Closed reduction of displaced intra-articular calcaneal fractures using ilizarov frame

Background: Treatment of displaced intra-articular calcaneal fractures (DIACFs) is still controversial. Aim: The objective of our study was to assess the capability of using Ilizarov frame as a minimally invasive technique to improve foot function and restore calcaneal length, height, width, and Bohler's angle in patients with DIACFs. Patients and Methods: We retrospectively reviewed forty patients (mean age, 25.4 ± 9.6 years, a mean follow-up of 44.9 ± 6.9 months) with 48 closed DIACFs who underwent indirect reduction and external fixation using Ilizarov technique. We applied distraction technique through the mechanical axis of the leg and through the foot axis. The drop wire technique was used to restore depressed subtalar fragments. Bone graft was not used. Results: We achieved good alignment in all cases except four feet who had varus deformity. The mean American Orthopaedic Foot and Ankle Society score was 84.6 ± 5. Superficial pin tract infection occurred in 7 feet. Skin pressure necrosis was seen in 3 feet. Statistically, all radiological measures were improved and significantly different from those measured preoperatively. Conclusion: Closed reduction of DIACFs using Ilizarov frame provides a good functional foot outcome with a low risk of postoperative complications. It also has the capability of restoring normal anatomy of the calcaneus

Evaluation of Syndesmosis Reduction on CT Scan

Background: Computed tomography (CT) imaging has traditionally been considered the gold standard for evaluation of syndesmostic reduction, but there is no uniformly accepted method to assess reduction. The aim of this study was to evaluate the intra- and interobserver reliability of published measurement techniques for evaluation of syndesmotic reduction on weightbearing CT scan (WBCT) in hopes of determining which method is best. Methods: Medical records were reviewed to identify patients who underwent operative stabilization of unilateral syndesmotic injuries. Exclusion criteria included patients younger than 18 years, ipsilateral fractures extending to the tibial plafond, any contralateral ankle fracture or syndesmotic injury, and body mass index greater than 40 kg/m2. Twenty eligible patients underwent WBCT evaluation of both ankles at an average of 3 years after syndesmotic fixation. The anatomic accuracy of syndesmotic reduction was evaluated by 2 observers using axial CT images at a level 1 cm proximal to the tibial plafond using 9 previously published radiological measurement techniques. Inter- and intraobserver reliability were assessed for each evaluation method. Results: The syndesmotic area calculation showed the highest interobserver reliability (0.96), the highest intraobserver reliability for observer 2 (0.97), and the second highest intraobserver reliability for observer 1 (0.92). Fibular rotation had the second highest interobserver reliability in our results (0.84), with intraobserver reliability of 0.91 and 0.8 for first and second observers, respectively. The intraobserver reliability of the side-by-side method was 0.49 and 0.24 for the first and second observers, respectively, and the interobserver reliability was 0.26. Conclusion: Qualitatively assessing syndesmotic reduction via side-by-side comparison with the uninjured ankle had the least intra- and interobserver reliability and should not be relied on to determine syndesmotic reduction quality. In contradistinction, syndesmotic area calculation demonstrated the highest reliability when evaluating syndesmotic reduction, followed by fibular rotation. Given that syndesmotic area measurement techniques are not readily available on standard image viewers, technologically updating image viewers to allow such calculation would make this approach more accessible in clinical practice. Level of Evidence: Level IV, case series

Distraction osteogenesis in management of composite bone and soft tissue defects

A soft tissue defect is one of the most difficult problems that may accompany bone defects. Plastic surgery is often required. During distraction osteogenesis, not only the bone but also the soft tissues are lengthened, which may help in spontaneous closure of the soft tissue defects. This study examines 11 cases of composite bone and soft tissue defects which were managed by distraction osteogenesis. After debridement of the necrotic tissues, the soft tissue defects ranged from three by four centimetres to five by 14 centimetres and the bone defects ranged from four to 12 centimetres. All the soft tissue defects healed during the process of bone transport without the need for plastic surgery, except in one case. The complications were successfully managed during the course of treatment. Distraction osteogenesis is a good method for simultaneous treatment of composite bone and soft tissue defects