It All Fell Apart … Now How Do I Reconstruct My End-stage Flatfoot?
We present our diagnostic algorithm, surgical techniques, and pearls for the treatment of the failed extra-articular flatfoot reconstruction. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus Source Type: research

Deltoid Insufficiency and Flatfoot—Oh Gosh, I’m Losing the Ankle! What Now?
Adult acquired flatfoot deformity is a severe condition in which the ankle is markedly affected by medial instability and valgus deformity. Unbalanced forces pose high stress on the tibiotalar joint, and different levels of arthritis may develop. Correcting valgus tilt in the ankle, at the time of flatfoot reconstruction, is imperative to prevent future collapse and the need for ankle arthrodesis or arthroplasty. Unfortunately, there has been no universal procedure adapted by foot and ankle surgeons for repair or augmentation of the deltoid ligament. We recommend a technique of reconstruction of the superficial and deep de...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus Source Type: research

The Flatfoot in Collapse Needs Stability and That is Why I Fuse It
The pathophysiology and treatment of the adult-acquired flatfoot is still quite controversial. Soft tissue reconstruction and tendon transfer surgery combined with corrective osteotomy for flexible deformities are well established in the literature. However, patients with signs of hindfoot osteoarthritis, rheumatological or neurological diseases, and obesity can benefit from surgical correction with arthrodesis because of greater outcome predictability. Various types of arthrodesis, including isolated, triple, double, or segmental procedures, have been described to treat this deformity. We will discuss the events leading t...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus Source Type: research

The Collapsing Flatfoot: Bone Alignment, Bone Alignment, Bone Alignment!
Stage II adult acquired flatfoot deformity involves a loss of the medial longitudinal arch and an increase in hindfoot valgus due to both soft tissue dysfunction and attenuation with subsequent collapse of the foot’s inherent bony architecture. Although there is an important role for soft tissue reconstruction in the majority of cases of adult acquired flatfoot deformity, any soft tissue procedure in the absence of correction of the underlying bony alignment will be prone to failure so these soft tissue procedures should only be performed after maximal bony realignment has been obtained. In this article, we discuss o...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus Source Type: research

The Collapsing Foot: It’s All About the Ligaments!
There are many surgical techniques described for the deltoid ligament and spring ligament reconstruction in the treatment of a collapsing flatfoot. In some cases, addressing these ligaments may offer a way to treat a collapsing flatfoot that preserves the talonavicular and subtalar joints. Preservation of these joints may lead to better outcomes for patients, as their functionality is not limited by hindfoot fusions. Preliminary evidence suggests that patients, when properly selected for, show good long-term outcomes after undergoing surgical reconstruction of those ligaments. The technique for spring ligament and deltoid ...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: CME Article Source Type: research

Should it Stay or Should it Go? Thinking Critically About Posterior Tibial Tendon Excision in Flatfoot Correction
Stage II adult acquired flatfoot deformity is characterized by painful, progressive collapse long thought to be driven by posterior tibialis tendon (PTT) deficiency or insufficiency. In this article, we discuss the history of our understanding the role of the PTT in the development of adult acquired flatfoot deformity, and considerations in tendon excision in flatfoot correction. We argue that routine excision of the PTT should be rethought and instead the tendon should be critically assessed in each case and debridement with repair should be attempted when appropriate. Technique for flexor digitorum longus transfer is det...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity (AAFD): To the Infinity and Beyond! Source Type: research

The Role of Biologics in the Treatment of Flatfoot
Symptomatic adult-acquired flatfoot deformity (AAFD) is traditionally treated by realignment osteotomy and a tendon transfer. Despite high success rates for this procedure, prolonged recovery time and associated morbidities may lead many patients to shy away from having this type of surgery performed on them. Over the past decade, the use of biologics such as platelet-rich plasma and concentrated bone marrow aspirate concentrate has been gaining much popularity. The efficacy of these biologics to treat tendon pathologies is currently well supported in the literature. Therefore, when treating early AAFD with a functioning p...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity (AAFD): To the Infinity and Beyond! Source Type: research

The Flatfoot Through a Pinhole: Do It Percutaneously!
Surgical treatment of adult-acquired flatfoot deformity typically requires multiple soft tissue and bony procedures, many of which can be effectively performed with minimally invasive surgery techniques. Use of minimal skin incisions helps limit the morbidity of surgery, reducing postoperative pain and the incidence of wound complications. This chapter will focus primarily on the bony procedures which can be accomplished through minimally invasive surgery, including the medializing calcaneal osteotomy and the first tarsometatarsal fusion. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete d...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity (AAFD): To the Infinity and Beyond! Source Type: research

Using the Scope in the Treatment of Flatfoot? Are You Kidding?
Flatfoot surgery is evolving. As in other areas, less invasive techniques result in fewer wound complications, less postoperative pain, less bleeding, shorter hospital stays, and potentially shorter recovery times. In this article, we outline how the arthroscope can be used in flatfoot surgery to reduce the invasiveness of surgery. The article outlines how to perform a percutaneous gastrocnemius slide for the associated tight heel cord, and how to perform tibialis posterior tendoscopy. A percutaneous medializing calcaneal osteotomy can be performed as an arthroscopic guided procedure to confirm the placement of the saw, an...
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity (AAFD): To the Infinity and Beyond! Source Type: research

Guest Editorial: Adult Acquired Flatfoot Deformity (AAFD): To the Infinity and Beyond!
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 22, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity (AAFD): To the Infinity and Beyond! Source Type: research

Surgical Technique and Algorithm for Treatment of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Approach and Plate Fixation
This article describes the surgical technique used in the treatment of closed and displaced intra-articular calcaneal fracture, sinus tarsi approach and fixation with a locking plate including a therapeutic algorithm. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: CME Article Source Type: research

Forefoot Supination and Medial Column Instability in the Setting of AAFD: The Role of the Medial Column
Several variables may contribute to adult-acquired flatfoot deformity, one such variable is the medial column of the foot, which commonly manifest as forefoot varus or supination. The medial column is subjected to considerable loads during gait, and under normal conditions provides dynamic stability during the stance phase of gait. Pathology occurring along the medial column and forefoot can disrupt normal foot mechanics and lead to flatfoot deformity. A careful history and examination can diagnose dysfunction relating to the medial column and forefoot. Specifically, first tarsometatarsal dysfunction can result in malalign...
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery Source Type: research

AAFD: Is the Gastroc Just Pulling Some Strings?
Whether ankle equinus predominantly contributes to or ensues from an adult-acquired flatfoot deformity (AAFD) remains unknown. Regardless of the exact nature of this relationship, current evidence supports a distinct role for concomitant gastrocnemius recession or Achilles tendon lengthening during surgical correction of significant AAFD deformity. Achieving the appropriate degree of surgical correction for components of ankle equinus, hindfoot valgus, and/or Chopart collapse that may contribute to AAFD requires proper clinical evaluation and an appreciation of contributory pathophysiology. Review of recent literature desc...
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery Source Type: research

Subtle Dynamic Flatfoot Deformity: Is It More Than Stage I PTTD?
We present our preferred treatment strategy. Nonoperatively, patients are managed with a stretching program focused on the hamstrings and gastrocsoleus as well as the use of orthotics and night splint. Operative treatment consists of treatment of any areas of impingement and correcting the biomechanics of the foot and ankle with a Strayer, Cotton Osteotomy, and lateral column lengthening. Resection of the accessory facet of the talus is optional depending on preoperative symptoms. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery Source Type: research

AAFD: Conventional Radiographs are not Enough! I Need the Third Dimension
In this study, we reviewed the recent literature about the use of WBCT in AAFD, starting from a critical analysis about the biases related to conventional radiography and to non-standing CT. Then, we focused on the effects of load on the 3D architecture of the foot and ankle in AAFD. Finally, we discussed the benefits and future perspectives for the use of WBCT in the management of this condition and as a surgical planning tool as well. Level of Evidence: Diagnostic Level V, expert opinion. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery Source Type: research

AAFD Staging System: Did We Get It Right?
We describe clinical as well as patient parameters which do not fit in with the current classification scheme, and make recommendations for future study. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery Source Type: research

Guest Editorial: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Special Focus: Adult Acquired Flatfoot Deformity: The Pandora’s Box of Foot and Ankle Surgery Source Type: research

Technique or Technician
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2019 Category: Orthopaedics Tags: Editorial Source Type: research

Total Talus Replacement for Traumatic Bone Loss or Idiopathic Avascular Necrosis of the Talus
More than a dozen surgical techniques have been described for management of avascular necrosis or traumatic loss of large portions of the talus. The smaller the area of necrosis, the better the outcomes. Procedures to induce revascularization (core decompression/drilling, vascularized bone grafts) have been reported with variable success. Patients with avascular necrosis of large portions of the talus present unique treatment difficulties. These techniques largely focus on pantalar or tibiotalar-calcaneal arthrodesis with large bone blocks. These surgeries eliminate motion, lead to high levels of patient dissatisfaction, a...
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Technique Source Type: research

Peroneal Tendon Tears: When to Use an Allograft
Allograft reconstruction of chronic peroneal tendon tears is a safe and effective option to help restore patient function and limit pain. Both the author’s experience, along with cadaveric and clinical studies, have shown that this technique can restore function and stability. The authors provide step-by-step instruction of their preferred allograft reconstruction technique for chronic peroneal attritional injuries, while limiting the comorbidities that may be seen with autograft reconstruction. Level of Evidence: Level IV—review article, expert opinion, operative technique. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

Ankle Microinstability
Ankle sprains are one of the most common injuries in foot and ankle, and the superior fascicle of the anterior talofibular ligament (ATFL) frequently is injured as a consequence. Patients with isolated rupture of ATFL’s superior fascicle can sustain a subtle ankle instability or ankle microinstability. Patients with symptomatic ankle microinstability may describe a subjective feeling of ankle instability, recurrent symptomatic ankle sprains, chronic anterolateral pain or a combination of any of them. When conservative management fails, anatomic all-inside ATFL’s superior fascicle repair under direct arthroscopi...
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

Ankle Ligament Reconstruction: The Role of Augmentation
The most reliable reconstruction for chronic ankle ligament instability continues to be debated. The conventional Broström is widely used, but there are limitations to the technique. By virtue of the tissue repair a conservative rehabilitation approach is advocated, and there is an increasing concern that the repair does not match the strength of the native ligament. That begs the question of whether an augmentation is needed and if it is done, how does it affect the native ligament repair and how does it stand up over time? This chapter will discuss these questions as well as our current approach to lateral ligament ...
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

Treatment of Osteochondral Lesions of Talus With Extracellular Matrix Cartilage Allografts
The treatment of osteochondral lesions of the talus (OLTs) can be challenging. Currently, there exists a wide variety of treatment options to address OLTs, and the development of new, innovative surgical techniques has continued to evolve. The use of extracellular matrix cartilage allografts, or BioCartilage, is a biological agent that can be utilized as an adjunct to bone marrow stimulation. There are early promising clinical, radiographic, and histologic results. Therefore, it is prudent to understand the application of extracellular matrix cartilage allograft in the treatment of OLTs. We will provide a detailed review o...
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

New Flexible Fixation for Subtle Lisfranc Injury
Lisfranc ligament injuries are not so common and often overlooked. If missed, they can cause long-term disability and pain. The treatment of these injuries are still controversial and very little is known about which types of injury can be treated without surgery. Successful surgical management of these injuries is predicated on anatomic reduction and stable fixation. Open reduction and internal fixation remains the standard treatment, although ligament reconstruction has emerged as a viable option for certain types of tarsometatarsal joint injuries. This paper describes the authors’ approach to treat Lisfranc’...
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

New Option for Achilles Tendon Ruptures, Combining the Best of All: The PARS-Dresden
Surgical treatment remains the standard of care for active patients with acute midsubstance Achilles tendon ruptures. Minimal invasive surgery, rupture’s site hematoma preservation, strong fixation, avoidance of sural nerve entrapment, and early rehabilitation are essential concepts desirable for any Achilles tendon repair. Hereby, we present a technique modification that incorporates all these advantages in one single procedure. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

Guest Editorial: Innovations in Foot and Ankle Sports Injury Treatment
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - May 23, 2019 Category: Orthopaedics Tags: Special Focus: Innovations in Foot and Ankle Sports Injury Treatment Source Type: research

Asymmetric Z-Tendon Shortening to Maximize Excision of Abnormal Tendon Tissue: A Technique Tip to Treat Elongated Tendons With Pathology
Operative treatment for a diseased or elongated Achilles tendon often involves resection of diseased tissue and Achilles tendon shortening. If the amount of diseased tissue is minimal, a traditional Z-shortening technique can be used to achieve appropriate tendon repair and function, which involves making an incision along the longitudinal axis mid-substance of the Achilles tendon. This technique is limited in its ability to resect abnormal tissue due to the placement of the incision traditionally along the midline of the tendon. In this chapter we describe an original modification of the Z-shortening technique to allow fo...
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: CME Article Source Type: research

Sliding Distal Metatarsal Minimally Invasive Osteotomy (S-DMMO) for the Treatment of Tailor’s Bunion
We present a surgical technique consisting in a distal osteotomy of the fifth metatarsal, which resembles DMMO, but requires a lateral displacement. We retrospectively investigated 38 feet from 32 patients with symptomatic bunionette deformity and showed good to excellent functional and clinical results. The S-DMMO proved to be a safe (low complication rate) and effective (adequate clinical results and powerful radiologic correction) procedure for the treatment of bunionette deformity. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques ...
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Technique Source Type: research

Appropriate MRI Evaluation of Lisfranc Ligaments: How to Avoid Missing Ligamentous Lisfranc Injuries
Knowledge of injuries at the tarsal metatarsal joints continues to evolve. Fractures and ligamentous injuries at the tarsal metatarsal joints, also known as the Lisfranc joint complex, are uncommon yet can be of great clinical significance. The initial radiographic findings, suspected mechanism of injury, and physical examination findings can result in varying diagnoses and recommendations. Subtle or ligamentous injuries can be missed and result in the potential of midfoot instability and rapid progression to posttraumatic osteoarthritis. The imaging features of injury at the Lisfranc joint are reviewed, and guidance is pr...
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Special Focus: Acute Lisfranc Injuries Source Type: research

Flexible Fixation Treatment Strategies for Low-energy Lisfranc Injuries
This article will focus on the technique of using a suture button device, and also introduce the technique of Lisfranc InternalBrace fixation. The internal brace technique allows for less bone loss from drilling, allows for collagen ingrowth, and can be used in conjunction with bridge plating techniques. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Special Focus: Acute Lisfranc Injuries Source Type: research

Transarticular Screw Technique for Stabilization of Lisfranc Injuries
Injuries to the tarsometatarsal joint complex are known as Lisfranc injuries. Although relatively rare when considered with all other injuries about the foot and ankle, they are frequently seen in the orthopedic clinic. These injuries are often missed and can lead to long-standing pain and disability. Therefore, a high index of suspicion must be maintained by the evaluating orthopedic surgeon. Studies have shown that anatomic reduction is critical to obtain a good result. Transarticular screw fixation has the ability to obtain and maintain an anatomic reduction. This technique has historically been the most common method o...
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Special Focus: Acute Lisfranc Injuries Source Type: research

Acute Arthrodesis of Lisfranc Injuries
We describe our technique for surgical management of acute Lisfranc injuries, both high-energy and low-energy variants, with primary arthrodesis. Satisfactory outcomes and complications of this treatment have been shown to be equivocal, if not better, than ORIF for the treatment of acute injuries. Level of Evidence: Treatment Benefits. Level V. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Special Focus: Acute Lisfranc Injuries Source Type: research

Dorsal Plating for Low and High-energy Lisfranc Injuries
Lisfranc injuries are uncommon but destabilizing injuries of the tarsometatarsal joint that are often missed on initial evaluation and have a high incidence of posttraumatic arthritis. These injuries can occur from low or high-energy mechanisms and feature unique characteristics. Open reduction and internal fixation is indicated in Lisfranc injuries that include a fracture component and different methods of fixation have been described. In this article, we present our operative techniques for open reduction and internal fixation of Lisfranc fractures using dorsal plating for both low and high-energy injuries. Level of Evi...
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Special Focus: Acute Lisfranc Injuries Source Type: research

Guest Editorial: Acute Lisfranc Injuries
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Special Focus: Acute Lisfranc Injuries Source Type: research

Learn to Teach to Learn
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - February 21, 2019 Category: Orthopaedics Tags: Editorial Source Type: research

Arthroscopically Assisted Percutaneous Fixation of a Talar Neck Fracture Via Posterior Approach: A Case Study
We present a case study of a patient with a type 1 talar neck fracture that was successfully treated with arthroscopically guided percutaneous screw fixation from a posterior arthroscopic approach. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Technique Source Type: research

A Minimally Invasive, Dual-incision (Medial and Lateral) Approach: An Alternative Technique for Reduction and Fixation of Intra-Articular Calcaneus Fractures
Calcaneus fractures are severe injuries that historically have been associated with poor outcomes and debilitating consequences. To maximize functional outcome, the literature in favor of operative management encourages anatomic reduction and alignment of displaced, intra-articular calcaneus fractures, while minimizing risk to soft tissues. Because of the increased risk of soft tissue complications with extensile approaches, minimally invasive techniques have continued to gain popularity. The current technique aims to describe a minimally invasive approach to calcaneus fractures through a dual-incision, lateral (sinus tars...
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: CME Article Source Type: research

Operative Treatment of Syndesmotic Injuries With Assisted Arthroscopic Reduction
There continues to be a lack of consensus on the proper treatment of syndesmotic injuries in the literature. Currently, much of the operative debate lies between using a suture-button technique or transsyndesmotic screw fixation to treat the injury. There are further arguments surrounding screw fixation involving the size and number of the screws, the number of cortices, and whether or not the hardware is to be removed. For patients presenting with a syndesmotic injury, it is important to properly diagnose and address the type of injury in order to prevent long-term morbidity and ultimately, degenerative arthritis. In the ...
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research

The Posterior Approaches to the Posterior Pilon Fracture
Between simple malleolar fractures and more complex pilon injuries, is the posterior pilon fracture. Involving a variable amount of posterior tibial articular surface, these injuries may benefit from a posterior approach to reduce and stabilize the fragments. The posterolateral approach can be considered the “workhorse,” and allows good access to the tibia and fibula. The posteromedial approach may be helpful for more complex patterns, but is closer to the tibial neurovascular bundle. These approaches can be performed safely, with low complication rates and generally favorable outcomes. Level of Evidence: Diag...
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research

Perioperative Care Protocols in Ankle Fracture Treatment: A Review of the Literature
Although ankle fractures are common injuries and often treated with surgery, there are still many unanswered questions with regard to the optimal perioperative protocols for pain control, venous thromboembolism prophylaxis, and rehabilitation. The purpose of this article is to review the best available literature in these areas and provide evidence-based recommendations. Level of Evidence: Diagnostic Level III (therapeutic). See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research

Basic Science Behind the Development of Posttraumatic Osteoarthritis of the Ankle
This article outlines the basic science behind the mechanical and inflammatory model of development of PTOA of the ankle. The purpose of this article is to review the state of literature and understanding of ankle PTOA and serve as a foundation for future research aimed at reducing severity and progression of PTOA. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research

Surgical Management of Geriatric Ankle Fractures
There is a perpetual increase in the number of elderly people in the United States, both as a function of raw population size, and improvements in health care and its delivery. As such, it is our duty as foot and ankle surgeons to be participants in the improvement of geriatric health care. One area that has garnered burgeoning interest is geriatric ankle fractures. Typically managed nonoperatively, new evidence has supported surgical management of these fractures to spare morbidity and mortality. Classically, a lag screw and one-third tubular plate construct for the fibula and long lag screws in the medial malleolus was t...
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research

Advances in Ankle Fracture Management
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fracture Management Source Type: research

Behind the Scenes
No abstract available (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - November 20, 2018 Category: Orthopaedics Tags: Editorial Source Type: research

Bipartite Talus: Arthroscopic Resection – Case Report
Conclusions: We present in detail the arthroscopic resection of a bipartite talus. This is an unusual pathology and a differential diagnosis for posterior impingement. We believe that arthroscopic resection of the bone fragment of the bipartite talus is a safe procedure, with less morbidity for the patient, compared with open resections. Level of Evidence: Level V—technique description. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2018 Category: Orthopaedics Tags: Online Articles: Case Report Source Type: research

Medial Approach to Lateral Sesamoid Removal and Presentation of Case Series
Sesamoidectomy is a common procedure for the foot and ankle surgeon. Traditionally, the lateral sesamoid has been accessed through the dorsolateral or plantar approach. Although these approaches reliably access the fibular sesamoid they have associated complications. Here, we provide our technique for medial approach to the lateral sesamoid as well as an overview of our results. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2018 Category: Orthopaedics Tags: Online Articles: Technique Source Type: research

Treatment of Ankle Fracture Complications and Subacute or Malreduced Ankle Fractures
Rotational ankle fractures are among the most prevalent intra-articular fractures of the body. When managed appropriately, they have favorable outcomes with relatively low complication rates. The proper management of these injuries requires an understanding of the radiographic imaging, surgical anatomy, and biomechanics of both the tibiotalar and distal tibiofibular joint. Some of the most common and impactful complications of operatively treated ankle fractures include wound necrosis, surgical site infection, malunion, nonunion, and posttraumatic ankle arthritis. The management of these complications must be assessed on a...
Source: Techniques in Foot and Ankle Surgery - August 21, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fractures: “It’s Just an Ankle Fracture” Source Type: research

Surgical Treatment of Posterior Malleolus Fractures and Posterior Fixation
Posterior malleolar fractures (PMFs) have been demonstrated to result in poorer outcomes than other types of ankle fractures with a higher incidence of posttraumatic arthritis. Accordingly, there has been a recent surge in interest in reduction and fixation of PMFs. Operative criteria for PMFs have been based on size, step-off, ankle joint instability, and syndesmotic injury, though universally accepted criteria have yet to be defined. Anatomically, the posterior malleolus is important as an insertion point of the posterior inferior tibiofibular ligament and thereby may play a role in syndesmotic stability. However, the im...
Source: Techniques in Foot and Ankle Surgery - August 21, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fractures: “It’s Just an Ankle Fracture” Source Type: research

Ankle Fractures in Diabetic Patients
Unstable ankle fractures in patients with complicated diabetes are an orthopedic challenge. Internal fixation, with augmentation, and prolonged immobilization and non–weight-bearing are important for improved patient outcomes. Despite the risks associated with surgical intervention, nonoperative treatment has been associated with significantly increased complications compared with operative treatment in diabetic patients with unstable ankle fractures. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fractures: “It’s Just an Ankle Fracture” Source Type: research

Current Strategies in the Management of Syndesmotic Injuries
This article reviews the background of syndesmotic injuries, as well as recent aspects of management that have generated controversy. Particular emphasis is placed on assessment of reduction, syndesmotic stability, and of various methods of fixation. Level of Evidence: Level V—review article, expert opinion. See instructions for authors for a complete description of levels of evidence. (Source: Techniques in Foot and Ankle Surgery)
Source: Techniques in Foot and Ankle Surgery - August 21, 2018 Category: Orthopaedics Tags: Special Focus: Advances in Ankle Fractures: “It’s Just an Ankle Fracture” Source Type: research