* Good-quality lateral and mortise radiographs are the standard for diagnosing ankle fractures and control of reduction.* Preoperative computed tomography (CT) imaging should be utilized generously for malleolar fractures with an unstable syndesmosis (including osseous avulsions), fractures involving the posterior malleolus, supination-adduction-type fractures with suspected medial plafond impaction, spiral fractures of the distal part of the tibial shaft, and transitional ankle fractures in adolescents.* The strict application of the established 2-dimensional radiographic criteria described by Weber and direct visual control of syndesmotic reduction enable the surgeon to prevent most clinically relevant malreductions.* Intraoperative 3-dimensional imaging within limitations (missing contralateral side, lower resolution) and postoperative CT scanning are useful for detecting relevant malreduction and other findings that may go unnoticed on radiographs, especially rotatory malalignment, intra-articular implants, loose bodies, and marginal joint impaction.* Relevant malalignment should be corrected as early as possible after detection in order to avoid joint incongruity and chronic syndesmotic instability leading to posttraumatic ankle arthritis. Although the potentially deleterious consequences of malreduction in the treatment of ankle fractures are well known, few studies on postoperative CT imaging have shown a direct impact on clinical decision-making.

Category: Basic Sciences/Biologics Introduction/Purpose: A scientifically sound validated foot and ankle specific outcome measure for different European languages is still missing. Indeed, language-specific cross cultural validation in other languages than English is largely absent. Some outcome measures were validated for specific pathologies such as hallux valgus, ankle arthritis or flatfoot. The European Foot and Ankle Society (EFAS) established in 2013 a Score Committee to develop, validate, and publish a new score, the “EFAS Score”, which is not specific for single pathologies for different European languages. The principal aim of this project was to develop and validate the EFAS Score simultaneously for different European languages. Methods: The EFAS Score was developed and validated in three stages: 1) item (question) identification, 2) item reduction and scale exploration, 3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre- operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. Results: Stage 1 resulted in 31 general and 7 sports related questions. In Stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In Stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach’s Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. Conclusion: The multi-language EFAS Score has been successfully validated for orthopaedic foot and ankle surgery populations incorporating a wide variety of foot and ankle pathologies, including language-specific validation in seven languages so far (English, German, French, Swedish, Dutch, Italian, Polish). Validation for other languages (Danish, Finnish, Norwegian, Portuguese, Spanish, Turkish) is in progress. All validated score versions are freely available at www.efas.co .

The multi-language EFAS Score was successfully validated in the orthopaedic ankle and foot surgery patient population, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co.

PurposeThe goal of this study was to evaluate clinical and radiological outcomes after arthroscopic Latarjet stabilisation in anterior shoulder instability.MethodsNinety-three patients after primary arthroscopic Latarjet stabilisation were reviewed. Satisfaction, subjective shoulder value (SSV), Walch–Duplay and Rowe scores, and range of motion and stability were evaluated on clinical examination. Computed tomography (CT) was used to analyse graft position and fusion.ResultsNinety patients (96.8%) were available for clinical and 85 for CT evaluation. The mean follow-up was 23.7 months (13–50, SD 7.1) and age at surgery was 26.2 years (16–44, SD 5.6). Intraoperative complications were reported in eight patients (8.9%) and recurrence in three (3.3%). Significantly, two out of three patients with recurrence had intraoperative graft complications (p = 0.0107). Forty-one patients (45.6%) reported the feeling of “subjective return to sport anxiety”. External rotation with arm at the side was 59° (10–90°, SD 20) with 15° (0–70°, SD 17) of loss of rotation. These two factors correlated with results the most. Patient satisfaction was evaluated as 92% (40–100, SD 14) and SSV 90% (30–100, SD12). Revision rate after primary surgery was 10%. CT showed graft healing in 81 (95.3%) patients. A graft position between 2 and 5 o’clock was found in 70 (83.4%) patients and flush to the anterior glenoid rim in 34 (40.5%). Osteolysis of the superior part of the graft was found in 55 (64.7%) patients. CT evaluation showed no correlation with clinical results.ConclusionArthroscopic Latarjet stabilisation demonstrates satisfactory results in short-term follow-up; however, intraoperative graft-related complications are a risk factor for recurrence. “Subjective return to sport anxiety” and loss of external rotation with the arm at the side are factors worsening the results. Graft position imperfections and osteolysis of the superior part of the graft reported in CT evaluation do not influence the clinical results.

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