The Role of Arthroscopic Debridement after Ankle Fractures Treated with ORIF

Category: Ankle, Ankle Arthritis, Arthroscopy Introduction/Purpose: The role of ankle arthroscopy in managing the consequences of ankle fractures is yet to be fully estab- lished. This study aims to assess this procedure in terms of the accuracy of preoperative diagnosis, re-operation rate and patient- reported outcomes. Methods: We compared two homogeneous groups of 16 patients (32 in total, average age 40.6 years) operated for a fracture of the distal tibia and/or fibula treated with ORIF. For all fractures the AO classification was used. The baseline was 6 months after surgery. Inclusion criteria were: patients aged between 19 and 50 a pre-trauma Tegner score >3, FAOS score <75 at the baseline, R.O.M. <20° vs contralateral; we included patients with well-aligned osteosynthesis and with radiographic union. Patients with open fractures, with osteochondral lesions and with previous were excluded. In the first group we planned an arthroscopy of the ankle from 6 to 12 months after trauma, in the second group, we continued with conservative rehabilitation treatment. All patients were then re-evaluated at 3,6 and 12 months with questionnaires (Tegner activity level, and FAOS). The mean follow-up was 18.2 months. For all data statistical analysis was performed. Results: The results of our case-series showed excellent patient satisfaction (12/14) with a FAOS Score and an improved R.O.M. statistically significant (p <.001) in patients treated with ankle arthroscopy. Eighty percent was able to return to previous activity. The average time until return to sport was 5.3 ± 2.4 months. Seventy percent of the athletes still had occasional pain with sport. Conclusion: The literature on arthroscopic treatment after fracture is still poor but results obtained, even with a limited number of cases, and with a short follow-up, are positive, especially in those patients where the functional demand is highest

Modified Youngswick Osteotomy for Treatment of Hallux Rigidus in Athletes

Category: Midfoot/Forefoot; Sports Introduction/Purpose: Hallux rigidus is a common condition that affects athletes, particularly those who engage in high-impact sports. This condition results in pain and limited range of motion in the big toe, and can significantly affect an athlete's performance. The goal of treatment is to alleviate pain, improve function, and return the athlete to their sport. There are various surgical options available for treating hallux rigidus, one of which is the Youngswick osteotomy. This procedure involves realigning the bones of the big toe to relieve pressure and improve range of motion. Methods: A retrospective study was conducted to evaluate the effectiveness of the modified Youngswick osteotomy in treating hallux rigidus in athletes. The study included 40 patients, with a median follow-up of 40 months. The patients were divided into two groups based on sex: 29 female and 11 male. The side affected was also recorded, with 26 patients having the condition on their right foot and 14 on their left. The grade of hallux rigidus was also recorded, with 25 patients having grade II and 15 patients having grade III. Results: The study found that the median preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score was 39, with a range of 25-60. After the Youngswick osteotomy, the median AOFAS score improved to 81.8, with a range of 50-90. This improvement was statistically significant (p < .0001). The range of motion (ROM) of the big toe also improved after the surgery, with the median preoperative ROM being 15.4 degrees and the median postoperative ROM being 54 degrees. Subjective satisfaction with the surgery was also recorded, with 80% of patients reporting excellent results, 10% good results, 7.5% fair results, and 2.5% poor results. The study found that there was no significant difference in the results based on sex or the side affected. Conclusion: The results of this study suggest that the Youngswick osteotomy is an effective treatment option for hallux rigidus in athletes. The procedure significantly improves pain, range of motion, and overall function, allowing athletes to return to their sport. The results of this study provide valuable information for clinicians who are considering the modified Youngswick osteotomy for their patients with hallux rigidus. However, it should be noted that further research is needed to confirm these findings and to determine the long-term outcomes of this procedure

Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis

Background The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis. Results A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively. Conclusions Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients. Level of Evidence IV

Adult Flexible Flatfoot Due to Insufficiency of Posterior Tibial Tendon

Category: Hindfoot Introduction/Purpose: We postulated that in a flexible adult flatfoot, calcaneo-stop procedure combined with medial tensioning of posterior tibial tendon allowed the resolution of symptoms by correcting the pattern of the gait and avoiding the evolution to a subsequent stage. The purpose of this study was to determine functional, biomechanic, and radiographic results in patients who underwent surgery for flexible flatfoot without osteotomies or arthrodesis. Methods: We evaluated clinically and radiographically 29 patients surgically treated for adult flatfoot grade IIa according to Myerson, with a mean age of 46.4 years. Mean follow-up was 34.15 months. For clinical evaluation the AOFAS hindfoot and VAS- FA scores were used. In 10 patients, pre and post-operatively gait analisys was performed. Results: Postoperative results showed a significant increase of AOFAS and VAS-FA scores, from 54.7 (range 34 to 78) to 83.1 (range 66-100) and 60.5 (range 35-86) 85 (range 64-100) points, respectively. For the X-ray parameters, in the AP projection, we observed a significant variation of Kite's angle, from 24.2° in the pre-op to 19.2° in the post-op. In lateral view Costa-Bertani angle showed changes from 146.8° to 140.5°. The Meary's angle, showed an average at the post-op of 4.3°. Postoperative satisfaction was excellent-good for 25 patients (86.2%). Postoperative gait analysis showed an improved pattern of the gait. Conclusion: The technique of arthroereisis with medial tensioning of PTT is a valid technique for the young adult, up to 50 years and with no signs of osteoarthritis of the midfoot and hindfoot