralateral ankle. The following anatomical landmarks of the distal fibula were computed: the most lateral aspect of the lateral malleolus and the anterior and posterior tubercle. The change in position of these landmarks relative to the stationary, healthy fibula was used to quantify the syndesmotic lesion. A control group of 7 studies was used. Results: The main clinical relevant findings demonstrated a statistically significant difference between the mean mediolateral diastasis of both the sprained (mean [SD], 1.6 [1.0] mm) and the fracture group (mean [SD], 1.7 [0.6] mm) compared to the control group ( P < .001). The mean external rotation was statistically different when comparing the sprained (mean [SD], 4.7 [2.7] degrees) and the fracture group (mean [SD], 7.0 [7.1] degrees) to the control group ( P < .05). Conclusion: This study evaluated an effective method for quantifying a unilateral syndesmotic lesion of the ankle. Applications in clinical practice could improve diagnostic accuracy and potentially aid in preoperative planning by determining which correction needs to be achieved to have the fibula correctly reduced in the syndesmosis. Level of Evidence: Level III, retrospective comparative study.

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