Syndesmosis Stabilisation: Screws Versus Flexible Fixation
Orthopedic surgery is not short of situations where there is controversy regarding optimum management. Treating ankle syndesmosis injuries is an example where practice varies widely and there are many questions that remain unsatisfactorily answered. When addressing the type of syndesmosis stabilization that is required it is essential to ascertain the extent of instability. Only then can a logical approach to restoring the ankle mortise be achieved. Fixation of fibula shaft fractures and posterior malleolus fractures can restore sufficient stability to render syndesmosis stabilization unnecessary. The indications and techn...
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Matthew C. Solan, Mark S. Davies, Anthony Sakellariou Source Type: research

Gastrocnemius or Achilles Lengthening at Time of Trauma Fixation
Gastrocnemius equinus is a frequent comorbidity with traumatic injuries of the foot and ankle. Gastrocnemius lengthening at the time of definitive treatment facilitates obtaining and maintaining an anatomic reduction of the injury. The lengthening procedure is accomplished in 5 steps and results in fewer long-term, problematic sequelae. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Stephen K. Benirschke, Patricia Ann Kramer Source Type: research

Complex Foot Injury
Complex foot injuries occur infrequently, but are life-changing events. They often present with other injuries as the result of a high-energy trauma. After initial stabilization, early assessment should be regarding salvagability. All treatment strategies are intensive. The initial treatment includes prevention of progression ischemia/necrosis, prevention of infection, and considering salvage or amputation. Definitive treatment for salvage includes anatomic reconstruction with stable internal fixation and early soft tissue coverage followed by aggressive rehabilitation. Prognosis after complex injuries is hard to predict. ...
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Tim Schepers, Stefan Rammelt Source Type: research

Current Controversies in Foot and Ankle Trauma
This issue of Foot and Ankle Clinics of North America covers a variety of controversial topics in foot and ankle trauma. At times, clinical decisions are straightforward, black or white, yes or no decisions. It is hoped that this issue provides some discussion of topics that fall into the gray. Controversy is defined as a prolonged public dispute or debate concerning a matter of opinion. Some of the work presented you may agree with —some you may not. It is intended to make you think and stimulate discussion. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Michael P. Swords Tags: Preface Source Type: research

Current Controversies in Foot and Ankle Trauma
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Authors: Michael P. Swords Source Type: research

Copyright
ELSEVIER (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Source Type: research

Contributors
MARK S. MYERSON, MD (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Source Type: research

Contents
Michael P. Swords (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Source Type: research

Forthcoming Issues
Current Updates in Total Ankle Arthroplasty (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Source Type: research

Index
Note: Page numbers of article titles are in boldface type. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - February 4, 2017 Category: Orthopaedics Source Type: research

Chopart Injuries
Chopart joint injuries have a profound effect on global foot function. Surgical treatment aims at joint reconstruction and axial alignment with restoration of the normal relationship of the lateral and medial foot columns. Internal fixation is tailored to the individual fracture pattern and achieved with resorbable pins, Kirschner wires, screws, and/or anatomically shaped minifragment plates. If instability persists, temporary joint transfixation may be achieved with Kirschner wires or bridge plating. Primary fusion sacrifices essential joints and should be reserved for severe initial cartilage damage. Corrective fusion be...
Source: Foot and Ankle Clinics - December 22, 2016 Category: Orthopaedics Authors: Stefan Rammelt, Tim Schepers Source Type: research

Late Treatment of Syndesmotic Injuries
Normal syndesmosis anatomy and alignment are essential to ankle function. Although injuries to the syndesmosis are common with ankle injuries, accurate diagnosis and reduction continue to be a challenge. Late reconstruction for syndesmosis is reviewed. A surgical technique for late reconstruction is outlined in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 22, 2016 Category: Orthopaedics Authors: Michael Swords, Andrew Sands, John R. Shank Source Type: research

Early Fixation of Calcaneus Fractures
The treatment of calcaneus fractures is controversial. Historically, most operatively treated fractures have been approached with a lateral extensile incision requiring delay in operative treatment until swelling has improved. There is a current trend and interest in small incision approaches allowing, and in some cases requiring, earlier operative fixation. Clinical scenarios amenable to consideration for early fixation are reviewed. The sinus tarsi surgical approach and reduction techniques are outlined in detail. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 22, 2016 Category: Orthopaedics Authors: Michael Swords, Phillip Penny Source Type: research

Calcaneal Fracture Management
Calcaneal fracture management has historically been a controversial topic and represents an area of sustained interest over the past several decades. The authors review current methods for calcaneal fracture fixation with an extensile lateral approach and small incision techniques. Early reports of small incision techniques have reported promising outcomes and reduced risks for complications. These techniques may be beneficial to reduce the risk of soft tissue complications and improve the rate of recovery. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 22, 2016 Category: Orthopaedics Authors: Nathan J. Kiewiet, Bruce J. Sangeorzan Source Type: research

Managing Complications of Calcaneus Fractures
Calcaneus fractures remain among the most complicated fractures for orthopedic surgeons to manage because of the complexity of various fracture patterns, the limited surrounding soft tissue envelope, and the prolonged rehabilitation issues impacting function after successful treatment. Despite this, appropriate management of complications associated with calcaneus fractures is critical for the complete care of this injury, whether treated operatively or nonoperatively. The authors present the common complications encountered with fractures of the calcaneus and management thereof. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 19, 2016 Category: Orthopaedics Authors: Michael P. Clare, William S. Crawford Source Type: research

Posterior Malleolar Fractures
Injuries to the posterior malleolus are of prognostic relevance in ankle fracture-dislocations. The three-dimensional outline of the fragments as reflected by computed tomography classification, involvement of the fibular notch, and the presence of intercalary fragments seem to be of greater therapeutic relevance than the size of the fragment and amount of the articular surface involved. Operative treatment aims at reconstruction of the posterior tibial plafond, the fibular notch, and the integrity of the posterior inferior tibiofibular syndesmosis. Direct open reduction and fixation of posterior malleolus fragments via po...
Source: Foot and Ankle Clinics - December 19, 2016 Category: Orthopaedics Authors: Jan Barton íček, Stefan Rammelt, Michal Tuček Source Type: research

Primary Arthrodesis for Tibial Pilon Fractures
Staged primary ankle arthrodesis is a viable option for high-energy pilon fractures that are nonreconstructible, in patients with delay in treatment or multiple medical comorbidities, or in patients with peripheral neuropathy. Small retrospective series demonstrate high union and low wound complication rates, although further studies are needed to determine the long-term results. Ankle arthrodesis offers decreased complication rates while eliminating the potential of posttraumatic ankle arthritis pain. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - December 19, 2016 Category: Orthopaedics Authors: Bryant Ho, John Ketz Source Type: research

Treatment of Peripheral Talus Fractures
Peripheral talus fractures include injuries to the lateral process, posteromedial talar body, and talar head. These injuries are rare and are often missed. Nonunion with conservative treatment is high and excision can lead to joint instability, rapid arthrosis, and earlier need for arthrodesis. Open reduction internal fixation of most peripheral talus fractures is critical to achieving a good outcome. Open reduction leads to more rapid union and ability to mobilize the ankle and subtalar joints, quicker revascularization of the talus, and lower rates of arthrosis. Surgical treatment can lead to substantial functional impro...
Source: Foot and Ankle Clinics - December 19, 2016 Category: Orthopaedics Authors: John R. Shank, Stephen K. Benirschke, Michael Swords Source Type: research

Role of Recombinant Human Bone Morphogenetic Protein-2 on Hindfoot Arthrodesis
Despite advances in understanding bone healing physiology and surgical techniques, delayed union and nonunion still occur after the treatment of hindfoot arthrodesis. There is increasing appeal of bone morphogenetic proteins (BMPs) owing to the innate osteoinductive abilities of BMPs. Effective treatment with BMPs has been shown in animal studies. Human clinical studies have also shown success. The only study investigating the use of recombinant human BMP (rhBMP)-2 in hindfoot arthrodesis found a significant increase in fusion rate. Treatment cost effective. Complications from their use remain low. rhBMP-2 is a safe and ef...
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Jeremy Hreha, Ethan S. Krell, Christopher Bibbo Source Type: research

The Efficacy of Platelet-Derived Growth Factor as a Bone-Stimulating Agent
This article highlights findings from basic science, animal, and human clinical research that led to the approval of Augment Bone Graft. We present an adaptation of the surgical techniques described for investigators participating in the pivotal trial. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Ethan S. Krell, Christopher W. DiGiovanni Source Type: research

The Role of Orthobiologics in Fracture Healing and Arthrodesis
Nonunion after tibial shaft fracture and hindfoot arthrodesis remains a major problem. Known risk factors include advanced age, immunosuppression, smoking, and diabetes. Several factors must be considered in the fracture healing process. This review evaluates the efficacy of orthobiologics in improving union rates after fracture or arthrodesis. Use of compounds have shown increased cellular proliferation experimentally. Percutaneous autologous bone marrow has shown increased cellular proliferation. Matrix supplementation has shown significant improvements in bone healing. Several studies have highlighted the importance of ...
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Sheldon S. Lin, Michael G. Yeranosian Source Type: research

The Science Behind Wear Testing for Great Toe Implants for Hallux Rigidus
Various methods of repairing damaged articular cartilage surfaces have been proposed and a variety of implant materials have been tried in an attempt to decrease pain and improve function after cartilage repair. The hydrogel made of polyvinyl alcohol and saline is a unique material used as an implant in the great toe for advanced stage arthritis. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Judith F. Baumhauer, Michele Marcolongo Source Type: research

Bone Marrow Aspirate Concentrate for Bone Healing in Foot and Ankle Surgery
Autologous bone marrow aspirate concentrate (BMAC) has become a popular orthobiologic to augment bone healing. The potential benefit comes from osteoprogenitor cells and growth factors that can lead to new bone formation in the setting of foot and ankle arthrodesis procedures. BMAC has an excellent safety record and has demonstrated efficacy in animal models of bone healing. Although scant, the literature on the use of BMAC in foot and ankle surgery does demonstrate promise for this orthobiologic adjuvant. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Joshua S. Harford, Travis J. Dekker, Samuel B. Adams Source Type: research

Large BM Intra-Articular Allograft
Posttraumatic tibiotalar arthritis is a challenging problem in young, active patients. Many of these patients do not want to pursue ankle arthrodesis after they fail conservative treatment measures, as they wish to preserve joint motion. Osteochondral shell allograft arthroplasty has been described as a reasonable alternative for treating these patients. The procedure itself is technically demanding; however, with improvements in surgical technique and adequate preoperative patient counseling, it provides improvement in ankle function and has good outcomes for most patients at long-term follow-up. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Joan R. Williams, Michael E. Brage Source Type: research

Autologous Bone Graft in Foot and Ankle Surgery
Bone graft is a common adjunct procedure in orthopedic surgery used for fusions, fracture repair, and the reconstruction of skeletal defects in the foot and ankle. Autologous graft, or autograft, involves the transport of bone from a donor site to another location in the same patient. It is considered by many to be the gold standard of bone grafting, as it is provides all biologic factors required for functional graft. Further, autograft is 100% histocompatible with no risk of disease transmission. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Christopher P. Miller, Christopher P. Chiodo Source Type: research

Efficacy of a Cellular Allogeneic Bone Graft in Foot and Ankle Arthrodesis Procedures
This study explores the utility and efficacy of MAP3 in foot and ankle arthrodesis procedures. Map3 is a cellular allogeneic bone graft that contains osteogenic, osteoconductive, osteoinductive, and angiogenic properties. A total of 23 mostly high-risk patients were included in this study. The overall fusion rate was 83%. Univariate analysis demonstrated diabetic patients remain at risk of recurrent nonunion (P (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Travis J. Dekker, Peter White, Samuel B. Adams Source Type: research

Vancouver Experience of Recombinant Human Platelet-Derived Growth Factor
Joint arthrodesis utilizing autogenous bone graft remains the gold standard of treatment in fusion procedures of the foot and ankle. Graft harvest, however, has been associated with increased morbidity to patients as well as increased costs. With this in mind, multiple clinical studies have evaluated the efficacy of recombinant human platelet-derived growth factor (rh-PDGF-BB) with beta-tricalcium phosphate (B-TCP) to augment in foot and ankle arthrodesis with favorable results. These factors have led to the increased use of rh-PDGF-BB with B-TCP in Vancouver with good clinical results. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Alistair Younger, Murray Penner, Harvey E. Montijo Source Type: research

Platelet-Rich Plasma and Concentrated Bone Marrow Aspirate in Surgical Treatment for Osteochondral Lesions of the Talus
Platelet-rich plasma (PRP) and concentrated bone marrow aspirate (CBMA) have the potential to improve the quality of cartilage repair in osteochondral lesions of the talus (OLT). In this review, we describe the basic science and clinical evidence that has been published on the topic of PRP and CBMA on 2 commonly used surgical techniques for the treatment of OLT: bone marrow stimulation and osteochondral autograft transfer. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Youichi Yasui, Andrew W. Ross, John G. Kennedy Source Type: research

The Use of Allostem in Subtalar Fusions
This article covers the use of adipose-derived stem cells as an adjunct or alternative to autologous or other bone grafting materials. Promising development and encouraging data exist with respect to the use of adipose-derived mesenchymal stem cells for bone arthrodesis, which is discussed in more detail in the article. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: J. Chris Coetzee, Mark S. Myerson, John G. Anderson Source Type: research

The Science Behind Surgical Innovations of the Forefoot
One of the areas of foot and ankle surgery that has had particular attention over the last 5  years has been forefoot surgery. Common procedures include correction of the lessor metatarsophalangeal joints and hammertoe deformities, specifically metatarsal shortening osteotomies and proximal interphalangeal joint fusions. The goals of these surgeries are to improve patient function and allo w patients to fit into shoes more comfortably in metatarsal shortening and hammertoe. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Judith F. Baumhauer, Michele Marcolongo Source Type: research

Injectable Recombinant Human Platelet-derived Growth Factor in Collagen Carrier for Hindfoot Fusion
This article provides a review of the role of rhPDGF in hindfoot fusions, and the surgical technique for performing an rhPDGF enhanced double-arthrodesis through a medial approach. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Andrew Dodd, Timothy R. Daniels Source Type: research

B2A Polypeptide in Foot and Ankle Fusion
Foot and ankle fusion procedures often incorporate autogenous bone graft to help achieve bony union. Pain and morbidity associated with graft harvest have resulted in decreased autograft use as alternative bone graft substitutes have become available. Recently B2A peptide-coated ceramic granules have been developed and investigated. B2A, a bioactive synthetic multi-domain peptide acting on bone morphogenetic protein receptors of osteoblast precursor cells, amplifies the cell response to bone morphogenetic proteins. Use of B2A-granule has the additional benefit of eliminating autogenous bone graft donor site morbidity. The ...
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Mark Glazebrook, Diana S. Young Source Type: research

Mesenchymal Stem Cell –Bearing Sutures for Tendon Repair and Healing in the Foot and Ankle
Improving the quality and strength of soft tissue repairs remains an important area of orthopedic research and innovation. The need for immobilization and early motion is an important balance essential for the successful treatment of tendon repair and reconstruction. Mesenchymal stem cell (MSC) –bearing sutures represent an emerging biological augmentation to traditional suture repair. Two previous large studies using stem cell sutures in rat Achilles tendon models have demonstrated early increased biomechanical strength and significantly increased ultimate failure strength. The MSCs see m to remain locally at the re...
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Eric W. Tan, Lew C. Schon Source Type: research

Orthobiologics in the Foot and Ankle
Many allogeneic biologic materials, by themselves or in combination with cells or cell products, may be transformative in healing or regeneration of musculoskeletal bone and soft tissues. By reconfiguring the size, shape, and methods of tissue preparation to improve deliverability and storage, unique iterations of traditional tissue scaffolds have emerged. These new iterations, combined with new cell technologies, have shaped an exciting platform of regenerative products that are effective and provide a bridge to newer and better methods of providing care for orthopedic foot and ankle patients. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: H. Thomas Temple, Theodore I. Malinin Source Type: research

The Biology of Bone and Ligament Healing
This review describes the normal healing process for bone, ligaments, and tendons, including primary and secondary healing as well as bone-to-bone fusion. It depicts the important mediators and cell types involved in the inflammatory, reparative, and remodeling stages of each healing process. It also describes the main challenges for clinicians when trying to repair bone, ligaments, and tendons with a specific emphasis on Charcot neuropathy, fifth metatarsal fractures, arthrodesis, and tendon sheath and adhesions. Current treatment options and research areas are also reviewed. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Jessica A. Cottrell, Jessica Cardenas Turner, Treena Livingston Arinzeh, J. Patrick O ’Connor Source Type: research

Orthobiologic in Foot Ankle
Significant advances continue to be made in the field of foot and ankle; especially in the treatment of arthrodesis and fracture healing, specifically addressing the complications of delayed union and nonunion. The triad concept of cellularity, critical growth factors, and matrix augmentation has ushered in a new clinical era and excitement. Despite these advances, we continue to see nonunion rates after elective arthrodesis between 7% and 10%, and of the estimated 8 million fractures in the United States, 5% to 10% continue to have issues in healing. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Sheldon S. Lin Tags: Preface Source Type: research

Bone Grafts, Bone Graft Substitutes, and Biologics in Foot and Ankle Surgery
FOOT AND ANKLE CLINICS (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Authors: Sheldon S. Lin Source Type: research

Copyright
ELSEVIER (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Source Type: research

Contributors
MARK S. MYERSON, MD (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Source Type: research

Contents
Sheldon Lin (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Source Type: research

Forthcoming Issues
Current Controversies in Foot and Ankle Trauma (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Source Type: research

Index
Note: Page numbers of article titles are in boldface type. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - November 19, 2016 Category: Orthopaedics Source Type: research

Percutaneous Surgery for Mild to Moderate Hallux Valgus
This article describes the surgery technique, including reduction of the first metatarsal head after translation, accurate positioning of the proximal first metatarsal fixation screw, and removal of the dorsomedial prominence of the first metatarsal head. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Peter Lam, Moses Lee, Jerry Xing, Martin Di Nallo Source Type: research

Percutaneous Surgery for Severe Hallux Valgus
Severe hallux valgus is a challenge to treat. If the basal osteotomy is a well known surgery for severe deformity, the chevron osteotomy is usually used in mild to moderate deformity. With a accurent fixation the chevron can also be used in severe deformity. Both techniques can be performed percutaneously and offer reliable techniques. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Joel Vernois, David J. Redfern Source Type: research

Percutaneous Surgery for Metatarsalgia and the Lesser Toes
The traditional open surgical options for the treatment of metatarsalgia and lesser toe deformities are limited and often result in unintentional stiffness. The use of percutaneous techniques for the treatment of metatarsalgia and lesser toe deformities allows a more versatile and tailor-made approach to the individual deformities. As with all percutaneous techniques, it is vital the surgeon engage in cadaveric training from surgeons experienced in these techniques before introducing them into his/her clinical practice. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: David J. Redfern, Joel Vernois Source Type: research

A Proposed Staging Classification for Minimally Invasive Management of Haglund's Syndrome with Percutaneous and Endoscopic Surgery
Haglund ’s syndrome encompasses several different pathologies, including Haglund’s deformity, insertional Achilles tendonopathy, retrocalcaneal bursitis, and superficial bursitis. Traditionally treated with open surgery, there is increasing interest in a more minimally invasive approach to this difficul t region to reduce complications and improve the rate and ease of recovery. We review the evidence available for 2 of these techniques: the endoscopic calcaneoplasty and percutaneous Zadek’s calcaneal osteotomy (also known as Keck and Kelly’s osteotomy). The senior author’s classification for m...
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Turab Arshad Syed, Anthony Perera Source Type: research

Minimally Invasive Osteotomies of the Calcaneus
Osteotomies of the calcaneus are powerful surgical tools, representing a critical component of the surgical reconstruction of pes planus and pes cavus deformity. Modern minimally invasive calcaneal osteotomies can be performed safely with a burr through a lateral incision. Although greater kerf is generated with the burr, the effect is modest, can be minimized, and is compatible with many fixation techniques. A hinged jig renders the procedure more reproducible and accessible. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Gregory P. Guyton Source Type: research

Percutaneous Hindfoot and Midfoot Fusion
Hindfoot and midfoot fusions can be performed with percutaneous techniques. Preliminary results of these procedures are encouraging because they provide similar results than those obtained with open techniques with less morbidity and quick recovery. The best indications are probably fusions for mild-to-moderate reducible hindfoot and midfoot deformities in fragile patients with general or local bad conditions. The main limit is linked to the surgeon ’s experience in percutaneous foot surgery because a learning curve with the specific tools is necessary before doing these procedures. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Thomas Bauer Source Type: research

Endoscopic Ankle Lateral Ligament Graft Anatomic Reconstruction
This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Frederick Michels, Guillaume Cordier, St éphane Guillo, Filip Stockmans, ESKKA-AFAS Ankle Instability Group Source Type: research

Managing Complications of Percutaneous Surgery of the First Metatarsal
The percutaneous osteotomy based on a Hohmanntype first metatarsal subcapital linear osteotomy was introduced into Mainland China in the late 1980s. No internal fixation is used for stabilization of the osteotomy, leading unfortunately to unpredictable results. Despite its high acceptance by patients and enthusiasm by surgeons at present, the clinical outcomes of percutaneous surgery have not been promising. The authors have no experience of performing this osteotomy and report only on their management of the complications of this technique and their recommended treatment algorithm. (Source: Foot and Ankle Clinics)
Source: Foot and Ankle Clinics - August 13, 2016 Category: Orthopaedics Authors: Shu-Yuan Li, Jian-Zhong Zhang, Yong-Tao Zhang Source Type: research