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 There is no consensus on the age restriction for total ankle arthroplasty (TAA) patients. The aim of our study was to analyze the clinical function, radiographic outcomes, patient satisfaction, and complications between patients under 50 years old and those over 65 years old who underwent TAA with the INBONE II prosthesis for end‐stage ankle arthritis. Methods Patients who received TAA with the INBONE II prosthesis between September 2016 and August 2021 were included in the study. A total of 68 patients were enrolled and divided into two groups based on age: the younger group (28 patients age ≤ 50 years) and the elderly group (40 patients age ≥ 65 years). Demographic data and patient‐reported outcomes, including 36‐Item Short‐Form Health Survey (SF‐36), American Orthopedic Foot & Ankle Society (AOFAS), Foot Function Index (FFI), and Visual Analogue Scale (VAS) scores, were collected preoperatively and at the latest follow‐up. Radiographic measurements, including tibial articular surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS), were evaluated on weight‐bearing images preoperatively and at the latest follow‐up. Range of motion (ROM) and complications were documented. Patient satisfaction was assessed using a five‐point Likert scale. Results With a median follow‐up of 4 years, there were no statistically significant differences in AOFAS and SF‐36 scores between the two groups at the latest follow‐up. However, the elderly group showed slightly lower VAS and FFI scores compared to the younger group, while the younger group demonstrated slightly greater dorsiflexion angles. There were no statistically significant differences in radiographic evaluations, patient satisfaction, and complications between the two groups. Conclusion The 4‐year postoperative outcomes of TAA using the INBONE II prosthesis were comparable between patients younger than 50 years and those older than 65 years, indicating that age alone may not serve as a definitive criterion for patient selection in TAA with this implant. Trial Registration Retrospectively registered. Level of Evidence 4.

OBJECTIVE:To evaluate the clinical outcomes of one-stage debridement, arthrodesis, and Ilizarov external fixation for the treatment of septic arthritis of the ankle and hindfoot. METHODS:A retrospective analysis was conducted on 12 patients with septic arthritis of the ankle or hindfoot who underwent one-stage debridement, arthrodesis, and Ilizarov external fixation performed by the same surgeon between April 2015 and June 2023. The study included 8 males and 4 females, with a mean age of (53.6±16.2) years at surgery; all procedures were unilateral. General clinical characteristics, bacterial culture results, and the time to external fixator removal were recorded. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) for pain were recorded and compared between the preoperative period and the final follow-up. Patient satisfaction with the surgery and the occurrence of complications were also documented. RESULTS:All patients were followed up for a mean of (51.3±34.0) months postoperatively. Positive bacterial cultures were found in 7 cases. Infection control was achieved in all patients, with a 100% bone fusion rate confirmed by radiographs or CT. The median time to external fixator removal was 16 (12, 24) weeks. Preoperatively, the median VAS score was 7 (5.3, 7.8) points, and the mean AOFAS ankle-hindfoot score was (42.8±10.4) points. At the final follow-up, the median VAS score was 1 (0, 2) point, and the mean AOFAS score was (77.6±10.2) points, both showing significant improvement compared with preoperative values (P < 0.01). Regarding complications, there was 1 case of pin tract infection, 3 cases of limb shortening, and 2 cases of skin numbness. Nine patients were very satisfied with the surgery, and 3 were satisfied. CONCLUSION:One-stage debridement, arthrodesis, and Ilizarov external fixation are a reliable method for treating septic arthritis of the ankle and hindfoot. It effectively controls infection, shortens treatment duration, and yields favorable functional and imaging outcomes, with high patient satisfaction and acceptable complication rates.

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.

Large, uncontained osteochondral lesions of the talar shoulder (OLTs) remain a surgical challenge. Three-dimensional (3D)-printed partial talar prostheses represent a potential treatment option because, compared with conventional autologous bone grafting, they can restore a smooth articular surface. However, the optimal position of the implant between the cartilage surface and the underlying bone surface remains controversial. Clinical experience suggests that the implant should be placed approximately 1 mm below the cartilage surface, but this empirical recommendation requires quantitative support. A 3D finite element analysis (FEA) model comprising the tibia, fibula, talus, calcaneus, talar prosthesis, corresponding cartilage, and ligaments was developed. Cartilage thickness was set to 1.5 mm, and the prosthesis was positioned flush with the cartilage surface (0 mm) or recessed by 0.5, 1.0, or 1.5 mm. The proximal tibia and fibula were constrained, and loading conditions representing bipedal standing and three positions in the gait cycle were applied. For each loading condition, von Mises stress and strain were calculated. Across the four loading conditions, implants recessed by 0.5 and 1.0 mm exhibited more favorable biomechanical behavior. During bipedal standing, maximum von Mises stress at the bone–implant interface was 0.596 and 0.617 MPa for the 0.5- and 1.0-mm configurations, respectively. These configurations also produced more uniform stress distributions during the gait cycle and lower strain magnitudes, suggesting potentially better long-term stability. Implantation depth significantly affected stress and strain in the talus, cartilage, and prosthesis. Recessing the implant by 0.5–1.0 mm below the talar cartilage surface produced a more favorable stress distribution in this single patient-specific geometric model. However, these in silico findings require experimental validation. Biomechanical study, Level V. Not applicable.

BackgroundChronic hindfoot infections poses a significant threat to limb integrity and quality of life. The one-stage procedure, involving implants removal, debridement, and simultaneous arthrodesis, may serve as an alternative choice. The present retrospective study aimed to assess the efficacy of the one-stage procedure using external fixators for the treatment of chronic hindfoot infections.MethodsFrom April 2016 to December 2022, 21 patients with chronic hindfoot infections underwent one-stage procedure with debridement and arthrodesis using external fixators. Pain and joint function were evaluated using the Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Score. Infection recurrence and osseous consolidation were appraised using the Musculoskeletal Infection Society criteria and radiological examination.ResultsThe tibiotalar, tibiotalocalcaneal, and pan-tarsal arthrodesis were performed in 6, 14 and 1 patients, respectively. The surgical debridement procedures were performed using arthroscopic (n = 9) and combined open (n = 12) methods. The mean follow-up duration was 38.2 (range 25–103) months. The procedure achieved significant pain relieve and functional improvement, as evidenced by the substantial improvement in VAS and AOFAS score from 6.4 ± 1.7 and 40.0 ± 11.6 preoperatively to 1.3 ± 1.4 (p < 0.001) and 78.4 ± 10.8 (p < 0.001) postoperatively, respectively. No instance of infection recurrence was observed during follow-up, and successful osseous consolidation was achieved in 20 patients.ConclusionsThe one-stage procedure with debridement and arthrodesis using external fixators represented an alternative method for the treatment of chronic hindfoot infections.

This study aimed to investigate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) for the management of post-traumatic ankle arthritis resulting from previous fractures. A retrospective analysis was conducted on the clinical data of 19 individuals with post-traumatic ankle arthritis secondary to old fractures treated with SMO between March 2018 and September 2022. The cohort included 6 males and 13 females, aged 15 to 59 years, with an average of 37.1 ± 15.8 years. Among these cases, 12 underwent surgical treatment for their initial fractures, while 7 received conservative management. Clinical efficacy was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot Function Index (FFI), and Visual Analog Score (VAS) for pain. Imaging analyses were conducted using the changes of tibial anterior surface angle (TAS), talar tilt (TT) angle, and modified Takakura stage. Evaluation of patient satisfaction after surgery was conducted during the final follow-up. All patients were followed up for 12 to 47 months (mean follow-up: 21.9 ± 11.1 months). At the final follow-up, the AOFAS ankle-hindfoot score improved to 81.9 ± 9.8, the FFI decreased to 24.2 ± 22.8, and the VAS score decreased to 3.2 ± 3.0, all showing significant improvement compared with preoperative values (p < 0.05). The TAS angle increased significantly to 90.2° ± 5.1° postoperatively (p < 0.05), while the TT angle was 0.3° ± 2.5°, without a statistically significant change (p = 0.314). No significant progression was observed in the modified Takakura stage (p = 0.458). The overall patient satisfaction rate was 89.5

PURPOSE:This study aimed to evaluate the effects of changing the keel shape of the tibial component of a keel-type total ankle prosthesis on its biomechanical behavior and to identify possible directions for further prosthesis selection and improvement. METHODS:Finite elements analysis was applied to analysis the influence on biomechanical effects of the shape of tibia implant keel in total ankle prostheses. CT of a male volunteer was used to develop tibia models with different prosthesis designs based on the tibia implant of Salto TalarisTM ankle prosthesis. Biomechanical properties including stress, micromotion and strain were evaluated. RESULTS:The peak stress and micromotion of the design with short keel and vertical holes were 85.3 MPa and 62.87 μm, respectively, which were 36.7 % and 84.4 % lower than the original design. The proportion of units with satisfactory osseointegration in the periprosthetic bone tissue reached 20.09 % in this design and was 19.1 % more than the original design. CONCLUSION:Reducing the length of keel of the tibia prosthesis to the underlying support structure and reorienting the lateral holes to the vertical direction could improve the stability of the prosthesis by reducing possible sterile loosening through the improvement of the mechanical effects mentioned above. But this may require further experiments for verification.

BACKGROUND:Revision total ankle arthroplasty (reTAA) is becoming more common. This meta-analysis aimed to evaluate its re-revision rate and factors affecting longevity. METHODS:Following Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and Assessing the Methodological Quality of Systematic Reviews guideline, we searched PubMed, Embase, Web of Science, and Cochrane Library databases from 1 January 2010 to 1 October 2024. Studies reporting survivorship of reTAA were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcome was the re-revision rate. Pooled estimates with 95% confidence intervals (CIs) were calculated using a random-effects model. The annual re-revision rate was introduced for time-adjusted analysis. Heterogeneity was explored using meta-regression and subgroup analyses. RESULTS:The analysis included 22 retrospective studies (cohort studies and case series) and one prospective cohort study. The NOS scores indicated moderate to high quality. A total of 999 reTAAs with a mean follow-up of 5 years were identified. The pooled re-revision rate was 9.9% (95% CI: 5.9% to 13.9%). The annual re-revision rate was 2.6% (95% CI: 1.8% to 3.6%). Subgroup analysis indicated that stemmed tibial components were potentially associated with a lower re-revision rate (5.5%) versus unstemmed tibial components (13.2%) ( P = 0.077). However, meta-regression model identified follow-up duration as the only significant factor influencing re-revision rates. The pooled complication rate following reTAA was 18.2%. Among those failed reTAAs, 64.9% underwent conversion to ankle fusion and 5.3% received below-knee amputation. CONCLUSION:Although most included studies were low-level evidence, our meta-analysis revealed an overall re-revision rate of 9.9% at 5-year follow-up, with an annual rate of 2.6% for reTAA. Limited evidence suggested that revision systems using stemmed tibial components might reduce the risk of re-revision.

ABSTRACTBackgroundGrowth rods are the gold standard for treating early‐onset scoliosis (EOS). However, current treatments with growth rods do not optimize spinal growth in EOS patients, and frequent distraction surgeries significantly increase complications, imposing considerable economic and psychological burdens on patients. An improved growth rod is urgently required to address the need for dynamic growth and external regulation.MethodsThis study designed a novel growth rod (NGR) with unidirectional sliding and external regulation capabilities. By establishing a three‐dimensional model of the EOS spine, we simulated the implantation of traditional growth rods (TGR) and NGR. We applied a compressive load of 400 N to test axial stiffness and a moment of 1 NM to assess bending stiffness under six different conditions. Additionally, we evaluated the range of motion (ROM) of the spinal joints, and the distribution of Von Mises stress in vertebrae, intervertebral discs, and the growth rods, and calculated the axial force, moment, fatigue life, and strain energy of the device.ResultsNGR exhibits higher axial compression and torsional stiffness than TGR and the Intact group. Additionally, Von Mises stress values for NGR are higher than those for TGR across all operating conditions, albeit with slightly lower total strain energy than TGR. Although Von Mises stress in NGR concentrates near the screw fixation, the fatigue life remains adequate for basic living requirements.ConclusionOverall, NGR demonstrates superior stiffness and stress distribution. NGR's distraction‐based implant features a unidirectional sliding component with a spring‐driven mechanism for dynamic correction and a novel non‐invasive extension mechanism to reduce infections. Compared to leading EOS implants, NGR offers improved stability, showing promise for enhancing EOS surgical interventions.

OBJECTIVE:To evaluate the early efficacy of local application of tranexamic acid on the osteotomy surface during hallux valgus surgery in reducing postoperative occult blood loss and thus postoperative swelling. METHODS:The data of 40 cases with hallux valgus osteotomy admitted to the Department of Foot and Ankle Surgery of Jishuitan Hospital from July 11, 2022 to October 8, 2022, including 5 males and 35 females were retrospectively analyzed. According to the inclusion and exclusion criteria, 32 cases were finally divided into 16 cases in the observation group (application of tranexamic acid) and 16 cases in the control group (no application of tranexamic acid). The observation group was paired with the control group one by one in accordance with the operation style, and the change in the anterior and posterior diameter of the first metatarsal head, the change in the circumferential diameter of the foot, the length of the first metatarsal midline and the length of the plumbline of the foot measured by postoperative CT were compared between the two groups before and after surgery, in order to evaluate the degree of swelling around the incision after the surgery. The first metatarsal midline and plumb line were measured by reference to the two auxiliary lines that intersect the soft tissue border in the sesamoid bone position to measure the rotation angle of the first metatarsal. A total of three clinicians completed the measurements of these two line segments and interobserver comparisons were performed. RESULTS:By interobserver comparison, the consistency of the length of the midline of the first metatarsal and the plumbline measured by CT was high and could be considered a reliable measurement. After the paired t-test, there was no statistical difference in the amount of changes in the anteroposterior diameter of the first metatarsal before and after surgery between the observation and control groups (P>0.05), and the amount of changes in the circumferential diameter of the foot before and after surgery was smaller in the observation group than in the control group, which was statistically significant (P < 0.05); the length of the midline of the first metatarsal and the plumbline of the foot measured by CT after surgery was smaller in the observation group than in the control group, which was statistically significant (P < 0.05). CONCLUSION:Local application of tranexamic acid on the osteotomy surface during hallux valgus osteotomy can relieve postoperative swelling to some extent, which may be related to the fact that tranexamic acid reduces occult blood loss in the postoperative period.

Aims:Growth rods are the gold standard for treating early-onset scoliosis (EOS), but current treatments often fail to optimally promote spinal growth and require frequent distraction surgeries, leading to complications and significant burdens on patients. Methods:We designed a novel growth rod (NGR) with unidirectional sliding and external regulation capabilities. Using a 3D model, we simulated the implantation of traditional growth rod (TGR) and NGR, applying a 400 N compressive load and a 1 Nm moment to test stiffness. We assessed spinal joint range of motion and growth rod stress distribution, and calculated axial force, moment, and fatigue life. Results:The axial compressive and torsional stiffness of the NGR were higher than those of the TGR and the intact group. The Von Mises stress values of the NGR under all conditions were higher than those of the TGR. Additionally, the fatigue life of the NGR met basic daily living requirements. Overall, the NGR demonstrated superior stiffness and stress distribution, with stress primarily concentrated near the screw fixation points and distributed along the titanium rods. Conclusion:The NGR, based on a distraction implant, includes a unidirectional sliding component and a spring-driven component, providing dynamic correction functionality. Additionally, it features a novel non-invasive lengthening mechanism that reduces the risk of infection. Compared to the current market-leading EOS implants, it offers enhanced stability. The novel device can potentially improve clinical outcomes in the surgical treatment of EOS.

Objective:To summarize the research and clinical application progress of foot lengthening surgery. Methods:Relevant research literature on foot lengthening surgery in recent years at home and abroad was reviewed, and a summary was made from aspects such as the types of lengthening surgery, the types of foot diseases treated by clinical application, effectiveness, and complications. Results:Bone defects and shortening deformities of the foot are relatively common clinically. As an innovative treatment method, foot lengthening surgery has gradually attracted attention, mainly including the Ilizarov technique and one-stage bone grafting lengthening surgery. The former promotes bone regeneration based on the tension-stress principle and is widely used in the treatment of calcaneal defects and congenital metatarsal brachymetatarsia, achieving good curative effects. However, there are also complications such as pin-tract infection, joint stiffness and contracture, non-union and delayed union of bone, re-fracture, and alignment deviation. The latter has a short treatment cycle, but the lengthening length is limited. Bone graft resorption and soft tissue complications are its main complications. Conclusion:Foot lengthening surgery will develop towards the direction of personalization, intelligence, and precision. With the help of multi-center research, biological materials, and intelligent technologies, the effectiveness and safety will be further improved to better restore the function and appearance of the foot.

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.

BackgroundFollowing the Chinese guidelines’ recommendation to completely cancel routine cephalosporin skin tests, the choice of cephalosporin as surgical prophylactic medication was affected. This was due to the limited cognition of the predictive value of cephalosporin skin test or the desire to avoid medical disputes. The aim of this retrospective study was to evaluate whether the pharmacist-led perioperative antibiotic prophylaxis model could improve clinicians’ medical behavior in choosing cephalosporin antibiotics for surgical prophylaxis.MethodsFrom July 2021 to May 2022, a retrospective analysis was conducted on the selection of surgical preventive medication, skin test, postoperative infection and adverse drug reactions in foot and ankle surgery. The study was divided into three period: the rountine cephalosporin skin test period (Period I: Skin Test), the period when the routine cephalosporin skin test was cancelled but the pharmacist did not intervene (Period II: Cancel Skin Test), and the period when the pharmacist-led perioperative antibiotic prophylaxis was implemented after the cancellation of the cephalosporin skin test (Period III: Pharmacist Intervention).ResultsA total of 1,583 patients were enrolled in this study. There was no significant difference in the utilization rate of cefuroxime between the routine skin test stage and the skin test cancelled stage [74.92% (Period I) vs. 74.54% (Period II), P > 0.05]. However, in the pharmacist intervention stage, the usage rate of cefuroxime significantly increased compared to the initial stage when the skin test was cancelled [87.07% (Period III) vs. 74.54% (Period II), P < 0.05]. The use of cephalosporins also increased in patients with self-reported beta-lactam allergies between these stages [41.94% (Period III) vs. 3.22% (Period II), P < 0.05)]. There was no significant difference in the incidence of postoperative infection and adverse drug reactions among the three periods.ConclusionThe pharmacist-led perioperative antibiotic prophylaxis model can significantly improve the medical behavior of clinicians in choosing cephalosporin antibiotics as surgical prophylactic medication and optimize the perioperative medication plan.

ObjectiveAlthough several reconstructive methods have been developed to manage large segmental tibial bone defects including bone transport (distraction osteogenesis), contralateral fibular graft, allograft, tibiofibular synostosis, Masquelet technique, and 3D printed scaffold, neglected large tibial defects in adults remain challenging problems. This study describes gradual transverse transport of naturally tibialized fibula using hexapod frames in management of adult patients with neglected large tibial defects.MethodsWe retrospectively reviewed four cases of transverse transport of naturally tibialized fibula from November 2018 to February 2022. We measured the length of the tibial defect and the transported fibular segment, the mid‐diaphyseal diameter and cortical thickness of the affected fibula, contralateral fibula, and tibia. The parameters measured both preoperatively and postoperatively were leg length discrepancy, hip‐knee‐ankle angle, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle, range of motion of the knee and ankle joints, and Lower Extremity Functional Scores (LEFS). Patients' satisfaction rates using Likert scale were also recorded.ResultsAmong four female patients, three suffered from tibial osteomyelitis, and one was due to congenital pseudarthrosis of the tibia. The average follow‐up time was 2.7 ± 1.4 years. The average length of tibial defect was 14.0 ± 0.8 cm. The average preoperative shortening of the affected leg was 9.0 ± 2.5 cm, which changed to 0.6 ± 0.8 cm postoperatively. The median length of the transported fibular segment was 15.2 cm. Two patients had varus deformity, two had recurvatum, and one had procurvatum preoperatively. Postoperative radiological measurement showed all deformities corrected and no ankle valgus deformity developed during follow‐up. All patients achieved union and can fully weight bear on the affected extremity. The average fixator time was 12.9 ± 2.9 months. The average preoperative and postoperative LEFS, respectively, were 53.5 ± 5.0, 70.5 ± 1.3, with a significant difference (p = 0.003). Three patients reported very satisfied with the outcome, and one patient reported satisfied. Three patients had pin tract infections, and one patient had skin necrosis which healed after additional surgery. One patient had surgical release of the hamstring tendons due to flexion contracture of the knee. Two patients had 15° of reduction in ankle range of motion. One patient had transient common peroneal nerve palsy which spontaneously recovered within 6 weeks.ConclusionThe transverse transport of naturally tibialized fibula was both a safe and effective method to treat the long‐standing type V tibial segmental defect.

OBJECTIVE:To analyze the clinical data of patients with end-stage ankle and hindfoot arthropathy who underwent tibiotalocalcaneal (TTC) arthrodesis by the same surgeon, explore the short- and mid-term clinical results, complications and functional improvement, and discuss the clinical prognosis and precautions of TTC arthrodesis.METHODS:Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020. In this study, 23 males and 17 females were included, with an average age of (49.1±16.0) years. All the patients underwent unilateral surgery. The clinical characteristics, imaging manifestations, main diagnosis and specific surgical techniques of the patients were recorded. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) between pre-operation and at the last follow-up. The fusion healing time, symptom improvement (significant improvement, certain improvement, no improvement or deterioration) and postoperative complications were also recorded.RESULTS:The median follow-up time was 38.0 (26.3, 58.8) months. The preoperative VAS score was 6.0 (4.0, 7.0), and the AOFAS score was 33.0 (25.3, 47.3). At the last follow-up, the median VAS score was 0 (0, 3.0), and the AOFAS score was 80.0 (59.0, 84.0). All the significantly improved compared with their preoperative corresponding values (P < 0.05). There was no wound necrosis or infection in the patients. One patient suffered from subtalar joint nonunion, which was syphilitic Charcot arthropathy. The median bony healing time of other patients was 15.0 (12.0, 20.0) weeks. Among the included patients, there were 25 cases with significant improvement in symptom compared with that preoperative, 8 cases with certain improvement, 4 cases with no improvement, and 3 cases with worse symptoms than that before operation.CONCLUSION:TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot arthropathy. The function of most patients was improved postoperatively, with little impact on daily life. The causes of poor prognosis included toe stiffness, stress concentration in adjacent knee joints, nonunion and pain of unknown causes.

Hallux valgus (HV) is a multiplanar deformity and surgical treatment is often guided by two-dimensional radiographic parameters. This study assessed the reliability and accuracy of the AIR classification(The first metatarsal head’s lateral edge can be delineated as angular (type A), round (type R), or intermediate (type I) through visual inspection or circle measurements on weight-bearing radiographs.)commonly used in clinical settings to categorize the shape of the lateral edge of the first metatarsal head, against measurements from weight-bearing computed tomography (WBCT). This retrospective study evaluated 18 patients, including 31 feet affected by HV. Two surgeons independently categorized the first metatarsal head’s lateral edge by both visual inspection and circle measurement. Additionally, two separate surgeons evaluated the α angle relative to the floor in WBCT scans. The reliability of the measurements was assessed using intraclass correlation coefficients (ICC) and weighted kappa statistics. While the first surgeon demonstrated perfect intra-observer reliability for both visual inspection and circular measurements (kappa values of 1.000 and 0.857, respectively), the second surgeon showed high and perfect reliability (kappa values of 0.759 and 1.000, respectively) for the same assessments. While the interobserver reliability for visual inspection was moderate (kappa values of 0.407 and 0.455, respectively), it was little to low for circular measurements (kappa values of 0.173 and 0.232, respectively). The interobserver reliability for the α angle assessment relative to the floor on WBCT scans was perfect (ICC = 0.968). The AIR classification may not provide a reliable estimate of first metatarsal pronation, so clinicians should be cautious and recognize these limitations in their diagnostic applications. Between the two AIR classifications, the visual inspection measurement seems to be more reliable according to kappa value. If allowed, it may be better to additionally include a 3D assessment method such as WBCT, in the preoperative evaluation. IV, case series.

BACKGROUND:The majority of the ankle osteoarthritis cases are posttraumatic and affect younger patients with a longer projected life span. Hence, joint-preserving surgery, such as supramalleolar osteotomy becomes popular among young patients, especially those with asymmetric arthritis due to alignment deformities. However, there is a lack of biomechanical studies on postoperative evaluation of stress at ankle joints. We aimed to construct a verifiable finite element model of the human hindfoot, and to explore the effect of different osteotomy parameters on the treatment of varus ankle arthritis. METHODS:The bones of the hindfoot are reconstructed using normal CT tomography data from healthy volunteers, while the cartilages and ligaments are determined from the literature. The finite element calculation results are compared with the weight-bearing CT (WBCT) data to validate the model. By setting different model parameters, such as the osteotomy height (L) and the osteotomy distraction distance (h), the effects of different surgical parameters on the contact stress of the ankle joint surface are compared. FINDINGS:The alignment and the deformation of hindfoot bones as determined by the finite element analysis aligns closely with the data obtained from WBCT. The maximum contact stress of the ankle joint surface calculated by this model increases with the increase of the varus angle. The maximum contact stresses as a function of the L and h of the ankle joint surface are determined. INTERPRETATION:The relationship between surgical parameters and stress at the ankle joint in our study could further help guiding the planning of the supramalleolar osteotomy according to the varus/valgus alignment of the patients.