Introduction: Premature radial physeal closure is a relatively rare occurrence in children. When isolated growth arrest of the radius with continued ulnar growth occurs, the resulting ulnar positive deformity leads to altered wrist mechanics and pain. Timely epiphysiodesis of the distal ulna with and without ulnar shortening osteotomy can address these issues, but continued ulnar overgrowth is a possible complication. We seek to evaluate the success rate of the primary epiphysiodesis of the ulna and associated clinical outcomes. Methods: A chart review was conducted at 2 children's hospitals from 2008 to 2019. Patients between the ages of 6 and 18 years old, with premature distal radius physeal closure, with or without positive ulnar variance, and > 2 months follow-up were included. We evaluated the following characteristics for each patient: demographics, initial cause of premature radial physeal closure, ulnar variance, additional procedures performed during epiphysiodesis, preoperative and postoperative pain, range of motion, instability. Summary statistics were conducted and expressed as proportions, medians and means. A paired t test evaluated change in ulnar variance for those who had an ulnar shortening osteotomy performed.Results: Thirty-one wrists among 30 patients were identified, and the median age at the time of surgery was 12.2 years (interquartile range: 3.4). Ulnar shortening osteotomies were performed in 53.1% of cases and distal radius osteotomy in 15.6%. Bone graft was utilized in 25.8% of the epiphysiodesis procedures. There were 2 failures of primary epiphysiodesis indicating an index success rate of 93.7%. The average ulnar variance correction was 3.1 mm (95% confidence interval: 1.9, 4.4). The mean physeal time to closure was 134 days. Preoperative symptoms were resolved for 90.6% cases at final follow-up. Conclusion: Ulnar epiphysiodesis successfully terminates ulnar physeal growth in 93.7% of cases. Preoperative symptoms were completely resolved with a median physeal closure of just over 4 months. Ulnar variance was corrected on average by 4.1 mm when a radial or ulnar shortening osteotomy was performed at the time of epiphysiodesis. Level of Evidence: Level IV-case series.

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Category: Ankle; Sports Introduction/Purpose: Ankle sprains occur frequently within the general population, however, the extent to which this injury impacts the military population remains unknown. The purpose of this study was to systematically review the literature describing ankle sprains in the military population. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were retrieved from PubMed, Embase, and Cochrane Library using the search terms 'military,' 'epidemiology,' 'incidence,' 'prevalence,' 'ankle sprain,' and 'ankle instability.' Inclusion criteria consisted of active military duty status, English language, and levels of evidence I-IV. Results: Nineteen articles were included, representing 1,671,763 study participants from six countries and four branches of the military. Among the ten studies that reported ankle sprain incidence in terms of overall injury incidence, seven studies reported ankle sprain as the most common injury, with an incidence ranging from 2.20% to nearly one third of all injuries in the paratrooper population. Ankle sprain was also reported as the most common injury among lower extremity injuries in two studies, with incidences of 35% and 38.7%, respectively. Ankle sprain incidence rate per 1,000 person-years was reported in four studies, with values ranging from 15.3 to 58.4. Incidence rate was also reported for males and females separately in three of these studies, ranging from 33.89 to 52.7 for males, and 41.17 to 96.4 for females. The number of days lost to ankle sprain ranged from one to eight days per servicemember. Conclusion: Ankle sprains are among the most prevalent injuries within the military population, with a reported incidence that is higher for females than males. This injury results in time away from active duty, which impacts overall readiness within the military system.

Ankle sprain is one of the most prevalent injuries within the military population, resulting in health-care costs, time away from active duty, and negative impacts on overall readiness.Female service members appear to be more likely to sustain ankle sprains than male service members.There is a need for additional research on prevention methods and rehabilitation programs for ankle sprains in the military population because the rate of ankle sprain in this population exceeds that in populations with less physically demanding lifestyles. Consequently, low-cost prevention strategies could yield substantial benefits.

Category: Ankle; Sports Introduction/Purpose: The high incidence of ankle sprain within the military sets the stage for prevalent chronic ankle instability. The purpose of this review was to compare and evaluate chronic ankle instability treatment strategies in the military population. Methods: Electronic databases were systematically searched for English-language, human studies with a military patient population that had been diagnosed with and treated for chronic ankle instability. Exclusion criteria were animal, cadaver, and review studies and case reports. Results: Eight studies met inclusion criteria and represented 695 military service members-625 males (89.9%) and 70 females (10.1%). The four treatment strategies included were Broström-related procedures, modified Watson-Jones procedure, Colville's technique, and anatomic lateral ligament reconstruction using semitendinosus tendon allograft. The percentage of subjective satisfactory outcomes ranged from 80 to 94.7%, and the percentage of objective satisfactory outcomes ranged from 72 to 100%. The range for Broström-related procedures was 73.2% (objective) to 94.7% (subjective). The modified Watson-Jones procedure had a subjective satisfactory outcome of 80% and objective satisfactory outcome of 72%. Colville's technique had an objective satisfactory outcome of 100%. No satisfaction outcome was available for the study utilizing the anatomic lateral ligament reconstruction with semitendinosus tendon allograft. Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores, anterior drawer displacement, talar tilt, and visual analogue scale (VAS) scores were also reported. Conclusion: This review demonstrates that the Bröstrom procedure has consistently satisfactory outcomes within the military population, and Colville's technique is another promising option for this patient population, but would require future studies to fully support this claim.

Category: Ankle; Sports Introduction/Purpose: Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair. Methods: In this systematic review and meta-analysis, we utilized Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) criteria to search for articles on electronic databases. Inclusion criteria consisted of English-language, in-vivo clinical studies, mean follow-up of at least one year, sex-specific evaluation of outcomes, and study participants who underwent primary lateral ligament repair. Functional postoperative outcomes for males and females were recorded and statistically analyzed. Results: Out of 2,768 studies, eight (0.29%) met inclusion criteria and were analyzed in this review. These studies included 631 patients (409 males [65%] and 222 females [35%]) who underwent primary lateral ligament repair for ankle instability. There was no statistically significant difference between males and females in terms of Karlsson scores (93.5 +- 1.6 for males, 92.7+- 2.3 for females, P =.1582) or American Orthopaedic Foot & Ankle Society (AOFAS) scores (90.44 +- 4.82 for males, 90.19 +- 3.54 for females, P =.1586). Postoperative success was defined as a 'good' or 'excellent' Karlsson score (>81), and success rate analysis revealed no statistically significant difference between males and females (86% +- 7.1% for males, 87% +- 3.5% for females, P =.9374). Conclusion: There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair. This surgical procedure appears to have comparable outcomes in both sexes; however, more research is warranted to further assess the impact of patient sex on postoperative outcomes.

Background: Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair. Methods: In this systematic review and meta-analysis, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to search for articles on electronic databases and included studies in which study participants underwent primary lateral ligament repair and sex-specific outcomes were evaluated. Functional postoperative outcomes for males and females were recorded and statistically analyzed. Results: Out of 2768 studies, 7 (0.25%) met inclusion criteria and were analyzed in this review. These studies included 618 patients (402 males [65%] and 216 females [35%]) who underwent primary lateral ligament repair for ankle instability. Karlsson score ( P = .1582) and American Orthopaedic Foot & Ankle Society (AOFAS) score ( P = .1586) analyses found no statistically significant difference between males and females. Postoperative success rate—defined as a “good” or “excellent” Karlsson score (>81)—was not found to be significantly different between males and females ( P = .9374). Conclusion: There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair. Level of Evidence: Level IV, therapeutic.