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.

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

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.

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 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.

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.

Objective: Hip fracture patients are recommended to undergo surgery within 24-36 h. The present study aimed to analyze the current status of hip fracture surgery among the elderly in China. Methods: The baseline information, such as the patient's age, gender, place of residence, place of treatment, fracture type, admission, and operation time, of hip fracture patients >65-years-old were retrieved from the hospital quality monitoring system (HQMS) database from 2013 to 2017 and analyzed. Results: A total of 304,279 patients >65-years-old with hip fractures were included in this study. The average length of hospital stay was 15 days, and the average waiting time for surgery after admission was 96 h. The average surgery rate of elderly hip fractures in China was 59.6 %, of which the lowest was recorded in the Northwest China (46.4 %). Conclusions: The major issues in diagnosing and treating elderly patients with hip fractures in China are the long waiting time for surgery and the low surgery rate.

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.

目的:探讨采用截骨复位治疗踝关节骨折畸形愈合的临床疗效.方法:回顾性分析2018年3月至2021年6月收治的30例采用截骨复位治疗踝关节骨折畸形愈合的患者资料.男9例,女21例;手术时年龄18～70岁,平均(40.5±15.5)岁;受伤或第一次手术到截骨手术间隔9(6.3,22.5)个月.比较患者术前及末次随访时的美国足踝外科协会(AOFAS)踝与后足评分、疼痛视觉模拟评分(VAS)、足部功能指数(FFI)、距骨倾斜角(TT)、距踝角(TCA)和踝关节活动范围(ROM),记录患者满意度及并发症.结果:所有患者术后随访18～57个月,平均(40.5±12.0)个月.末次随访时AOFAS踝与后足评分为(86.5±7.6)分、VAS为1.0(1.0,2.0)分、FFI为18.5(9.2,23.8)分、TT为1.4°(1.0°,2.1°)、TCA为79.2°±3.3°,较术前均显著改善,差异有统计学意义(P＜0.05).踝关节ROM术前和末次随访比较,差异无统计学意义.1例踝关节炎发生了进展,总体满意度86.7%(26/30).结论:采用截骨复位治疗踝关节骨折畸形愈合具有良好的临床疗效,满意度较高,可有效延缓关节炎进展.

Objective:To evaluate the clinical and radiographic outcomes of tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach.Methods:From March 2018 to February 2021, 23 patients underwent tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach at the Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital.Of them, 15 were males and 8 females. Their average age at surgery was 54.4 years (range, from 28 to 72 years). There were 11 cases of traumatic arthritis, 2 cases of Charcot arthropathy, 6 cases of neurogenic equinovarus, 2 cases of traumatic equinovarus, and 2 cases of Kashin-Beck disease. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), visual analogue scale (VAS), foot function index (FFI), hindfoot alignment angle (HA), hindfoot alignment distance (HD), and hindfoot alignment ratio (HR). The tibia-foot angle on lateral weight-bearing and patient satisfaction at the last follow-up and postoperative complications were documented.Results:This cohort were followed up for an average of 24.7 months (from 12 to 48 months). The AOFAS ankle-hindfoot score (78.2 ± 9.2), VAS [2.0 (0.5, 2.0)], FFI [19.0 (10.5, 35.0)], HA (2.7° ± 5.8°), HD [(0.1 ± 0.8) cm] and HR [44.2 (36.4, 59.2)%] at the last follow-up were significantly improved than the preoperative values [43.4 ± 12.7, 4.0 (4.0, 6.0), 98.0 (60.0, 127.0), 22.0° ± 14.3°, (2.2 ± 1.6) cm and 86.0 (66.3, 100.0)%] (all P<0.05). The tibia-foot angle on lateral weight-bearing was 89.0° (87.1°, 90.4°) at the last follow-up. By the Likert scale, 17 cases were very satisfied with the surgery, 4 cases satisfied and 2 cases tolerate, giving a satisfaction rate of 91.3%(21/23). Infection occurred in one case and nonunion in one. Conclusion:Tibiotalocalcaneal arthrodesis via the fibula-preserving anterolateral approach yields good mid- to short-term clinical and radiographic outcomes, showing a strong capability to correct ankle and hindfoot varus and equinus.

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 report our clinical outcomes of open reduction and internal fixation (ORIF) of chronic isolated fractures of a metatarsal head in the lesser toes.Methods:A retrospective consecutive case-series study was performed in 5 patients with symptomatic chronic isolated shear fracture of a metatarsal head in the lesser toes who had been treated from January 2018 to April 2021 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 4 males and one female, with an average age of 26.2 years (from 19 to 36 years) at the time of injury. The fracture had been missed at the initial diagnosis in 2 of the patients. Their main symptom was limited dorsiflexion of the metatarsophalangeal joint (MTPJ). Preoperative X-rays and CT scans revealed dorsal displacement of the distal fragment without dislocation of the MTPJ. All patients were treated by ORIF. Their American Orthopaedic Foot & Ankle Society-lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS), and range of passive dorsiflexion of the MTPJ were compared between preoperation and the final follow-up. Postoperative complications were also recorded.Results:The 5 patients were followed up for an average of 27.8 months (from 6 to 45 months). All the chronic fractures achieved bony union. At the final follow-up, the average AOFAS-LMI score was 90.6 (from 82 to 100), the average VAS score 0 (from 0 to 2), and the average range of passive dorsiflexion of the MTPJ 40.0° (from 35° to 45°), all improved compared with the preoperative values [70.6 (from 59 to 79), 4 (from 2 to 5) and 10.0° (from 5.0° to 10.0°), respectively]. All the patients recovered their activity levels before injury. Three patients developed arthritis of the MTPJ.Conclusion:ORIF may achieve good short- and mid-term clinical outcomes in patients with chronic isolated shear fracture of a metatarsal head in the lesser toes.

Abstract. Background:. Total ankle replacement (TAR) is a viable option for the treatment of end-stage ankle arthritis. In China, the INBONE-II implant is the only total ankle prosthesis approved since 2016. The purpose of this study is to report a large sample of findings for the TAR with INBONE-II prosthesis. Methods:. A total of 64 patients with end-stage ankle arthritis, who underwent primary TAR using INBONE-II by the same surgeon from 2016 to 2019, at a single institution were included in this retrospective, single-center study. Clinical data, radiographic findings, survival rate, and complications were recorded and assessed pre-operatively and at the most recent follow-up. Results:. A total of 64 patients were available for follow-up at least 2 years after surgery; the mean follow-up duration for clinical outcomes was 37.9 months (24–59 months), and for radiographic findings was 22.8 months (12–59 months). There were significant improvements (P < 0.01) in the American Orthopedic Foot and Ankle Society hindfoot scale, the visual analog scale for pain, and the Short Form-36. There were statistically significant differences between pre-operative and post-operative comparisons of the talar tilt angle (TT) and the tibial lateral surface angle (TLS) in the radiographic findings (TT from 4.7 ± 4.3° to 1.3 ± 1.3°, TLS from 80.4 ± 7.7° to 87.4 ± 2.3°, P < 0.01). There was no statistically significant difference in improvement of the tibial anterior surface angle (P = 0.14). Ten complications (all low grade) were recorded according to the Glazebrook classification system. The survivorship of the prosthesis was 100% (64/64). Conclusion:. Patients who underwent TAR with INBONE-II prosthesis demonstrated significant improvements in all measures of pain and function as well as in radiographic findings. High survival and a low incidence of complications were observed in this study.

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).