Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus

Background Talar cartilage injury is a kind of disease that causes long-term and chronic pain of ankle joint. Autologous osteochondral transplantation has been viewed as an alternative choice for treating these lesions, but donor-site morbidity has limited its application. This study aimed to analyze the efficacy of iliac bone autografting for Hepple V osteochondral lesions of the talus. Methods This retrospective study included 32 patients surgically treated for Hepple V osteochondral lesions of the talus from January 2015 to January 2020. All patients underwent open surgery. Ipsilateral iliac bone grafts were taken and filled with talar cartilage injury area. The improvement of postoperative ankle pain was evaluated by Visual Analogue Scale (VAS), and the improvement of ankle function was evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS). During the postoperative follow-up, X-ray examination of the front and side of the ankle joint and CT of the ankle joint were performed to evaluate the bone cartilage healing in the graft area. Results Thirty-two patients (32 ankles) (100%) returned for clinical and radiologic follow-up at an average of 28 (range 24–36) months postoperatively. At 3 months postoperatively and at the last follow-up, the AOFAS scores were (80.4 ± 3.6) and (89.2 ± 6.4), respectively, which were significantly improved compared with the preoperative score (49.7 ± 8.1), and the difference was statistically significant (P < 0.05). The VAS scores were (2.1 ± 0.9) and (1.5 ± 0.8), respectively, which were significantly better than the preoperative score (6.2 ± 1.7), and the difference was statistically significant (P < 0.05). Re-examination of the front and side of the ankle joint X-rays and CT showed that the bone healing at the osteotomy of medial malleolus and osteochondral transplantation area. All patients had no pain at the donor site. No complications occurred in 32 patients at the last follow-up. Conclusions With iliac bone autografting for Hepple V osteochondral lesions of the talus can effectively relieve ankle joint pain and significantly improved ankle function. Level of evidence Level III, Retrospective series.

Minimally Invasive Percutaneous Plate Osteosynthesis technique combined with locking compression plates guided by C-Arm X-Ray machine in treatment of tibial metaphyseal fractures: Curative effect and postoperative complications

Objectives: To explore the curative effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) technology combined with locking compression plates (LCP) guided by C-arm X-ray machine in the treatment of tibial metaphyseal fracture and its impact on the surgical indexes and postoperative complications. Methods: The present study was a retrospective analysis focusing on the clinical data of 104 cases of tibial metaphyseal fracture who were treated surgically in our hospital from February 2019 to February 2021. According to different surgical methods, patients who were treated by using MIPPO technology combined with LCP guided by C-arm X-ray machine were divided into the observation group (n=54), while those who underwent traditional open reduction and internal fixation were classified into the control group (n=50). Further comparison was made on the differences of the curative effect, surgical index (operation time, intraoperative blood loss, incision length, and healing time) and postoperative complications between the two groups. In addition, the differences in ankle function, knee function and quality of life [Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36)] were evaluated between the two groups before treatment and 6 months after treatment. Results: The clinical curative effect and total efficacy of the observation group were better than those of the control group (All p<0.05). The operation time, intraoperative blood loss, incision length, and healing time were lower in the observation group when compared to those of the control group (All p<0.05). The total incidence of postoperative complications was also lower in the observation group than that in the control group (p<0.05). In addition, the scores of ankle function, knee function and MOS SF-36 in both groups were higher after 6 months of treatment than those before treatment; besides, the inter-group comparison showed that the scores of ankle function, knee function and MOS SF-36 in the observation group were higher than those in the control group (All p<0.05). Conclusion: MIPPO technology combined with LCP guided by C-arm X-ray machine has a significant curative effect on the treatment of tibial metaphyseal fracture. It can significantly improve the surgical index, reduce postoperative complications, and have an obvious effect on postoperative recovery of ankle function, knee joint function and quality of life. doi: https://doi.org/10.12669/pjms.38.3.4757 How to cite this:Zhang X, Liu B, Wang Q, Shang H. Minimally Invasive Percutaneous Plate Osteosynthesis technique combined with locking compression plates guided by C-Arm X-Ray machine in treatment of tibial metaphyseal fractures: Curative effect and postoperative complications. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4757 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tips and Tricks in surgical reduction of the posterior column of AO/OTA C3 pilon fractures

Background Accurate posterior column reduction remains a challenging and controversial topic in the management of complex pilon fractures (AO/OTA C3). We aim to report the outcomes of surgical treatment for 22 AO/OTA C3 pilon fracture cases between January 2015 and May 2017 and highlight some traps and tips. Methods Three patients underwent two-stage early plating on the posterior column through a posterolateral approach. The remaining 19 patients were treated with two-stage delayed plating on the posterior column: 11 patients were treated with a posterolateral approach, five patients with a modified posteromedial approach, and three patients with a single anterior approach. The reduction of the posterior column was evaluated according to the Burwell-Charnley’s radiographic criteria, and functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores. Results Posterior column malreduction occurred in five cases, including in one case that was re-adjusted immediately and in another case that was re-adjusted during a two-staged delayed operation. According to Burwell-Charnley’s criteria, the satisfactory rate of fracture reduction was 81.8%. After 1 year, the mean AOFAS score was 81.9 (81.9 ± 9.9); the outcome was excellent in three (20.0%), good in nine (60.0%), and fair in three (20.0%). Excellent or good outcomes were noted in 12 patients (80.0%). Conclusions The combined anterior and posterior approach is suggested in the second stage of plating so that the posterior column fragments can be re-adjusted intraoperatively, if necessary. Following these procedures, satisfactory reduction and recovery of good ankle function can be anticipated.

Effect Analysis of Iliac Bone Autografting for Hepple V Osteochondral Lesions of The Talus

BackgroundThis study aimed to analyze the efficacy of iliac bone autografting for Hepple V osteochondral lesions of the talus.MethodsThis retrospective study included 32 patients surgically treated for Hepple V osteochondral lesions of the talus from January 2015 to January 2020. All patients underwent open surgery. Ipsilateral iliac bone grafts were taken and filled with talar cartilage injury area. The improvement of postoperative ankle pain was evaluated by Visual Analogue Scale (VAS), and the improvement of ankle function was evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS). During the postoperative follow-up, X-ray examination of the front and side of the ankle joint and CT of the ankle joint were performed to evaluate the bone cartilage healing in the graft area.ResultsThirty-two patients (32 ankles) (100%) returned for clinical and radiologic follow-up at an average of 28 (range, 24–36) months postoperatively. At 3 months postoperatively and at the last follow-up, the AOFAS scores were (80.4±3.6) and (89.2±6.4) respectively, which were significantly improved compared with the preoperative score (49.7 ± 8.1), and the difference was statistically significant (P<0.05). The VAS scores were (2.1±0.9) and (1.5±0.8) respectively, which were significantly better than the preoperative score (6.2±1.7), and the difference was statistically significant(P < 0.05). Re-examination of the front and side of the ankle joint x-rays and CT showed that the bone bone healing at the osteotomy of medial malleolus and osteochondral transplantation area. All patients had no pain at the donor site. No complications occurred in 32 patients at the last follow-up.ConclusionsWith iliac bone autografting for Hepple V osteochondral lesions of the talus can effectively relieve ankle joint pain and significantly improved ankle function. The clinical effect is remarkable.Level of evidence：Leve III, Retrospective series.

Comparative Analysis of Assessment Systems of Foot Function

Summary. The assessment of foot and ankle function still remains an actual issue of the modern orthopedics. Objective: comparative qualitative analysis of the most common assessment systems of foot and ankle function. Materials and Methods. The search from PubMed databases from 1946 to 2021 was done. 8898 publications were detected in which assessment systems of foot and ankle function have been used. 12 assessment systems presented in 5705 publications were selected for analysis (inclusion criterion – no less than 40 publications): AOFAS scale, VAS, SF-36 EQL, FFI, FAOS, FAAM, FADI, BFS, MOFAQ, FFI-R, Roles&Maudsley scale, VAS FA. The analysis predicted the assessment system philosophy: numerical estimate, VAS, Likert scale, patient- or investigatororiented, and reliability evidence. Results. Most of the analized assessment systems meet criteria of reliability (r>0.8; Kronbach’s α≥0.9). For Roles&Maudsley scale and VAS, FA reliability has not been established. The validity fluctuates widely. Conclusions. The choice of an assessment system must meet the research tasks. The consideration of strong and weak sides of assessment systems promotes their adequate combinations to avoid the bias effect.

Study on the Application Value of CT Thin-Layer Scan Data Assisted 3D Printing Technology in Hip and Knee Replacement

To better study hip and knee replacement, 50 eligible hip and knee patients from March 2020 to April 2021 were selected. A 1 : 1 scale solid model was printed with CT thin-layer scanning data assisted by 3D printing technology to evaluate the ankle function of patients six months after surgery. The results showed that the 3D rapid prototyping time of the 1 : 1 fracture model in 50 patients was 3-4 hours. The operation time was 70–90 min, and the average operation time was 80 min. The actual application in operation was consistent with that in the simulation of the 3D printing model, after surgery, and there was no infection of incision soft tissue or loss of reduction in all 50 patients. CT thin-layer scan data aided 3D printing technology can help clinical hip and knee replacement simulation and planning, improving surgery’s accuracy and safety.

Calcaneal Tuberosity Fracture (Beak Fracture) Fixation Using a Pre-contoured “L-form” Hook Plate: A Retrospective Study

Background: The treatment of calcaneal tuberosity fracture (beak fracture) is very tricky. Patients’ ankle function may be badly affected by skin flap necrosis and internal fixation failure. This study presented a simple, and safe internal fixation technique which is to fix the fracture fragment with a pre-contoured “L-form” hook plate.Methods: A retrospective study was done to analyze patients with calcaneal tuberosity fracture who were treated with pre-contoured “L-form” hook plate fixation from January 2015 to February 2020. When the patients could complete single-legged heel raise tests, and when they achieved clinical healing criteria were reviewed. Functional assessment was performed according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS-AH) scores and the Visual Analogue Scale (VAS) was recommended for assessment of pain intensity (PI).Results: There were a total of 15 patients of calcaneal tuberosity fracture (beak fracture) treated with the pre-contoured “L-form” hook plate fixation technique, among which eight patients were female and the others were male, with the age ranging from 35 to 69 years (average of 55.3±9.0 years). And the mean duration of follow-up was 22.53±5.78 months (range: 12 to 36 months). 11 cases underwent emergency surgery. After the operation, there were no complications such as wound dehiscence, poor wound healing, infections, or plate exposure, no sural nerve injuries or venous thromboembolic events. Also, there was no loss of reduction or fixation failure in the follow-up. All 15 cases achieved clinical healing at 8-13 weeks (average 10.5±1.4 weeks) postoperatively. They were able to perform the test on their affected leg after 3.7±0.7 months (3-5 months) on average. The preoperative VAS and AOFAS-AH scores were 5.7±0.6 and 24.0±9.9 respectively, while the postoperative VAS and AOFAS-AH scores at the last follow-up were 1.3±0.5 and 93.8±5.2 (p<0.001).Conclusion: Emergency open reduction and internal fixation should be provided as soon as possible. For patients with Beavis type II beak fractures, the pre-contoured “L-form” hook plate fixation technique helps them restore normal ankle function. This simple, safe, and strong internal fixation technique can be one of the treatment options for avulsion fractures of the calcaneal tuberosity.

Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results

Objectives: This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. Patients and methods: A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. Results: The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine patients (64.3%) returned to sports activities after surgery at a mean period of 9±2.1 months. Conclusion: In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.

Delayed functional therapy after acute lateral ankle sprain increases subjective ankle instability – the later, the worse: a retrospective analysis

Background The lateral ankle sprain (LAS) is one of the most common injuries in everyday and sports activities. Approximately 20–40 % of patients with LAS develop a chronic ankle instability (CAI). The underlying mechanisms for CAI have not yet been clearly clarified. An inadequate rehabilitation after LAS can be speculated, since the LAS is often handled as a minor injury demanding less treatment. Therefore, the aims of this retrospective study were to determine the CAI rate depending on age and sex and to identify possible determinants for developing CAI. Methods Between 2015 and 2018 we applied the diagnostic code “sprain of ankle” (ICD S93.4) to identify relevant cases from the database of the BG Klinikum Duisburg, Germany. Patients received a questionnaire containing the Tegner-Score, the Cumberland Ankle Instability Tool (CAIT) and the Foot and Ankle Disability Index. Additionally, there were questions about the modality and beginning of therapy following LAS and the number of recurrent sprains. There was a total of 647 completed datasets. These were divided into a CAI and non-CAI group according to a CAIT cut-off-score with CAI ≤ 24 and non-CAI > 24 points, representing one out of three criteria for having CAI based on international consensus. Results The overall CAI rate was 17.3 %. We identified a higher CAI rate in females and within the age segment of 41 to 55 years. A later start of therapy (> 4 weeks) after acute LAS significantly increases ankle instability in CAIT (p < .05). There was a significantly higher CAIT score in patients having no recurrent sprain compared to patients having 1–3 recurrent sprains or 4–5 recurrent sprains (p < .001). Conclusions Females over 41 years show a higher CAI rate which implies to perform specific prevention programs improving ankle function following acute LAS. A delayed start of therapy seems to be an important determinant associated with the development of CAI. Another contributing factor may be a frequent number of recurrent sprains that are also linked to greater levels of subjective ankle instability. Therefore, we would recommend an early start of functional therapy after acute LAS in the future to minimize the development of CAI.