Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Although the clinical relevance is unknown, dynamic syndesmotic fixation may mitigate clamp-induced malreduction.

No abstract

All four total ankle arthroplasty systems tested posed a risk of injury to the extraosseous talar blood supply, but the risks of injury to specific arteries were higher for specific implants.

No abstract

Background Realignment osteotomies about the knee may be performed as distal femoral or proximal tibial osteotomies; both may be performed either on the medial or lateral sides of the knee, in closing-or opening-wedge fashion. Although rare, injury to neurovascular structures may occur, and the proximity of the vascular structures to the osteotomy saw cuts has been incompletely characterized. Questions/purposes We performed a cadaver study to assess the risk of vascular injury in patients undergoing realignment osteotomies by (1) quantifying the distances between osteotomy saw cuts and blood vessels using threedimensional CT reconstruction after distal femoral and proximal tibial osteotomies; and (2) qualitatively describing the small-and medium-sized vasculature around the knee, to provide the link between the CT analysis and wedge incision measures, and better show the potential extraosseous supply to the regions investigated. Methods Twelve human cadaveric knees were injected with a latex and barium sulfate suspension into the superficial femoral artery. Each specimen underwent CT to evaluate vascular perfusion and was randomized to either a lateral opening-wedge distal femoral osteotomy and medial opening-wedge proximal tibial osteotomy group, or a medial closing-wedge distal femoral osteotomy and lateral closing-wedge proximal tibial osteotomy group. Postoperatively, knees underwent CT in extension to measure the shortest distance between the osteotomies and the popliteal artery, anterior and posterior tibial arteries, and genicular arteries. Vessels between 5 mm and 10 mm from the osteotomy cut were considered in a zone of moderate risk for damage, while vessels less than 5 mm from the cut were considered in a zone of high risk for damage. Vessels more than 10 mm from the cut were not considered to be at risk. Subsequently, knees underwent dissection and chemical débridement to qualitatively describe the smaller One of the authors certifies that he (SB) has received grants during the study period, an amount of USD 10,000 to 100,000 from ''Fondazione Enrico ed Enrica Sovena'' (Rome, Italy), a nonprofit foundation that partially sponsored his fellowship at the Department of Orthopaedics vessels. This part of the study added visual information and gave a comprehensive overview of the vessels at risk. Results All variations of the osteotomies put at least one artery at risk. The popliteal artery was found in a risk zone for injury in two specimens during closing-wedge distal femoral osteotomy (median distance, 11.6 mm; range, 5.2-14.6 mm). The superior lateral genicular artery was in a risk zone in all the specimens during opening-wedge distal femoral osteotomy (median distance, 3.0 mm; range, 0.7-6.5 mm), and in five specimens during closing-wedge distal femoral osteotomy (median distance, 4.5 mm; range, 1.3-11.2 mm). A concomitant risk for superior medial genicular artery injury was observed in five specimens during opening-wedge distal femoral osteotomy (median distance, 8.7 mm; range, 0.8-13.9 mm) ...

Level IV, case series.

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.