Three-wire Fixation Technique for Displaced Fifth Metatarsal Base Fractures

Authors: James L. Thomas & Barry C. Davis

Journal: Journal of Foot and Ankle Surgery

Abstract: Fractures of the tuberosity of the fifth metatarsal are the most common type of fifth metatarsal fractures. This particular fracture usually produces low morbidity and low rates of nonunion when treated nonoperatively. However, on occasion, significant displacement, comminution, or significant intra-articular involvement may warrant operative intervention. Multiple techniques have been described for the operative care of this fracture. We present a somewhat simplified fixation method for displaced fifth metatarsal fractures in a small set of patients who were all followed up to final healing of the fracture.

Keywords: bone, foot, injury, surgery, trauma

Mechanical Comparison of Two Types of Fixation for Ludloff Oblique First Metatarsal Osteotomy

Authors: Stavros P. Tsilikas, Emmanouil D. Stamatis, Stavros K. Kourkoulis, Athanasios S. Mitousoudis, Panayiotis E. Chatzistergos, Panayiotis J. Papagelopoulos

Journal: Journal of Foot and Ankle Surgery

Abstract: The Ludloff oblique metatarsal osteotomy is an effective method to correct hallux valgus deformity, although a number of problems have been associated with it, including inherent instability, delayed union, dorsal malunion, and fixation failure. The purpose of the present study was to compare the mechanical characteristics of fixation of the Ludloff osteotomy in 20 identical synthetic bone models, 10 fixated using 2 screws (group I) and 10 fixated using 2 screws augmented with a mini locking plate (group II). Each specimen was loaded to failure, and the mean average load to failure, stiffness, and absorbed energy to failure were compared using unpaired Student’s t test. The mean average stiffness of the Ludloff osteotomy fixed with 2 screws (group I) and with the supplementary mini locking plate (group II) was 172.7 ± 31.7 N/mm and 193.3 ± 39 N/mm, respectively (p = .21). The mean average load to failure for groups I and II was 278.4 ± 64.4 N and 356.2 ± 77.9 N, respectively (p = .025). The mean average energy absorbed before failure for groups I and II was 506.7 ± 206.4 Nmm and 769.8 ± 339.4 Nmm, respectively (p = .05). The use of a medially applied supplementary mini locking plate offers a simple and effective method to improve the mechanical stability of the Ludloff oblique osteotomy.

Keywords: bone, hallux valgus, interfragmental compression screw, locking plate, surgery

Advances in Intramedullary Nail Fixation in Foot and Ankle Surgery

Authors: Woods JB, and Burns PR

Journal: Clinics in Podiatric Medicine in Surgery

Abstract: Tibiotalocalcaneal arthrodesis for the treatment of complex foot and ankle deformities are extremely challenging cases. Technological advances in intramedullary nail fixation have improved the biomechanical properties of available fixation constructs in recent years. Nails designed specifically to accommodate hindfoot anatomy, advancement in the understanding of optimal screw orientation, fixed angle technology, the availability of spiral blade screws, and features designed to achieve compression across the arthrodesis site have provided the foot and ankle surgeon with a greater armamentarium for performing tibiotalocalneal arthrodesis. Although advances may help to improve clinical results, small sample sizes and the low-level evidence of study designs limit the evaluation of how these advances affect clinical outcomes.

Keywords: Tibiotalocalcaneal, Intramedullary nail, Foot, Ankle, Arthrodesis

Digital Arthrodesis: Current Fixation Techniques

Authors: Jared L. Moon, Carl A. Kihm, Daniel A. Perez, Leslie B. Dowling, David C. Alder

Journal:  Clinics in Podiatric Medicine in Surgery

Abstract: Several hammertoe implant devices have recently been introduced in an attempt to provide optimal fixation for proximal interphalangeal joint arthrodesis. This article reviews these implants individually, and discusses their advantages and disadvantages. There is a lack of research with long-term follow-up available for these devices. Percutaneous Kirschner-wire fixation persists as a time-honored and effective method of fixation. The buried Kirschner-wire technique is also an effective, cost-conscious option, with many of the same advantages as newer implantable devices.

Keywords: Proximal interphalangeal joint arthrodesis, Hammertoe, Digital arthrodesis

Fractures of the Calcaneal Tuberosity Treated With Suture Fixation Through Bone Tunnels

Authors: Banerjee R, Chao J, Sadeghi C, Taylor R, Nickisch F.

Journal:  Journal of Orthopaedic Trauma

Abstract:  Fractures of the calcaneal tuberosity, although rare, present a challenge for the treating surgeon. The goal of treatment is restoration of function of the gastrocnemius–soleus complex and the Achilles tendon. These fractures often occur in diabetics and elderly osteoporotic patients and therefore fixation of the displaced fragment is difficult. Displaced fractures, if not recognized and promptly reduced, often result in secondary soft tissue compromise. Often, the fragment is a small shell of osteoporotic bone, which is less than optimal for bony fixation. We present our technique for surgical fixation of calcaneal tuberosity fractures using a suture placed through bone tunnels in the calcaneal body. This technique is used by itself for smaller fragments or supplemented with screw fixation for larger fragments.

Keywords: calcaneus fracture, calcaneal tuberosity, calcaneal avulsion

Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury

Authors: Mohammed R, Syed S, Metikala S, and Ali SA

Journal:  Indian Journal of Orthopedics

Abstract:  Background: With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation.

Materials and Methods: 12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise.

Results: At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred.

Conclusion: We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.

Keywords: Weber type-C ankle fractures, syndesmotic disruption, syndesmosis-only fixation, functional outcomes

Ankle Arthrodesis Utilizing a Single Lateral Exposure and Headless Screw Fixation

Authors: Taylor, BC

Journal:  Techniques in Foot and Ankle Surgery

Abstract:  Ankle arthrodesis is a well-accepted treatment method for patients with severe pain and dysfunction arising from degenerative changes of the ankle joint. Many different techniques have been described and can be appropriately utilized with the proper patient presentation. In this paper, we describe a technique of ankle arthrodesis performed utilizing a single lateral incision without fibular osteotomy and employing cannulated headless compression screw technology for fixation. When compared with traditional techniques, this approach has advantages of limited soft tissue dissection and periosteal stripping, possible incorporation of a previous surgical incision, rapid healing time and return of functionality, and elimination of hardware prominence.

Keywords: Ankle arthrodesis, lateral incision, headless screw