Background Accurate component positioning remains a critical technical objective in total ankle arthroplasty. Conventional two-dimensional measurements may not fully characterize deviations between the preoperative plan and achieved implant position. This study quantified planned-versus-achieved implant positioning after patient-specific instrumentation-assisted total ankle arthroplasty using a three-dimensional CT-based registration method and validated the precision and accuracy of the registration workflow. Methods We retrospectively analyzed 95 patients who underwent primary patient-specific instrumentation-assisted total ankle arthroplasty using a single implant system. Preoperative implant plans were compared with postoperative CT reconstructions using three-dimensional surface registration. Translational and rotational deviations were calculated for the tibial component, and rotational deviations were assessed for the talar component. Systematic directional bias was evaluated using signed measurements. A cadaveric validation experiment with 11 fresh-frozen below-knee specimens was performed using bead-based registration as the reference standard. Results For the tibial component, median absolute translational deviations were 0.86, 0.95, and 1.16 mm along the mediolateral, anteroposterior, and proximodistal axes, respectively; 71 of 92 components were within 3 mm in three-dimensional displacement. Median rotational deviations were approximately 3° in the axial plane, 1.5° in the coronal plane, and 4° in the sagittal plane. Signed measurements demonstrated a systematic anterior tilt of approximately 4° in the sagittal plane. The registration method showed a translational precision of 0.03 mm, rotational precision of 0.25°, and mean three-dimensional translational error of 0.24 mm relative to the bead-based reference. Conclusions Patient-specific instrumentation-assisted total ankle arthroplasty achieved small translational deviations from the preoperative plan, but a consistent sagittal-plane anterior tilt bias was identified. Three-dimensional CT-based registration provides a reproducible framework for quantifying planned-versus-achieved implant positioning after arthroplasty. Level of Evidence: Level III, retrospective cohort study.

Abstract Objective To evaluate the efficacy of external fixation in treating rigid equinus deformity associated with fibro-adipose vascular anomaly (FAVA). Methods This retrospective study included five patients (four males, one female; mean age 19.4 ± 5.6 years) with FAVA-related rigid equinus who underwent external fixation between January 2021 and August 2023. Three patients were treated with the Ilizarov apparatus and two with the Taylor Spatial Frame. Radiological outcome was measured by the anterior tibiotalar angle (TTA) on weight-bearing lateral radiographs. Functional assessments included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, weight-bearing Visual Analog Scale (VAS) for pain, and patient satisfaction using a Likert scale. Results The overall follow-up duration was 46.6 ± 13.2 months. The first assessment was performed at a mean of 20.6 ± 13.2 months and the second at a mean of 46.6 ± 13.2 months. At the first assessment, peak ankle dorsiflexion improved significantly from − 43.4 ± 10.4° preoperatively to 4 ± 6.5° ( P < 0.05); TTA improved from 145.0 ± 18.3° to 106.8 ± 3.0° ( P < 0.05); and AOFAS score increased from 63.6 ± 4.6 to 75.8 ± 8.0 ( P < 0.05). Weight-bearing VAS changed from 2 ± 1.2 to 0.8 ± 0.8 ( P > 0.05). At the second follow-up, AOFAS score was 77.2 ± 12.1 ( P < 0.05 vs. preoperative) and VAS was 1.4 ± 0.5 ( P > 0.05 vs. preoperative). The patient satisfaction rate was 80%. Two patients experienced mild recurrence and one patient had severe recurrence. Conclusion Gradual correction of rigid equinus deformity secondary to FAVA using external fixation is safe and yields satisfactory short- to mid-term outcomes, providing valuable evidence for the management of this rare condition.

Background: Solely relying on the tibial ankle surface (TAS) angle for determining the mechanical ankle axis might be insufficient. We introduce a novel method to determine the distance from the center of the talus to the tibial axis (TTD). This study aimed to investigate the association between clinical outcomes and radiological changes before and after supramalleolar osteotomy (SMO), including TAS angle, talar tilt (TT) angle, tibiotalar surface (TTS) angle and TTD. Methods: Seventy patients who received SMO were enrolled. Radiological changes were measured using weight-bearing anteroposterior imaging. The percentage of talar center displacement (TTDP) was calculated as the difference between postoperative and preoperative TTD, divided by talar width (TW). Clinical assessments were performed using the American Orthopedic Foot and Ankle Society ankle-hindfoot (AOFAS) scale. Differences in the aforementioned indicators before and after the operation were analyzed. We defined AAOFAS, ATAS, ATT and ATTS as the difference between postoperative and preoperative values. Results: ATTS correlated with AAOFAS (r = 0.40, p = 0.008), as did TTDP (r = 0.32, p = 0.035). No correlation was observed between AAOFAS and ATAS. In the comparison between groups, patients with a TTDP greater than 26.19 exhibited a significantly greater AAOFAS. The high intraclass correlation coefficient indicated good reliability of the novel method. Conclusion: Solely relying on the TAS angle for tibial correction was insufficient. We found TTD as a novel method to evaluate mechanical ankle joint axis. TTDP and ATTS both positively correlated with AAOFAS, indicating the usefulness of these radiologic parameters. (c) 2024 European Foot and Ankle Society. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

ObjectiveSurgical technique in distraction osteogenesis for the treatment of brachymetatarsia can influence the final prognosis. However, there are currently no standardized guidelines for surgical procedures and complication management. The aim of this study is to investigate the effect of bone lengthening with external fixation by minimally invasive osteotomy based on Ilizarov technique in the treatment of congenital brachymetatarsia.MethodsA retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening, from June 2017 to December 2020. There were 11 patients with 17 shorted fourth metatarsals, including 10 females and 1 male, with age of 24.6 ± 4.5 years (16–31 years). Six patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth MTP joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal‐interphalangeal (MTP‐IP) scores, metatarsal length, complications were recorded. Statistical comparison was performed using the paired t‐student test for pre‐ and postoperative AOFAS MTP‐IP scores.ResultsPatients were followed up for 55 ± 10.8 months. The mean length of the fourth metatarsal bone was 49.9 ± 2.9 mm preoperatively. The mean metatarsal shortage was 18.8 ± 3.1 mm. The mean lengthening achieved was 19.8 ± 3.3 mm, with a lengthening ratio of 39.7% ± 6.6%. The lengthened callus ossified completely at 3–4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 83.7 ± 4.2 preoperatively to 93.2 ± 2.7 postoperatively (t = −10.27, p < 0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes.ConclusionMetatarsal lengthening by minimally invasive osteotomy with external fixator had satisfactory results in the treatment of congenital brachymetatarsia.

Objective: To study the application effect of the Enhanced Recovery After Surgery (ERAS) model in patients undergoing spinal fracture surgery. Methods: A randomized controlled trial was designed, and 86 patients undergoing spinal fracture surgery were randomly divided into the ERAS group and the conventional care group. Postoperative recovery outcomes of the two groups were compared. Results: The ERAS group showed better outcomes in terms of postoperative pain scores, activities of daily living, length of hospital stay, and adherence to rehabilitation training compared to the conventional care group, with shorter hospital stays and lower medical expenses (P < 0.05). Conclusion: The ERAS model significantly improves the postoperative recovery quality of patients undergoing spinal fracture surgery, reduces hospital stay and medical costs, and increases patient satisfaction.

Objective: To study the effect of diversified rehabilitation nursing on the postoperative recovery of patients with thoracolumbar osteoporotic fractures after PKP. Methods: The recovery of patients in the new group (diversified rehabilitation nursing) was compared with that of the traditional group (standard nursing). Results: The new group showed better performance in pain control, activity ability, quality of life, length of hospital stay, and complications. Conclusion: Diversified rehabilitation nursing effectively promotes postoperative recovery after PKP and reduces the risk of complications.

Objective Distal tibial deformities can significantly impact patients if left uncorrected, often leading to pain, alterations in gait, and the eventual development of post‐traumatic arthritis. The criteria for surgical correction in these patients continues to be a subject of debate, while supramalleolar osteotomy (SMO) is an effective method for correcting distal tibial deformities. The purpose of this study was to evaluate and compare the clinical results of SMO using internal fixation or using computer‐assisted hexapod external fixator in the treatment of distal tibial deformity. Methods A retrospective study was conducted on 290 patients who underwent SMO between June 2015 and January 2023. Forty‐four patients met the inclusion and exclusion criteria. Among the participants, 19 underwent SMO combined with a computer‐assisted hexapod external fixator, while 25 received SMO with plate and screw internal fixation. The tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, the tibiotalar (TT) angle and the talocrural (TC) angle were assessed on weight‐bearing X‐ray films. Functional assessments were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle‐hindfoot score. Results The study followed patients for an average duration of 31.7 ± 15.3 months, with a range from 12 to 67 months. Successful bone union was achieved in all cases. For patients treated with the computer‐assisted hexapod external fixator, significant improvements were observed: the mean deviation in sagittal plane deformity parameters decreased from 14.3 ± 10.4 degrees preoperatively to 2.8 ± 3.8 degrees postoperatively (p < 0.05). Similarly, coronal plane deformity parameters showed a reduction from 25.9 ± 22.5 degrees preoperatively to 5.9 ± 11.0 degrees postoperatively (p < 0.05). The AOFAS ankle‐hindfoot score improved markedly from 66.0 ± 14.9 to 86.1 ± 11.7 points (p < 0.05). For patients undergoing internal fixation, the absolute difference in coronal plane parameters improved from 15.4 ± 12.6 degrees preoperatively to 3.7 ± 3.4 degrees postoperatively (p < 0.05). A significant enhancement in AOFAS ankle‐hindfoot score was also noted, increasing from 68.3 ± 14.3 points to 79.4 ± 13.5 points (p < 0.05). There were no significant differences in gender, side, follow‐up time, postoperative deviation of deformity, pre‐ or postoperative AOFAS between the two groups. Conclusion In conclusion, comprehensive preoperative planning of SMO combined with either internal fixation or a hexapod external fixator for treating distal tibial deformities can achieve satisfactory outcomes. The utilization of a computer‐assisted hexapod external fixator facilitates a gradual and precise correction process, which proved to be an effective and relatively safe method.

ObjectivesThe occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one‐stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis.MethodsA retrospective consecutive case‐series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one‐stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle‐hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow‐up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle‐hindfoot score and VAS pain score between preoperative measures and those at the final follow‐up were conducted using paired t‐tests or paired Wilcoxon rank‐sum tests.ResultsThe study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26–75) at the time of surgical intervention. At the final follow‐up (mean, 26.5 months; range, 16–48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12–57) to 80.0 (range, 54–92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4–9) to 0 (range, 0–5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%.ConclusionOne‐stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.

Objective: To explore the construction and application effect of a postoperative nursing intervention program for osteoporotic vertebral compression fractures. Methods: A total of 68 cases of osteoporotic vertebral compression fractures treated with vertebroplasty in our hospital from March 2023 to April 2024 were selected and randomly divided into the control group and the constructed program group, with 34 cases in each group. The control group received routine postoperative nursing after vertebroplasty, while the constructed program group was provided with a targeted postoperative nursing intervention program based on the control group, which was implemented postoperatively. The postoperative outcomes and thoracolumbar dysfunction of the two groups were compared. Results: The total postoperative efficacy rate in the constructed program group (97.06%, 33/34) was significantly higher than that in the control group (76.47%, 26/34) (P < 0.05). The thoracolumbar dysfunction score in the constructed program group (15.02 ± 1.36) was significantly lower than that in the control group (22.56 ± 2.41) (P < 0.05). Conclusion: Constructing a targeted nursing intervention program based on the postoperative nursing requirements for osteoporotic vertebral compression fractures and individual patient characteristics can effectively improve thoracolumbar dysfunction and enhance the postoperative surgical outcome. The clinical application of this program is reliable.

This study examined the effects of Kartogenin (KGN), a small molecule compound, on intervertebral disc degeneration (IDD) cells of varying degrees. Human nucleus pulposus (NP) cells were isolated from tissues with different levels of degeneration, and the influence of KGN on cell viability, senescence, extracellular matrix (ECM), and matrix metalloproteinases (MMPs) production was investigated. Mild and severe degeneration of NP cells was induced using IL-1 β . KGN increased cell viability in naturally regressive NP cells, particularly in severely regressive cells. It had no effect on healthy NP cells but promoted collagen II, aggrecan, and proliferation while decreasing p16, p21, p53, collagen I, MMP3/9, and apoptosis in naturally regressive NP cells, especially at advanced degeneration stages. Furthermore, KGN effectively prevented IL-1 β -induced NP degeneration, particularly at a 10 ng/mL dose. KGN delayed NP cell degeneration, with a greater impact observed at later degeneration stages. Therefore, KGN shows potential for repairing IDD in advanced stages, but higher doses should be considered for early-stage IDD.

Osteoporosis disproportionately affects older women, yet gender differences in human osteoblasts remain unexplored. Identifying mechanisms and biomarkers of osteoporosis will enable the development of preventative and therapeutic approaches. Transcriptome data of 187 osteoblast samples from men and women were compared. Differentially expressed genes (DEGs) were identified, and weighted gene co-expression network analysis (WGCNA) was used to discover co-expressed modules. Enrichment analysis was performed to annotate DEGs. Preservation analysis determined whether modules and pathways were similar between genders. Blood methylation, transcriptome data, mouse phenotype data, and drug treatment data were utilized to identify key osteoporosis genes. We identified 1460 DEGs enriched in immune response, neurogenesis, and GWAS osteoporosis-related genes. WGCNA uncovered 8 modules associated with immune response, development, collagen metabolism, mitochondrion, and amino acid synthesis. Preservation analysis indicated modules and pathways were generally similar between genders. Incorporating GWAS and mouse phenotype data revealed 9 key genes, including GMDS, SMOC2, SASH1, MMP2, AHCYL1, ARRDC2, IGHMBP2, ATP6V1A, and CTSK. These genes were differentially methylated in patient blood and differentiated high and low bone mineral density patients in pre- and postmenopausal women. Denosumab treatment in postmenopausal women down-regulated 6 key genes, up-regulated T cell proportions, and down-regulated fibroblast proportion. qRT-PCR was used to confirm the genes in postmenopausal women. We identified 9 key osteoporosis genes by comparing the transcriptome of osteoblasts in women and men. Our findings' clinical implications were confirmed by multi-omics data and qRT-PCR, and our study provides novel biomarkers and therapeutic targets for osteoporosis diagnosis and treatment.

ObjectiveThis study was performed to compare the clinical effect of arthroscopic debridement vs. arthroscopic microfracture in the treatment of osteochondral lesions of the talus.MethodsWe retrospectively reviewed patients with osteochondral lesion of talus who were admitted to our hospital from April 2020 to April 2021. The patients were divided into Group A (arthroscopic debridement group, n = 39) and Group B (arthroscopic microfracture group, n = 42), and the intraoperative details in the two groups were analyzed. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were compared between the two groups before surgery and at the last follow-up.ResultsThe postoperative AOFAS score (Group A, 40.9–82.26; Group B, 38.12–87.38), VAS score (Group A, 6.44–3.92; Group B, 6.38–2.05) significantly improved in both groups, but the improvement was significantly greater in Group B than in Group A (P < 0.05). Among all patients, the AOFAS and VAS scores of men aged ≤30 years and patients with a low body mass index (BMI) improved more significantly (P < 0.05).ConclusionThe arthroscopic microfracture for the treatment of osteochondral lesion of talus is superior to joint debridement in terms of improving ankle function, especially in relatively young men with a relatively low BMI.

Collision tumors are less encountered in spine. Especially meningioma co-exist with lung cancer has rarely been report in the spine. The authors present a case of a 65-year-old male who presented with 2 weeks of intermitting cervical pain radiating to right upper limb. MRI revealed an intradural, extramedullary enhancing mass at C2. The mass was successfully resected surgically. Pathologic evaluation revealed a meningioma with components of metastasis from small cell lung cancer. To the authors' knowledge, this is the first case of collision tumor involving metastasis from small lung cell cancer with co-exist spinal meningioma described in an extramedullary location.

Objective:To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis. Methods:A clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed. All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy. The osteotomies were fixed with the new minimally invasive plate. There were 7 males and 8 females with an average age of 49.8 years (range, 16-71 years). The causes of ankle arthritis included post-fracture deformity in 1 case, sprain in 8 cases, and acquired clubfoot in 1 case; and 5 cases were without obvious factors. The disease duration ranged from 1 to 12 years, with an average of 4.1 years. Comparisons were made between pre-operation and the last follow-up in the Takakura staging, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, foot function index (FFI), visual analogue scale (VAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT). Results:All incisions healed by first intention. All patients were followed up 7-18 months (mean, 12.8 months). At last follow-up, the AOFAS ankle-hindfoot score, FFI, VAS score, and Takakura staging significantly improved when compared with the preoperative ones ( P<0.05). X-ray films showed that the osteotomy healed at 3 months after operation. At last follow-up, TAS significantly increased and TT decreased when compared with the preoperative ones ( P<0.05), and the difference in TLS between pre- and post-operation was not significant ( P>0.05). Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot. None of the patients complained of significant discomfort at the plate placement during follow-up, and no loosening of the internal fixator occurred. Eleven patients were very satisfied with the effeectiveness, while 4 were relatively satisfied. Conclusion:The new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain, correcting deformity, improving limb alignment and ankle function, and reducing the incidence of postoperative incisional complications.

Purpose This study aimed to evaluate the clinical outcomes, patient-reported outcomes, and recurrence rate of patients diagnosed with ankle gouty arthritis who underwent arthroscopic surgery based on the new classification. Methods A total of 51 patients diagnosed with ankle gouty arthritis were included in this retrospective study. A new classification was proposed based on the location and extent of MSU crystal deposition under an arthroscopy view. Patients are classified into different types and underwent arthroscopic surgery accordingly. The primary outcome measure was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. The secondary outcomes included the visual analog pain scale (VAS), serum uric acid levels, and the recurrence rate of ankle gouty arthritis at one year postoperatively. Results Based on the new classification, five patients were Type I, 24 patients were Type II, five were Type III A, six were Type III B, and 11 were Type IV. The average follow-up time was 23.5 ± 10.9 months. The AOFAS hindfoot-ankle score improved significantly from 70.3 ± 15.9 to 85.6 ± 13.0 ( p < 0.01). The mean serum uric acid level was significantly decreased from 442.0 ± 109.2 to 540.5 ± 132.4 ( p < 0.01). The average VAS scale decreased from 3.8 ± 1.9 to 1.4 ± 1.7 ( p < 0.01). The median of recurrences in one year postoperatively was significantly decreased from 1.5 (1, 3.75) to 0 (0, 0.75) ( p < 0.01). Conclusion A new classification strategy for ankle gouty arthritis based on arthroscopic view was proposed. Patients with ankle gouty arthritis showed significant improvement in ankle function and pain relief after undergoing arthroscopic surgery driven by the new classification.

BackgroundCharcot neuroarthropathy (CN) is a severe disease that primarily affects the foot and ankle. Conservative treatment with total contact casts is suitable for early stages, but surgery is necessary for complications such as ulceration, malalignment, infection, or severe pain. The ankle instability caused by excessive axial load may require arthrodesis. However, preserving joint function in young patient can significantly enhance the quality of life.Case reportA 33-year-old woman underwent open reduction and internal fixation after the right tibia and fibula fractures following a fall while walking. She developed severe pain and deformity in her right ankle after full weightbearing. After further evaluation, she was diagnosed with Charcot neuroarthropathy (CN) of the right ankle. The patient declined arthrodesis and opted for a supramalleolar osteotomy (SMO) instead 18 months after the initial surgery. The SMO procedure involved correcting the hindfoot malalignment through osteotomy and fixation. Although she experienced skin necrosis, the patient eventually achieved satisfactory outcomes with improvements in pain, deformity, and functionality of the ankle. Radiographic measurements showed positive realignment, and the patient reported a significant improvement in her quality of life at the final follow-up.ConclusionsThe SMO procedure could potentially be considered as an option to preserve ankle function and delay the disease development of CN for young patients. The restored foot stability and hindfoot alignment can help improve patients' quality of life.

Introduction To date, long-term safety including functional outcomes of transanal natural orifice specimen extraction surgery (NOSES) for colorectal cancer resection has not been confirmed. Aim To explore the short- and long-term outcomes as well as anal function of transanal NOSES versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection. Material and methods A retrospective review of data from a prospectively maintained database was performed to analyze the data of 69 patients who underwent transanal NOSES for sigmoid colon or rectal cancer resections and another 69 matched patients who underwent conventional laparoscopic (CL) surgery. Anal function of patients was evaluated using the Wexner fecal incontinence scale postoperatively. Results Transanal NOSES resulted in faster recovery of intestinal function, shorter postoperative length of stay, less incisional pain, fewer postoperative complications and shorter scars than CL surgery (p < 0.05). The two groups had similar overall survival (p = 0.863) and disease-free survival (p = 0.961). Wexner scores of the NOSES group at 1, 3 and 6 months after surgery were higher than in the CL group (p < 0.05), and there was no difference between the two groups at 12, 18 and 24 months after surgery. Conclusions Transanal NOSES achieves similar survival outcomes to CL surgery. Transanal NOSES has the advantages of faster recovery, shorter postoperative hospital stay, less incisional pain, shorter scars, etc. However, transanal NOSES can indeed impair anal function, needing more attention.

Objective To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy. Methods Clinical data of 57 patients with varus arthritis who underwent supramalleolar osteotomy at our hospital between March 2018 and December 2019 were retrospectively analyzed. The patients were grouped according to the Takakura classification, and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Visual Analogue Score (VAS). Tibial anterior surface (TAS) angle and talar tilt (TT) angle were measured at the weight-bearing anteroposterior view. Tibial lateral surface (TLS) angle was measured at the weight-bearing lateral view. The differences in the above indicators of patients with different stages of varus ankle arthritis before and after treatment were analyzed. Results The patients were followed up for an average of 31.9 ± 5.8 months. Upon the last follow-up, the AOFAS score was 84.1 ± 9.7, the VAS score 2.2 ± 1.3, the TAS angle 92.4 ± 5.5°, the TLS angle 79.3 ± 5.3°, and the TT angle 3.7±3.4°, which were significantly different from the preoperative levels (64.2 ± 14.6, 4.5 ± 1.8, 80.5 ± 6.7°, 74.9 ± 4.6°, and 5.2 ± 64.1°, respectively) ( p < .05). There were significant differences in AOFAS and VAS scores before surgery and upon the last follow-up in each group ( p < .05). The postoperative TT angle was significantly different from the preoperative level in stage IIIb patients ( p = .003). Conclusions Supramalleolar osteotomy achieved good short-to mid-term clinical outcomes for intermediate stage varus ankle arthritis. This procedure could significantly improve the TAS and TLS angles of the patients at any stage and the TT angle of stage IIIb patients.

Objective To explore whether modified Chevron osteotomy together with distal soft tissue release would correct moderate to severe HV deformity and what is the minimal clinical important difference (MCID) for objective and subjective evaluating parameters. Methods From March 2018 to January 2019, 40 hallux valgus patients (including moderate to severe) were enrolled in this retrospective study. The cohort included four males and 36 females. The average age at surgery was 50.95 (range 22–75) years. All patients underwent modified Chevron osteotomy together with distal soft tissue release and completed at least one follow‐up at clinic. The American Orthopaedic Foot and Ankle forefoot score (AOFAS, forefoot), Visual Analog Scale (VAS), and Foot Function Index (FFI) were all collected before and after surgery. Besides, the hallux valgus angle (HVA), 1st–2nd intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured both before surgery and at last follow‐up. All MCID values were calculated by employing distribution‐based method. Results Thirty‐seven patients (92.5%) showed satisfied result at a mean 14.3‐month follow‐up (range 13–22 month). Two patients complained about residual pain at the bunion, and overcorrection (hallux varus) occurred in one patient. Meanwhile, no patient observed nonunion. Being female, age more than 60, residual HVA deformity (>15°), and post IMA more than 9° showed no statistical relationship with the post‐operation residual pain (P > 0.05). However, high VAS score before surgery (more than 7) showed strong correlation with residual pain (P < 0.01). The subjective MCID value was 9.50 for AOFAS, 18.92 for FFI, and 1.27 for VAS, respectively. Conclusion The modified Chevron osteotomy together with distal soft tissue release could achieve a satisfied result for moderate to severe HV deformity at early follow‐up. The residual pain was associated with severe pain before surgery (VAS more than 7).