The Seymour fracture is a “hidden” open physeal injury of the pediatric hallux that requires a high degree of clinical suspicion. We report a 6-year-old male with a one-week delayed presentation of a stubbed great toe, initially misdiagnosed as a minor soft tissue injury. Clinical signs of eponychial bruising and nail avulsion, combined with radiographic widening of the physis, confirmed a Salter-Harris Type I injury. The patient underwent irrigation, debridement of the incarcerated germinal matrix, and K-wire stabilization. The patient achieved complete union without infection, growth arrest, or nail dystrophy. This case emphasizes that aggressive surgical management is essential to prevent permanent deformity in these injuries. Level of Evidence : Level 4.
Varus ankle osteoarthritis typically develops as a result of chronic malalignment and asymmetric medial loading of the tibiotalar joint. Supramalleolar osteotomy (SMO) is a joint-preserving procedure that improves ankle alignment and rebalances tibiotalar contact pressures, thereby relieving symptoms; however, it can be limited by delayed union or nonunion, especially in large opening wedge corrections or in patients with poor bone quality. The Jung Sandwich Bone Graft Technique was developed to enhance osteotomy stability through combined mechanical and biological augmentation. The technique combines a medial opening wedge SMO with a fibular valgization osteotomy. A layered “sandwich” graft construct is composed of 2 femoral head allograft wedges with a bone morphogenetic protein (BMP)-infused hydroxyapatite/β-tricalcium phosphate scaffold in between them. This construct is inserted into the osteotomy gap and fixed with a precontoured anatomic medial locking plate. Follow-up radiographs have demonstrated adequate correction and reliable union typically observed within ∼12 weeks. By combining both immediate structural support and biological stimulation, this technique is designed to address factors associated with delayed healing after conventional SMO, further refining this joint-preserving option for treating varus ankle osteoarthritis. Level of Evidence: Level 5.
Symptomatic accessory navicular is a recognized cause of medial foot pain, particularly in patients with type II morphology and its close relationship to the posterior tibial tendon. Although various surgical techniques, including simple excision and the Kidner procedure, have been described with generally favorable outcomes, no single technique has demonstrated clear superiority. Moreover, traditional approaches often overlook the biological characteristics of the bone bed following excision. We describe a novel cortical-preserving technique designed to optimize the biological environment of the navicular bone and the tendon insertion site. In this method, a thin cortical layer is first created over the accessory navicular and navicular prominence using a flat osteotome before resection. The accessory navicular is then removed en bloc, and the exposed medullary surface of the navicular is prepared to receive the previously created cortical layer. This cortical fragment is repositioned as a “cortical cap,” covering the medullary bone surface. Fixation is achieved using a suture anchor placed into the medullary canal, with sutures passed through both the cortical fragment and the posterior tibial tendon, allowing simultaneous stabilization and tendon reattachment. This technique aims to reduce medullary bone exposure, preserve cortical continuity, and enhance the biological conditions for tendon-to-bone healing. It represents a biologically oriented modification of existing surgical approaches and may provide theoretical advantages in tissue healing and postoperative recovery. Level of Evidence: Level V.
The medial closing wedge osteotomy of the proximal phalanx, known as the Akin osteotomy, is a commonly utilized procedure to help achieve hallux valgus (HV) deformity correction. With developments in surgical instrumentation, the option to perform osteotomies percutaneously has grown in popularity. We analyzed radiographic alignment of prospectively enrolled subjects that underwent percutaneous Akin osteotomy fixation with a single screw as an adjunct to first metatarsal osteotomy. Over 2 years, 86 Akin osteotomies were performed on 83 patients. Average follow-up was 68 (range: 43 to 151) weeks. IPA changed by median −5.0 (IQR: −7.5 to 0.5) degrees ( P <0.001). PDPAA changed by median −4.0 (IQR: −7.5 to 0.0) degrees ( P <0.001). Toe separation increased by median 5 (IQR: 3 to 7) mm ( P <0.001). There were no proximal phalangeal nonunions and incremental improvement in HV deformity correction was maintained. Patients who underwent minimally invasive Akin osteotomy with 2.5 mm cannulated fully-threaded screws improved in radiographic and clinical alignment. Complication rates were low, and incremental improvement in HV deformity correction was maintained. Level of Evidence: Level III—nonrandomized prospective cohort study.
End-stage ankle osteoarthritis is a debilitating condition that significantly impacts patient function and quality of life. Total ankle arthroplasty (TAA) has emerged as an alternative to arthrodesis, offering pain relief while preserving joint mobility. However, its outcomes in younger patients remain controversial due to concerns regarding implant survival and revision rates. This study evaluates the functional outcomes of TAA in patients ≤50 years compared with those >50 years. A retrospective cohort of 32 patients was analyzed, with functional assessment based on the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Foot Function Index (FFI). The median follow-up period was 4.1 years in the younger cohort and 4.4 years in the older cohort. Both groups demonstrated statistically significant postoperative improvements in pain and function ( P <0.05). Prosthesis revision was more frequent in patients ≤50 years, whereas all forms of reoperations were more common in those >50 years. Despite differences in complication profiles, overall functional outcomes were comparable. These findings support TAA as a viable surgical option across age groups, with younger patients demonstrating satisfactory functional results despite a higher revision rate. Adequate patient selection and long-term surveillance remain critical for optimizing outcomes. Level of Evidence: Level III.
