Background: The deep deltoid ligament (DDL) is a key stabilizer to the medial ankle and ankle mortise and can be disrupted in ligamentous supination external rotation type IV (LSER4) ankle fractures. The purpose of this study was to define the medial clear space (MCS) measurement on injury mortise radiographs that corresponds with complete DDL injury. Methods: A retrospective record review at a level 1 hospital was performed identifying patients with LSER4 ankle fractures who underwent arthroscopy and open reduction internal fixation. Chart reviews provided arthroscopic images and operative reports. Complete DDL injury was defined as arthroscopic visualization of the posterior tibial tendon (PTT). Inability to completely visualize the PTT was defined as a partial DDL injury. MCS was measured on injury mortise radiographs. Eighteen subjects met inclusion criteria. Results: Twelve subjects had complete and 6 subjects had partial DDL injury based on arthroscopic findings. Patients with complete DDL injury and those with partial DDL injury had injury radiograph MCS ranging from 5.5 to 29.9 mm and 4.0 to 5.0 mm, respectively. All patients with MCS ≥5.5 mm on injury radiographs had complete DDL injury and all patients with MCS ≤5.0 mm on injury radiographs had partial DDL injury. Conclusion: Complete DDL injury was found on injury ankle mortise radiographs as MCS widening of ≥5.5 mm, which correlated with arthroscopic visualization of the PTT. Using this cutoff, surgeons can surmise the presence of a complete deltoid ligament injury, allowing for improved preoperative planning. Level of Evidence: Level III, retrospective comparative study.

Background: There is a growing trend toward early weightbearing as tolerated (WBAT) after open reduction and internal fixation (ORIF) of ankle fractures. To date, studies have excluded fractures with associated syndesmotic injuries from their cohorts. Methods: In this retrospective cohort study, a chart review was performed at a single level 1 trauma center, identifying all unstable ankle fractures that underwent operative fixation between July 2016 and July 2017. After exclusion criteria, 63 patients were identified and 31 were included in the final analysis, with 14 undergoing syndesmotic fixation. WBAT was initiated after suture removal, between 2 and 4 weeks postoperatively. Outcomes included fracture union, radiographic maintenance of alignment, hardware failures, wound complications, and the need for repeat surgery. Results: Weightbearing was initiated at an average of 17.8 days. All 31 patients progressed toward fracture union, with no hardware failures. Three patients developed superficial wound breakdown, which was treated with protected weightbearing in all cases and oral antibiotics in 1 case. All 3 went on to heal from their incisions. One patient had delayed wound breakdown and required a split-thickness skin graft that subsequently healed without complication. One patient underwent hardware removal 6 months postoperatively. There were no revision ORIF procedures. Conclusion: There is literature supporting early WBAT after ORIF of unstable ankle fractures in patients without major comorbidities. This article supports this trend, demonstrating that a group of ankle fractures requiring syndesmotic fixation were included in the early weightbearing cohort without a higher rate of catastrophic failure or increased wound problems. Level of Evidence Level IV, retrospective cohort study.

Introduction Segmental bone loss is a challenging condition to manage, and some of the techniques employed are difficult for patients to tolerate and involve lengthy treatment and rehabilitation times. The Masquelet technique is a two-stage bone grafting technique used to treat segmental bone defects. The technique has primarily been described for bone defects averaging 5.5 cm in length. This technique's advantages include protection against autograft resorption, relative maintenance of graft position, and prevention of soft-tissue interposition. We present a case report of a male who achieved successful bone defect union utilizing the Masquelet technique for a right femoral shaft infected non-union with a resultant 20 cm bone defect. Case report This is a case report of a 28-year old male who presented to our clinic for evaluation and treatment for a segmental bone defect secondary to a right femur fracture with non-union after infection. The patient had been in a motor vehicle collision. Our patient was interested in limb salvage surgery and declined bone transport. Given the significant size of his defect, we opted to treat him utilizing the Masquelet technique. He went on to have a successful union of his defect with associated increased subjective quality of life and functionality. Conclusion The Masquelet technique is a useful limb salvage treatment for patients with segmental bone defects, including large defects of 20 cm in length.

We have identified severely disabled arthritics who live in the community through social service records. All had either rheumatoid arthritis (RA) or osteoarthritis (OA). The diagnosis influenced referral to hospital, those with RA being referred while only half of those with OA had been referred. Referral was important for both surgical and environmental intervention. Provision of social services and community occupational therapy services was greater if the patients had been seen in hospital departments irrespective of the diagnosis. Recipients of joint surgery had all gained temporary benefit although progression of arthritis or other disabling disease compromised this after several years. There was a substantial minority of people with severe OA living in the community who had not been considered for joint replacement and did not have optimal provision of aids, appliances and environmental adaptation.

Talus fractures are the second most common tarsal fracture after the calcaneus. Traditional treatment methodology includes open reduction and internal fixation; however, there has been increased interest and literature in arthroscopically assisted fixation of talus fractures. We present a case study of a patient with a type 1 talar neck fracture that was successfully treated with arthroscopically guided percutaneous screw fixation from a posterior arthroscopic approach. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Assessment of ASIS is sensitive but not specific at discrepancies of 5 mm or greater. Length of experience positively influences the percentage of correct results, and eye dominance does not significantly change this outcome. This form of assessment can be used to screen for ASIS asymmetry.

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Lisfranc injuries are uncommon but destabilizing injuries of the tarsometatarsal joint that are often missed on initial evaluation and have a high incidence of posttraumatic arthritis. These injuries can occur from low or high-energy mechanisms and feature unique characteristics. Open reduction and internal fixation is indicated in Lisfranc injuries that include a fracture component and different methods of fixation have been described. In this article, we present our operative techniques for open reduction and internal fixation of Lisfranc fractures using dorsal plating for both low and high-energy injuries. Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence.