Background Bilateral computed tomography (CT) accounts for patient-specific anatomical variation in postoperative syndesmotic assessment, but unilateral CT remains common. Methods This retrospective single-center cohort study included 144 patients who underwent ankle fracture fixation with syndesmotic stabilization and postoperative bilateral low-dose CT. Paired unilateral and bilateral classifications based on validated CT criteria were compared using McNemar’s test. Results Classification differed in 21 of 144 cases (14.6%). Relative to bilateral assessment, unilateral CT overestimated malreduction in 17 cases (11.8%) and missed malreduction in 4 cases (2.8%). Interobserver agreement was substantial (κ = 0.795). Conclusions Unilateral CT more often classified syndesmotic reduction as malreduced than bilateral CT. Bilateral low-dose CT may improve interpretation when revision surgery is being considered. Levels of Evidence Level III
BACKGROUND:Fourth-generation minimally invasive techniques for hallux valgus correction have demonstrated positive clinical outcomes. However, incorporation into orthopaedic training remains unexplored. This study evaluated whether orthopaedic trainees, operating under direct supervision of an experienced MIS surgeon, achieve comparable outcomes to consultant-performed procedures. METHODS:A retrospective study of 100 MIS hallux valgus corrections compared consultant-performed (n = 50) and trainee-performed (n = 50) groups. Radiographic parameters (HVA, IMA, DMAA) and PROMs (MOXFQ, EQ-5D-5L) were compared. RESULTS:47 consultant and 49 trainee procedures were analysed. Both groups demonstrated significant improvement in all radiographic parameters, MOXFQ and EQ-5D-5L index (P < 0.01). No significant differences were observed between consultant- and trainee-performed groups for postoperative HVA, IMA, MOXFQ, or EQ-5D-5L scores (P > 0.05). Complication rates were comparable (12 each, P > 0.05). CONCLUSION:Trainees performing MIS hallux valgus correction under direct supervision achieved comparable radiographic correction, patient-reported outcomes, and complication rates to those of a consultant surgeon. LEVEL OF EVIDENCE:Level III, Comparative study.
BACKGROUND:The aim of this study is to present early outcomes following revision of failed TAA using a low-profile, transfibular TAA prosthesis. METHODS:This was a retrospective review of 11 ankles (11 patients; average 72.1 years-old) who underwent revision TAA using the transfibular trabecular metal (TM) prosthesis. Modes of failure included aseptic loosening/subsidence (n = 7) and periprosthetic joint infection (PJI, n = 4). Demographic, radiographic, and patient-reported outcomes were analyzed at minimum 2-years. RESULTS:Average time to revision TM TAA was 9 years (range, 2-22), All 4 cases with PJI were successfully treated with two-stage revision. There was significant improvement in VAS and AOS Pain (both p < 0.05). Mean coronal (90.7°) and sagittal (86.1°) alignment were within normal limits. There was 1 (9%) revision, 4 (36%) reoperations. CONCLUSION:In select patients with failed TAA who wish to avoid fusion or amputation, revision arthroplasty using a transfibular approach may be a possible alternative. LEVEL OF EVIDENCE:IV, Case-Series.
PURPOSE:Lisfranc injuries are bony and ligamentous disruptions of the tarsometatarsal joint complex associated with significant morbidity, and several aspects of their management remain controversial. To our knowledge, no citation analysis dedicated to Lisfranc injuries has been published. METHODS:The Web of Science Core Collection was searched on May 1, 2026. After document-type and language filters, articles were sorted by citation count, and two reviewers screened the top 100 records to identify the 50 most-cited articles primarily focused on Lisfranc injuries. RESULTS:The 50 articles accumulated 4911 citations (mean 98.2 ± 51.5; range 49-274) and were published between 1973 and 2020. Foot & Ankle International was the most prolific journal (28%), and the United States contributed 64% of articles. Eighty percent were Level IV-V evidence; only 6% were Level I-II. CONCLUSION:Higher-quality comparative trials are needed to address persistent controversies, particularly regarding optimal surgical management. LEVEL OF EVIDENCE:Level V (bibliometric analysis).
BACKGROUND:This study uses time-driven activity-based costing (TD-ABC) to compare the cost and efficiency of a 2.0 disposable needle arthroscope to a reusable 2.7-mm arthroscope in anterior ankle arthroscopy. METHODS:This prospective, hand-timed cohort study of 60 anterior ankle arthroscopy procedures (needle=41, traditional=19) with retrospective cost review calculated procedure and OR turnover costs at a single institution from 2021 to 2023. RESULTS:Needle arthroscopy demonstrated significantly shorter OR turnover time (28.53 vs 35.65 min, p = .021), incision to joint space time (1.06 vs 2.14 min, p = .007), and total arthroscopic time (12.58 vs 16.87 min, p = .023). Total costs were not significantly different ($1891.91 vs $1957.74, p = .546). Excluding OR turnover costs, traditional arthroscopy was less costly ($669.23 vs $850.78, p < .001). CONCLUSION:Needle arthroscopy was more time efficient with no significant cost difference, offering surgeons a useful option to increase the efficiency of ankle arthroscopy and OR turnover.
BACKGROUND:This study compared pediatric and adult Charcot-Marie-Tooth (CMT) foot deformities using radiologic and clinical data and evaluated the relationship between age and deformity severity. METHODS:Sixty-eight CMT patients were retrospectively analyzed and divided into pediatric (< 18 years, n = 19) and adult (n = 49) groups. 3D measurements from foot weightbearing CT scans were obtained. Clinical outcomes were assessed using PROMIS scores. RESULTS:Adults showed significantly higher Meary's angle (10.9° vs. -5.9°, P = .002) and talonavicular angles (2.4° vs. -11.7°, P < .001) than pediatrics. Pediatric patients demonstrated higher Saltzman view angles (40.8° vs. 21.4°, P = .003). Adults showed higher PROMIS Pain Interference scores (58.8 vs. 52.6, P = .031). Age showed a positive correlation with sagittal Meary's angle, talonavicular angle, and Pain Interference score, and a negative correlation with the Saltzman view angle. CONCLUSION:The adult patients exhibited a higher arch and more pain interference, whereas the pediatric patients showed greater midfoot adduction and hindfoot varus. LEVEL OF EVIDENCE:Level IV.
BACKGROUND:Hallux rigidus causes first metatarsophalangeal joint pain and limitation. Decompressive first metatarsal osteotomy (DCO) aims to improve joint biomechanics and preserve motion whilst avoiding arthrodesis. METHODS:A PRISMA-compliant systematic review of MEDLINE and Cochrane was conducted, assessing patient-reported outcomes and complications. RESULTS:Thirty studies (n = 1293 feet) met inclusion criteria (44-month follow-up). Youngswick osteotomy was commonest (33.3%); 76.7% had concomitant cheilectomy performed. Mean improvements: AOFAS 41 points, VAS 5 points, range of motion 26 °. Most studies showed moderate to serious risk of bias. CONCLUSION:DCO combined with cheilectomy may improve outcomes in selected patients with early/moderate hallux rigidus. The evidence is predominantly low-quality observational data, and concomitant cheilectomy in most studies confounds the independent benefit of the osteotomy, with outcomes comparable to published cheilectomy series. Patient selection is critical, with greatest benefit likely in grade II-III disease and a long / elevated first metatarsal or functional hallux limitus.
BACKGROUND:This study evaluated sex differences in radiological lesion characteristics in patients with primary OLTs. MATERIALS AND METHODS:This cross-sectional study included patients with symptomatic primary OLTs. Lesion size, location, and morphology were assessed using computed tomography. Sex differences were evaluated using univariable analyses and multivariable regression analyses adjusted for patient height and lesion etiology. RESULTS:94 female and 156 male patients were included. Male patients presented with larger OLTs across all dimensions compared with female patients (p ≤ 0.01). After adjustment for patient height, these differences were no longer statistically significant. Lesion morphology differed by sex, with females demonstrating higher odds of crater-type lesions (OR 2.5, 95%CI 1.1-5.9). CONCLUSION:Sex differences in OLT size were attributable to talar dimensions rather than intrinsic sex-related factors. Females presented more frequently with crater lesions than males. Therefore, patient size and sex-specific morphological patterns should be considered in OLT treatment decision-making. LEVEL OF EVIDENCE:Level III, cross-sectional cohort study.
BACKGROUND:Pilon fractures are complex intra-articular injuries of the distal tibia often caused by high-energy trauma. Although ORIF remains the gold standard for restoring alignment and joint congruity, the influence of patient age on clinical and radiographic outcomes remains unclear. This study aimed to compare healing, complication rates, and functional outcomes between patients below and above 40 years old following ORIF of Pilon fractures. MATERIALS AND METHODS:A prospective comparative study was conducted on 56 tibial Pilon fractures in 55 patients. Patients were stratified into two groups according to age: < 40 years (35 fractures) and ≥ 40 years (21 fractures). Functional outcomes were assessed using the AOFAS and Olerud-Molander scores. Radiographic union, alignment, and complications rates were assessed in both groups. RESULTS:Among 56 included patients, both age groups showed comparable demographics and fracture characteristics. Falls were the most common mechanism of injury, followed by MVA. All fractures healed successfully, with a mean union time of 15.1 ± 2.7 weeks and no significant difference between both groups. Functional outcomes (AOFAS and OMS) were comparable between groups without statistical significance. Although postoperative complications were more frequent in older patients (47.6% vs. 22.9%), no significant difference was detected and no nonunion or implant failure occurred. CONCLUSION:Age did not significantly influence healing or functional outcomes after ORIF of Pilon fractures. Despite slightly longer union time and a higher rate of complications in older patients, both groups achieved comparable recovery. These findings suggest that satisfactory outcomes can be achieved across different age groups when appropriate staged management and fixation principles are applied. LEVEL OF EVIDENCE:Level 4.
