OBJECTIVES: To compare the clinical outcomes of open vs. closed reduction methods for femoral neck fractures (FNFs) in young patients treated with fracture repair. METHODS: Design: Multicenter retrospective cohort study. Setting: Twenty-six North American Level 1 trauma centers. Patient Selection Criteria: Skeletally mature patients aged <50 years with displaced FNFs (OTA/AO type 31B) undergoing surgical repair and having minimum follow-up >6 months, except in cases where major complications occurred earlier. Intervention: Open vs. closed fracture reduction. Main Outcome Measurements: The primary outcome of “major complication” was defined as nonunion/failed fixation, osteonecrosis, malunion (vertical or femoral neck shortening of ≥15 mm) and/or subsequent major reconstructive surgery was compared by reduction method using chi-squared tests and risk-adjusted binary mixed effects regression models. RESULTS: A total of 290 patients with FNFs were included in the study, 107 treated with closed reduction (average follow-up 27.1 months [range, 4.1 to 159.5 months]) and 183 treated with open reduction and (average follow-up 22.4 months [range, 3.7 to 141.3 months], P=0.105). Sex distribution showed no difference between the groups, with 25.5% of the closed group, and 29.0% of the open cohort being female (P=0.615). Patients who received open reduction were younger than patients who received closed reductions (mean age 35.6±8.8 vs. 39.5±8.0 years, P<0.001) and had fewer cases of cases of diabetes mellitus (2.2% vs. 8.6%, P=0.027). Overall, adverse events were observed following 57.0% of closed reduction reductions vs. 54.1% of open reductions (P=0.890). No differences were seen in the frequency of defined failure modes, including failed fixation/nonunion (33.6% closed vs. 35.0% open, P=0.919), osteonecrosis (21.5% closed vs. 14.2% open, P=0.151), malunion (17.8% closed vs. 14.8% open, P=0.611), or major reconstructive surgery (33.6% closed vs. 36.6% open, P=0.702). CONCLUSIONS: Open and closed reductions of FNFs in patients <50 years old were associated with similar rates of repair failure. Level of Evidence: Level III (Therapeutic).
OBJECTIVE:To examine the clinical outcomes of one-stage repair for infected humeral nonunion following failed prior ORIF. METHODS:Design: Retrospective study. SETTINGS:Tertiary referral hospital. PATIENTS SELECTION CRITERIA:Included were patients with infected humeral nonunion after an initial fixation of fracture, who underwent surgical repair at the study site between 2016-2024. OUTCOME MEASURES AND COMPARISONS:Primary outcomes were union, infection eradication, number of surgeries, and duration of antibiotic therapy. RESULTS:Fifteen patients (80% male) who underwent humeral nonunion repair surgery, with positive intraoperative cultures were included. The mean age was 48.1 years (range 26-70) and 80% were male. Two patients (13.3%) were active smokers, and two (13.3%) had diabetes mellitus. Nine (60%) patients sustained OTA/AO type 12 fractures, four (26.7%) type 11 fractures, and two (13.3%) type 13 fractures. Twelve (80%) had closed fractures and 3 (20%) had open fractures. The most common initial fixation was plate and screw fixation (n=11, 73.3%), followed by intramedullary nail (n=4, 26.7%). Inflammatory markers were normal in seven patients (46.7%), elevated in three (20%), and unavailable in five (33.3%).A one-stage infected nonunion repair was planned for all cases (100%), with plate and screws (n=13, 86.7%), or intramedullary nailing (n=2, 13.3%). Bone graft was used in 13 (86.7%) cases and local antibiotics in two (13.3%). Cutibacterium acnes grew in 80% of cultures, followed by Staphylococcus aureus (13.3%) and Staphylococcus epidermidis (6.7%).Thirteen patients (86.7%) achieved union. In 10 cases (66.7%), the index single-stage repair was sufficient to achieve union, while 3 cases required additional interventions to achieve union. Mean antibiotic treatment duration was 8.1 months (SD 7.1 months, range 1.2-26.4). Two patients (13.3%) developed recurrent infection, and five patients (33.3%) required unplanned reoperations to promote union or treat infection. CONCLUSIONS:This study found a high ultimate union rate (86.7%) for one-stage infected humeral nonunion repair after prior failed osteosynthesis although 1 in 3 patients required unplanned reoperation for recurrent infections or recalcitrant nonunion.Level of Evidence Therapeutic level IV study.
OBJECTIVES:To evaluate outcomes of percutaneous pelvic fixation in the treatment of displaced vertically unstable pelvic ring injuries and identify fixation constructs that predict success. METHODS:Design: Retrospective cohort study. SETTING:Level I trauma center. PATIENT SELECTION CRITERIA:Patients ≥18 years old who underwent operative management of a vertically unstable pelvic ring injury (OTA/AO 61C.1-3) displaced ≥ 10 millimeters (mm) with sacroiliac (SI) or transsacral (TS) screws over a 24-year period. Exclusion criteria were spinopelvic dissociation, pathologic fracture, treatment with spinopelvic fixation or plate fixation of the posterior pelvic ring, and less than six months follow-up. OUTCOME MEASURES AND COMPARISONS:The primary outcome was treatment failure, defined as ≥10 mm of radiographic displacement compared to initial post-operative imaging. Secondary outcomes included failure rates stratified by posterior pelvic ring injury type and rates of revision surgery. Outcomes were compared between constructs that included both Multilevel sacral fixation and Transsacral fixation (MAT) versus constructs that lacked one or both of these features; that is, constructs with either Single-level fixation or only SI screws (SS). RESULTS:The cohort meeting inclusion criteria comprised sixty-seven patients: MAT fixation N=38 (71% male; median age 37 years, IQR 33-53) and SS fixation N=29 (62% male; median age 39 years, IQR 34-47). The posterior ring injury patterns included sacral fractures ( n=36, 53.7%), sacroiliac fracture dislocations (n=17, 25.3%), and sacroiliac dislocations (n=14, 20.9%). MAT fixation had a significantly lower rate of treatment failure compared to SS fixation (2.6% vs 48.3%, P<0.001). Rates of revision surgery were also significantly lower when MAT fixation was utilized (2.6% vs 31.0%, P= 0.002). CONCLUSIONS:In this cohort of vertically unstable pelvic ring injuries, fixation at multiple sacral levels with at least one TS screw was associated with a significantly lower treatment failure rate (2.6%) compared to single-level fixation or SI screw-only fixation (48.3%). When multilevel transsacral fixation cannot be achieved due to patient anatomy or injury, adjunctive fixation strategies should be considered. LEVEL OF EVIDENCE:Therapeutic Level III.
OBJECTIVES: To compare the clinical outcomes of plate fixation with and without coracoclavicular (CC) suture Endobutton augmentation in the management of displaced lateral clavicle fractures. METHODS: Design : Retrospective study. Setting: Tertiary referral hospital. Patient Selection Criteria: Included were adult patients with displaced lateral clavicle fractures (OTA/AO 15.3) who underwent plate fixation between June 2021 and April 2024. The Augmentation group received adjunctive suture Endobutton fixation, while the Control group did not. Outcome Measures and Comparisons: Clinical outcomes including union, coracoclavicular (CC) distance, infection, re-operation, and self-reported functional outcomes consisting of the Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) and numerical rating scale for pain (NRSP) were evaluated and compared between the two groups. To normalize for magnification, the ratio of CC distance to midclavicular width (CCD/MCW) was used to compare the CC distance over time. RESULTS: Forty-nine patients were included, 21 in the Augmentation group (76.2% male, mean age 47.5 years) and 28 in the Control group (75% male, mean age 46.6 years). In the Augmentation group, 15 patients (71.4%) underwent dual plating and 6 (28.6%) underwent single plate fixation. In the Control group, 15 patients (53.6%) underwent dual plating, 10 (35.7%) underwent single plate fixation, and 3 (10.7%) underwent hook plate fixation. The mean study follow-up was 33.7 months (range 4.2-118.6). Union was achieved in all patients (100%) in the Augmentation group, compared to 92.8% in the Control group (p = 0.19). Preoperative CCD/MCW ratios were 2.6 for the Augmentation group and 2.3 for the Control group (p = 0.12). Intraoperative ratios were reduced to 1.4 in both groups (p = 0.6), and maintained at 1.4 during follow-up (p = 0.3). There were no infections. Two patients (9.5%) in the Augmentation group and 7 patients (25%) in the control underwent hardware removal. The median QuickDASH score was 2.3 in both groups (p=0.7), and the median NRSP score was 0.0 in the Augmentation group and 0.5 in the control (p=0.3) CONCLUSIONS: In displaced lateral clavicle fractures, plate fixation with CC ligament suture Endobutton Augmentation achieved a 100% union rate, long-term CC stability, and excellent functional results. With the numbers available in the study, the lower (92.8%) healing rate in the control group without Endobutton Augmentation did not reach statistical significance. LEVEL OF EVIDENCE: A level IV therapeutic retrospective cohort study.
OBJECTVES:To detect early postoperative subclinical nerve injury in pediatric supracondylar humerus fractures and to identify associated risk factors. METHODS:Design: Prospective cohort study. SETTING:Single Level 1 trauma center. PATIENT SELECTION CRITERIA:Patients aged 1-12 yr with Gartland type III and IV supracondylar humerus fractures, normal preoperative and postoperative neurovascular examinations, and treated with closed reduction and percutaneous pinning (CRPP) between April 2024 and 2025 were included. OUTCOME MEASURES AND COMPARISONS:The primary outcome was electromyography (EMG)-detected axonal injury of the median, ulnar, or radial nerves, assessed within the first week after pin removal at 1 month postoperatively. Secondary outcomes included identification of surgical and radiographic risk factors for ulnar nerve injury. Multivariable logistic regression analysis was performed to determine independent predictors. RESULTS:A total of 73 pediatric patients (31 females and 42 males; mean age, 5.68 ± 2.35yr) were analyzed. EMG findings were normal in 74% (54/73) of patients. Axonal injury was detected in the ulnar nerve in 19.2% (14/73) of patients and in the median nerve in 6.8%(5/73), whereas no radial nerve injury was observed. Among the 14 patients with ulnar nerve injury treated with cross-pinning, the medial pin was positioned posteriorly in the sagittal plane in 85.7% (12/14) and in a inferior position in the coronal plane in 100% (14/14). Posteriorly and inferiorly positioned medial pin insertion sites were associated with significantly higher rates of ulnar nerve injury detected on EMG. (p = 0.024 and p = 0.037, respectively). Logistic regression analysis identified a posterior pin entry site in the sagittal plane as an independent risk factor (p=0.033; OR, 6.745; 95% CI, 1.16-39.00). Among patients with ulnar nerve injury, 71.4% (10/14) had an operative time exceeding one hour. In addition operative time was significantly longer in patients with ulnar nerve injury (p = 0.007). Interobserver agreement for radiographic measurements was excellent (intraclass correlation coefficient (ICC) = 0.864-0.897; 95% CI,0.807-0.907; p < 0.01). CONCLUSIONS:Subclinical ulnar nerve injury may occur in pediatric patients with clinically normal postoperative findings following CRPP. EMG detection suggests that injury is associated with a posterior-inferior medial pin entry site. Careful medial pin placement and minimizing operative time may reduce preventable technical risks during CRPP. LEVEL OF EVIDENCE:Level II, therapeutic study.
Objectives: Intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures; however, postoperative malalignment remains a relevant complication. Deviations in distal nail position can influence tibial alignment, and eccentric drilling during distal interlocking screw placement may alter fracture reduction and length. The purpose of this study was to quantify the effect of intentionally eccentric distal interlocking screw placement on tibial alignment in a controlled cadaveric model. Methods: Ten paired, formalin-fixed, human-cadaveric tibias underwent standardized IMN via suprapatellar approach following reaming of 1.5mm over nail diameter. A simulated comminuted distal tibia-fibula fracture was created using a 2-cm defect 4-cm proximal to the plafond. A 10mm IMN was then seated and secured with a 60mm interlocking screw, placed in the medial-to-lateral proximal oblique hole. Crossing K-wires were placed in the coronal and sagittal planes to serve as markers for angular and axial displacement. Using fluoroscopic “perfect-circles” technique, three surgeons performed standardized, intentional, eccentric-drilling with proximal-to-distal trajectory. Distal screw placement was performed in the medial-lateral plane, then removed and repeated in the anterior-posterior plane. Coronal and sagittal angulation and axial length were measured by digital goniometer and calipers following screw insertion, respectively. Results: For medial-lateral screws, proximal-to-distal eccentric drilling yielded a mean coronal angulation of 6.0° induced valgus (SD= 3.8°, R:1.5° min -12.2° max ). While for anterior-posterior screw placement, proximal-to-distal eccentric drilling yielded a mean of 5.8° procurvatum (SD = 2.0°, R: 2.8° min -8.5° max ). Translational distraction in the coronal plane was 3.0mm (SD = 2.2mm, R: 0.05mm min -7.8mm max ), and distraction in the sagittal plane was 3.9mm (SD = 3.0mm, R: 1.1mm min ,-9.8mm max ). Conclusion: Eccentric distal interlocking screw placement produced radiographically appreciable angular and axial changes in distal tibial IMN constructs. Deviations during the “perfect-circles” technique can generate malalignment, or alternatively, be used to fine tune reduction in theory. Precise distal screw trajectory and strategies to minimize drilling eccentricity may reduce postoperative malalignment, particularly in distal tibial fractures. Level of Evidence: Level V
OBJECTIVES: To compare nonunion surgery effectiveness for occult infected, aseptic, and septic nonunions in patients identified using the FRI criteria. METHODS: Design: Retrospective Review Setting: Single Level I Tertiary Academic Center Patients Selection Criteria: All skeletally mature patients over a 10-year period with nonunions and inflammatory labs at the time of index surgery were evaluated. Patients were classified using fracture-related infection (FRI) criteria as septic (SP) or aseptic. Aseptic patients were further stratified by intraoperative cultures into aseptic (AP, culture-negative) and occult infected (OP, culture-positive) groups. Exclusion criteria were pathologic fractures. Outcome Measure and Comparisons: Primary outcome measured was successful union after index nonunion surgery without need for additional surgical interventions. RESULTS: A total of 208 patients with nonunion fractures were included (OP: 29; AP: 125; SP: 54). Mean age was similar between groups (OP: 47.6 ± 21.2 years, range 19.9-79.9 years; AP: 54.5 ± 25.6 years, range 15.4-93.4; SP: 54.9 ± 23.5 years, range 16.5-81.3, p=0.854). Male sex distribution in occult infected patients, aseptic patients, and septic patients was 65.5%, 66.4%, and 46.3%, respectively (p=0.035). Occult infected patients had the highest rate of successful union after index surgery without need for additional operative intervention (79.3%), followed by aseptic patients (72.8%) and septic patients (50.0%) (p=0.004). Postoperative infections following index nonunion surgery were significantly lower in aseptic patients (16.0%) and occult infected patients (10.3%) compared to septic patients (35.2%) (p=0.005). CONCLUSIONS: Index nonunion surgery in septic patients, as defined by FRI criteria, was associated with worse outcomes compared to aseptic and occult infected patients. The success of surgery in occult infected nonunion is comparable to aseptic cases, suggesting that subclinical fracture related infection does not significantly compromise outcomes. LEVEL OF EVIDENCE: Prognostic Level III.
Background:Total hip arthroplasty (THA) is an effective procedure for relieving the symptoms of hip arthritis, with accurate component positioning being essential for optimal outcomes. Advances in robotic and navigation-assisted THA have introduced imaging protocols that incorporate standard radiographs, functional radiographs, and CT-based imaging. While these approaches improve surgical accuracy, they may also increase radiation exposure. This study aims to evaluate and compare radiation exposure associated with imaging modalities used in conventional, navigated, and robotic THA. Methods:A retrospective analysis of 104 patients was performed. Of these, 50 underwent Mako robotic-assisted THA, 23 underwent Corin OPS-assisted THA, 18 underwent conventional THA with standard AP radiographs, and 13 underwent lateral radiographic imaging. Imaging data were obtained from radiology records. Dose-length product (DLP) was recorded for CT scans and dose-area product (DAP) for radiographs. Effective doses (E) were calculated using specialised software, including the ImPACT CT Dosimetry Calculator and the PCXMC Dose Calculator. Statistical comparisons between imaging modalities were conducted using ANOVA testing, with statistical significance defined as p < 0.05. Results:The Mako CT protocol demonstrated a mean effective dose (E) of 8.3 mSv, while the Corin OPS CT protocol showed a lower mean E of 6.6 mSv. Functional radiographs used in the OPS pathway contributed an additional mean E of 0.73 mSv. Conventional AP and lateral radiographs were associated with the lowest mean E at 0.174 mSv. Conclusion:This study highlights the importance of monitoring and optimising radiation exposure in preoperative imaging for THA. The implementation of low-dose CT protocols and alternative imaging strategies may reduce radiation exposure while maintaining diagnostic accuracy. Further research and collaboration are required to develop standardised guidelines for radiation dose optimisation in THA.
OBJECTIVES:To evaluate the accuracy of time to union (TTU) in a cohort of patients after intramedullary nailing (IMN) of tibial shaft fractures where radiographic union was measured retrospectively with uncontrolled intervals between radiographs. METHODS:Design: Retrospective cohort. SETTING:A single Level I academic Trauma Center. PATIENT SELECTION CRITERIA:Included were adult patients (18 years and older) treated with IMN for an acute tibial shaft fracture (OTA/AO 42A, 42B, 42C) between January 2020 to January 2025 with at least 6 week and 12-week post-operative radiographic evaluations. Patients who required a reoperation to promote union were excluded. OUTCOME MEASURES AND COMPARISONS:The modified radiographic union scores for tibial fractures (mRUST) were determined at each post-operative radiographic follow-up. The observed TTU was defined as the days from IMN to radiographic union (defined as mRUST ≥ 12). Cohort median time intervals were determined for: the time from IMN to the radiograph immediately prior to union; the time between the radiograph prior to union and union, and the TTU. The inter-quartile range to median ratio (IQR:median) was calculated for these intervals to normalize the time interval ranges and was used to define accuracy. Accuracy was defined as follows: low accuracy = IQR:median ≥0.5; moderate accuracy = IQR:median 0.2-0.5; and high accuracy = IQR:median ≤0.2. A predicted TTU for the cohort was calculated by considering all mRUST scores from the entire cohort over time to estimate the time at which 50% of the population would be expected to achieve radiographic union. This was a way to account for the changing nature of mRUST scores with time in between clinical visits. To determine if the observed TTU over- or underestimated the predicted TTU, the predicted TTU was compared to the observed TTU by taking the difference between the two. RESULTS:89 patients with a mean age of 43.1 years (SD = 13.7 years) and 65.9% male were included. The median observed TTU was 96 days (mean 208.6, SD 363.8 days) with an IQR:median of 0.9, indicating low accuracy. The median time from surgery to the radiograph immediately prior to union was 47 days (mean 58.7, SD 37.3 days) with an IQR:median of 0.4 (moderate accuracy). The median time between the radiograph immediately prior to union and union was 49 days (mean 150, SD 358 days) with an IQR:median of 1.1 (low accuracy). The predicted TTU was 61.8 days. The observed TTU over-estimated TTU by 34.2 days. CONCLUSIONS:In patients treated with tibial IMN, retrospectively determining radiographic time to union (TTU) with uncontrolled interval radiographic evaluations was an inaccurate method to determine TTU. The observed TTU over-estimated a predicted TTU by 34.2 days. These findings highlight the inaccuracy of retrospectively determined TTU in orthopaedic clinical cohorts. LEVEL OF EVIDENCE:Level III.
OBJECTIVES:To compare 2 methods of initial immobilization of closed humeral shaft fractures-coaptation splinting followed by delayed functional bracing and immediate functional bracing-with respect to pain, satisfaction, and skin-related complications during the initial 10-day post-injury period. METHODS: DESIGN:Multicenter, randomized, two-arm, parallel clinical trial. SETTING:One academic medical center with 2 Level 1 academic trauma centers and 1 tertiary care orthopaedic center. PATIENT SELECTION CRITERIA:Patients with acute, closed humeral shaft fractures (AO/OTA 12A, 12B, 12C) were randomized to either initial coaptation splinting followed by delayed transition to Sarmiento bracing or immediate Sarmiento bracing. OUTCOME MEASURES AND COMPARISONS:Pain intensity over time measured by a patient-reported Likert scale (numerical rating scale, 0-10) once daily at the same time during the first 10 days post-injury, skin-related complications (skin damage ranging from abrasion or blistering to full-thickness skin loss secondary to pressure from the splint or brace), analgesic consumption in morphine milligram equivalent (MME), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores, and patient satisfaction. RESULTS:Fifty-eight patients were included in the analysis with a mean age of 48.8 ± 23.9 years (mean 50.5 years [range 18.4-92.2 years] in the coaptation splint group vs. mean 47.3 years [range 19.7-85.9 years] in the immediate Sarmiento brace group). Patients in the immediate Sarmiento bracing group reported significantly higher pain scores compared with coaptation splinting during the first 10 days postinjury (mean treatment effect = 0.97 points, 95% CI [0.26-1.69], P = 0.010; Figure 3). Cumulative opioid consumption over the 10-day period was similar between groups (median 20.0 MME for the coaptation splint group vs. 32.5 MME for the Sarmiento brace group, P = 0.308). PROMIS Physical Function scores were not significantly different between groups on postinjury day 7 (median 53.0 [IQR 44.5-68.5] for the splint group vs. 51.1 [IQR 45.0-60.5] for the brace group, P = 0.756). The rate of skin-related complications was higher in the Sarmiento brace group (33.3% vs. 7.1%, P = 0.022). Patient satisfaction scores at day 7 were not significantly different between groups (6.3 ± 2.7 for the coaptation splint group vs. 5.8 ± 3.1 for the Sarmiento brace group, P = 0.520). CONCLUSIONS:Immediate Sarmiento bracing was associated with increased patient-reported pain (roughly 1 point on the 0-10 numeric rating scale) and higher skin complication rates during the initial 10-day period after injury compared with initial coaptation splinting for acute humeral shaft fractures, without demonstrable benefits in function, analgesic requirements, or patient satisfaction. These findings support the traditional approach of initial coaptation splinting followed by delayed transition to functional bracing once acute swelling subsides. LEVEL OF EVIDENCE:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
SUMMARY:Transradial amputation of appropriate length preserves forearm rotation and facilitates prosthetic use; however, high rates of phantom limb pain and neuropathic medication use persist. This case describes a multidisciplinary approach to transradial amputation that integrates targeted muscle reinnervation, regenerative peripheral nerve interfaces, and bone and soft tissue management to optimize pain control and prosthetic success. A 29-year-old man with a severe ballistic injury and complex regional pain syndrome underwent transradial amputation with targeted muscle reinnervation and regenerative peripheral nerve interface. Limb length was preserved in accordance with prosthetic guidelines, and myodesis was performed to improve residual limb stability and myoelectric signal quality. This case highlights how nerve management and prosthetic-informed surgical planning optimizes functional outcomes and quality of life after traumatic transradial amputation.
SUMMARY:Displaced intra-articular calcaneal fractures disrupt hindfoot alignment and are associated with long-term morbidity. Although minimally invasive approaches reduce wound-related complications, they can limit reduction of a displaced calcaneal tuberosity. This report describes a 29-year-old man with a displaced intra-articular calcaneal fracture treated using a laterally applied femoral distractor to facilitate correction of coronal, sagittal, and axial malalignment while limiting soft-tissue disruption.
SUMMARY:This review details an open reduction internal fixation technique of a comminuted, intraarticular Y-type bicolumnar distal humerus fracture using supplemental minifragment plating in addition to dual locking plates. Owing to significant articular comminution, an olecranon osteotomy with an anconeus pedicle flap was used to facilitate exposure to achieve an accurate articular reduction to restore elbow function.
SUMMARY:This review describes intramedullary nailing of humeral shaft fractures through antegrade technique. The case involved a high-energy injury to the humerus in a patient with relevant comorbidities, and discusses the rationale for both surgery in general and nailing in specific. Indications for surgery, setup considerations unique to the lateral decubitus position, and intraoperative methods for avoiding complications are all discussed. A brief review of current relevant literature is included.
SUMMARY:This review describes an alternative hemiarthroplasty technique for high-risk patients using a direct lateral approach through the anterior one-third of the gluteus medius and vastus lateralis.
SUMMARY:Isolated ankle syndesmotic injuries are uncommon and are typically discussed in the context of athletic high ankle sprains; however, concomitant rupture of the posterior tibial tendon represents an exceedingly rare injury pattern. This case highlights the importance of maintaining a high index of suspicion for associated soft-tissue pathology in patients presenting with syndesmotic instability in the absence of fracture. This case underscores the need for comprehensive clinical and imaging evaluation of isolated syndesmotic injuries and supports primary tendon repair when rupture is identified.
SUMMARY:This review describes a case of chronic post-traumatic foot drop managed with posterior tibial tendon transfer through the interosseous membrane and percutaneous Achilles tendon lengthening. Key technical considerations and postoperative rehabilitation principles are highlighted. This approach provides a durable solution for restoring ankle dorsiflexion and improving ambulation in patients with irreversible peroneal nerve injury.
SUMMARY:Acromioclavicular joint injury reconstructive options include a wide number of described techniques. Although no single technique has consistently demonstrated superior clinical outcomes in the literature, there are theoretical biomechanical benefits to a combined reconstructive technique using cortical suture button and semitendinosus allograft. This review describes an acromioclavicular joint reconstruction using a cortical suture button and semitendinosus allograft.
SUMMARY:This abstract describes an open reduction and internal fixation technique used for a supination adduction ankle injury. This technique demonstrates medial plafond articular disimpaction with backfilling of the bony void with cancellous allograft. The medial malleolus was then fixed with a mini fragment plate in antiglide fashion with subchondral rafting screws. The lateral malleolus fracture was addressed with use of a retrograde screw rather than a fibular plate. This technique emphasizes the importance of both recognizing and addressing the anteromedial plafond impaction of supination adduction ankle fractures.
