Aims

The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial.

Introduction

Unstable ankle fractures are routinely managed operatively. Due to soft-tissue and implant related complications, there has been recent literature reporting on the non-operative management of well-reduced medial malleolus fractures following fibular stabilisation, but with limited evidence supporting routine application. This trial assessed the superiority of internal fixation of well-reduced (displacement ≤2mm) medial malleolus fractures compared with non-fixation following fibular stabilisation.

Aims

This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures.

Objectives

The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits.

Lisfranc injuries were previously described as fracture-dislocations of the tarsometatarsal joints. With advancements in modern imaging, subtle Lisfranc injuries are now more frequently recognized, revealing that their true incidence is much higher than previously thought. Injury patterns can vary widely in severity and anatomy. Early diagnosis and treatment are essential to achieve good outcomes. The original classification systems were anatomy-based, and limited as tools for guiding treatment. The current review, using the best available evidence, instead introduces a stability-based classification system, with weightbearing radiographs and CT serving as key diagnostic tools. Stable injuries generally have good outcomes with nonoperative management, most reliably treated with immobilization and non-weightbearing for six weeks. Displaced or comminuted injuries require surgical intervention, with open reduction and internal fixation (ORIF) being the most common approach, with a consensus towards bridge plating. While ORIF generally achieves satisfactory results, its effectiveness can vary, particularly in high-energy injuries. Primary arthrodesis remains niche for the treatment of acute injuries, but may offer benefits such as lower rates of post-traumatic arthritis and hardware removal. Novel fixation techniques, including suture button fixation, aim to provide flexible stabilization, which theoretically could improve midfoot biomechanics and reduce complications. Early findings suggest promising functional outcomes, but further studies are required to validate this method compared with established techniques. Future research should focus on refining stability-based classification systems, validation of weightbearing CT, improving rehabilitation protocols, and optimizing surgical techniques for various injury patterns to ultimately enhance patient outcomes. Cite this article: Bone Joint J 2024;106-B(12):1431–1442

Introduction. Patients who present with atypical foot pain in a non specific sensory distribution may benefit from having nerve conduction studies (NCS). The aim of this study was to confirm whether NCS is a useful tool. Methods. Between July 2005 and March 2011, 78 patients had NCS to investigate foot pain. The management following NCS was compared with the initial management plan. Results. Complete data was available for 60 patients, of whom 31 were male. The mean age at presentation was 54.4 years (range 18–89.7). Eighteen patients had bilateral symptoms. The predominant symptom was pain in 47 patients. Aching, burning, throbbing, shooting, pins and needles, proximal/distal radiation, numbness, and paraesthesia were also described in 23 patients. Twenty patients had a history of trauma and five developed symptoms following elective lower limb surgery. Eight patients had a cavovarus foot. There were 22 normal results. The NCS diagnosed peripheral nerve (13)/nerve root (8) pathology, Charcot-Marie-Tooth (1), amyotrophic lateral sclerosis (1), tarsal tunnel syndrome (3), and nonspecific neuropathy (12). Surgery was initially considered for 9 patients. Following a normal result, 4 out of 7 had surgery. One patient with an abnormal result proceeded to surgery. The NCS was abnormal in 70.1% (36/51) of patients who were for nonoperative management, 4 of whom proceeded to have surgery. None of the patients who had a normal NCS had an operation. Conclusion. NCS provided a diagnosis for 63.3% of the patients. Following NCS, the management plan changed in 44% of patients who were initially considered for surgery (4/9) and in 7.8% of patients who were initially considered for nonoperative management (4/51). This investigation is a useful adjunct in guiding the management of patients who present with atypical non specific foot pain

Background. We compared platelet rich plasma (PRP) injection to cortisone (40mg triamcinolone) injection in the treatment of chronic plantar fasciitis resistant to traditional nonoperative management. The aims were to compare early and long term efficacy of PRP to that of Steroid (3, 6 and 12 months after injection). Methods. 60 heels with intractable plantar fasciitis with failed conservative treatment were randomized to either PRP or Steroid injection. All patients were assessed with Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection. The mean scores of the two groups were compared using Student t test. Results. Pre-injection, the two groups were well matched with no statistically significant difference in the values. At 3 months, all three outcome scores in both groups had significantly improved from their pretreatment level with no significant difference between the groups (PRP: RM 3.7 to 2.0, VAS 8.3 to 3.5, AOFAS 58 to 84; Steroid: RM 3.6 to 1.9, VAS 8.3 to 2.8, AOFAS 57 to 86). At 6 months, improvement was maintained in both groups with no significant difference between groups (PRP: RM 2.1, VAS 3.7, AOFAS 89; Steroid: RM 2.2, VAS 3.3, and AOFAS 84). At 12 months, all outcome measures were significantly better for the PRP group as response in the steroid group had deteriorated (PRP: RM 1.9, VAS 3.3 and AOFAS 89; Steroid: RM 2.6, VAS 5.1 and AOFAS 77: p = 0.008, 0.02 and 0.002 respectively). Conclusions. PRP is better for the treatment of chronic plantar fasciitis as compared to steroid. It shows no statistical difference in effectiveness early on, but unlike steroid, its effectiveness does not wear off with time, making it more durable

Introduction:. Isolated Weber B lateral malleolus fractures heal uneventfully, but concern that late subluxation may occur due to unrecognised medial ligament tearing, despite an intact mortice on initial radiographs, often results in overtreatment. The aim of this study was to determine the incidence of late talar shift with nonoperative management in a cohort of patients with no initial talar shift, and also record functional outcomes at 16–28 months following injury. Methods:. This was a retrospective review of 129 patients with Weber B lateral malleolar fractures initially referred to the fracture clinic between October 2011 and October 2012. Eight had obvious talar shift and therefore underwent surgery, with the remaining 121 treated in plaster (n=41), a Velcro boot (n=70) or bandage (n=10). No stress x-rays or MRI scans were performed. Weight-bearing was permitted as pain allowed. Radiographs taken on discharge from the clinic were reviewed to assess talar shift. Functional outcomes assessment was carried out using Manchester Oxford Foot Questionnaire and Olerud-Molander score. Results:. None of the 121 patients had talar shift initially; 21 patients where medial injury was strongly suspected were closely followed and had check x-rays more often (average 2.9 appointments per patient) than the other groups. No patients had talar shift in any of the subsequent x-rays and therefore none underwent delayed internal fixation. The mean MOXFQ and Olerud-Molander scores were 27 and 78 respectively in 57 patients and the functional outcomes were not influenced by type of immobilisation or suspected medial injury. Conclusion:. Our observation is that the risk of late talar shift is likely to be low in patients where initial x-rays had showed no talar displacement. It may be unnecessary to perform additional tests/imaging to establish the integrity of the medial ligament as satisfactory functional results are routinely observed

Introduction. Hallux valgus deformity is a common potentially painful condition. Over 150 orthopaedic procedures have been described to treat hallux valgus and the indication for surgery is pain intractable to nonoperative management. Methods. A retrospective analysis of the treatment of complex hallux valgus with bifocal metatarsal and Akin osteotomies of the first ray performed by the senior author (CC). 22 patients were treated over a three year period from 2008 to 2011, 24 trifocal osteotomies were undertaken. Hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were all measured from pre- and postoperative radiographs. The patients were also clinically reviewed. Results. The study group consisted of 21 women and 1 man with a mean age of 53 years. The average time to follow up was 19 months. Four cases had undergone previous surgery. Average HVA correction was 26.9 degrees (p < 0.0001), average IMA correction was 12.65 degrees (p < 0.0001). No patients had postoperative infection and all osteotomies went on to union. All patients reported resolution of pain. Two patients required removal of metalwork and the distal osteotomy angulated slightly in one patient not requiring reoperation. Conclusion. We demonstrate that bifocal metatarsal and akin osteotomies of the first ray are a safe and effective method of correcting complex hallux valgus

Aims

Osteochondral lesions of the talus (OLT) are a common cause of disability and chronic ankle pain. Many operative treatment strategies have been introduced; however, they have their own disadvantages. Recently lesion repair using autologous cartilage chip has emerged therefore we investigated the efficacy of particulated autologous cartilage transplantation (PACT) in OLT.

Aims

Achilles tendon re-rupture (ATRR) poses a significant risk of postoperative complication, even after a successful initial surgical repair. This study aimed to identify risk factors associated with Achilles tendon re-rupture following operative fixation.

Aims

Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR.