PULLED ELBOW IS CLASSIFIED AS FOLLOWS: type I, with an interposed RAL, and type II, with torn ligament.

Background: Haglund’s deformity is not an uncommon cause of retrocalcaneal pain. Currently, there is neither a classification system nor a standard surgical protocol for this condition. The purpose of this study was to evaluate the outcome after Achilles tendon debridement, partial detachment, and anchor reattachment of the tendon, osteotomy of the Haglund deformity, and excision of the retrocalcaneal bursa. An MRI-based classification system is proposed that relies on the extent of Achilles tendon pathology in the presence of the Haglund deformity. Methods: Fifty heels in 46 patients were surgically treated with the proposed surgical protocol. Patients were evaluated using the Tegner Activity Level and the Foot and Ankle Outcome (FAOS) scores. Results: The mean Tegner Activity Level score improved from a preoperative mean of 3.44 to a mean of 6.56 at 6 mo, then to a mean of 6.84 at 12 mo follow-up. The mean FAOS score improved from 47.60 preoperatively to a mean of 66.50 at 6 mo and to a mean of 79.49 at 12 mo follow-up. Conclusions: Surgical treatment of Haglund’s deformity with tendon debridement, partial detachment, calcaneal osteotomy, and bursal debridement provides good results and functional outcomes that continues to improve over 12 mo follow-up.

Background: Posterior malleolar fractures are not uncommon ankle injuries. Despite their biomechanical significance for syndesmotic stability and stress distribution, there is no consensus about which fractures to treat surgically. The purpose of this study was to evaluate arthroscopic guided fixation of posterior malleolar fractures. This technique is hypothesized to provide visualized optimal reduction in a minimally invasive manner. Methods: Twelve consecutive ankle injuries with posterior malleolar fracture were treated and enrolled in this prospective study. The standard procedure included posterior ankle arthroscopic guided reduction and cannulated screw fixation of the posterior malleolus. Patients were evaluated using the Foot and Ankle Outcome Score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the EQ-5D and visual analog scales (VAS) for pain and satisfaction was accomplished. Results: Postoperatively, all radiographs showed good reduction of the posterior malleolus and an even joint, with a mean tibiofibular clear space of 4.2 mm. All patients had returned to their preinjury activity levels at their final follow-up. The mean FAOS score for patients included in the study was 92.46, and the mean Ankle-Hindfoot score was 92.0. Adequate range of motion was achieved in relation to the contralateral ankle, with insignificant comparative chi-square statistic at a P-value of 0.99, and overall satisfaction scale of 9.42. Conclusions: Arthroscopic guided fixation of the posterior malleolar fracture is an effective treatment modality that achieves direct reduction of the fracture, faster rehabilitation, and has a lower risk of neurovascular complications.

Background: The deltoid ligament is the main medial stabilizer of the ankle joint. Rupture of this ligament is not uncommon in pronation ankle injuries and should be suspected in the absence of medial malleolar fractures. The purpose of this study was to evaluate the effectiveness of deltoid ligament reconstruction using suture anchor fixation to the medial malleolus for such conditions. Methods: Twenty-seven ankles with pronation ankle injuries were surgically treated and enrolled in this prospective study. Sixteen patients with pronation-external rotation injury (group 1) and 11 patients with pronation-abduction injury (group 2) were evaluated using the Foot and Ankle Outcome score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the Health-related Quality of Life Index (EQ-5D) and visual analog scales (VAS) for pain and satisfaction, was used to assess the surgical result. Results: All patients returned to their preinjury activity level at their final follow-up. The mean FAOS score for all patients included in the study was 94.44, and the mean Ankle-Hindfoot scale was 93.3, with no statistical difference between the two groups. Adequate range of motion was achieved in all patients. Twenty-five patients reported being fully satisfied, while two patients reported to be just satisfied, with an overall satisfaction scale of 8.85. Conclusions: Surgical reconstruction of a ruptured deltoid ligament in pronation ankle injury using suture anchors is an effective treatment modality with excellent functional outcome.

No abstract

Background: Tenosynovitis of the flexor hallucis longus (FHL) tendon is more frequent than previously reported, and the condition is often overlooked or misdiagnosed. Overuse in ballet dancers or competitive runners was believed to be the main triggering factor. Recent advances in diagnostic modalities have shown a wide occurrence in nonathletes. The purpose of this study was to evaluate arthroscopic decompression of the FHL tendon in posttraumatic tenosynovitis. Methods: Nine consecutive patients with posttraumatic flexor hallucis longus stenosing tenosynovitis were treated and enrolled in this prospective study. All patients dated their complaint to previous ankle fracture or major sprain. The standard procedure included posterior ankle arthroscopy, thorough debridement of posterior adhesions, and adequate decompression of the tendon at the fibroosseous tunnel. Patients were evaluated for functional outcome through both Foot and Ankle Outcome Score (FAOS) and Ankle-Hindfoot Scale. Results: The mean FAOS score at 1-year follow-up improved from a preoperative mean of 72.56 (SD 4.43) to a postoperative mean of 87.33 (SD 4.03), which is considered to be extremely statistically significant with a P value less than 0.0001. The mean Ankle-Hindfoot Scale improved from a preoperative mean of 71.78 (SD 3.77) to a postoperative mean of 85.33 (SD 5.94). All patients reported being fully satisfied with an overall satisfaction score of 9.42. Conclusions: Flexor hallucis longus stenosing tenosynovitis is more frequent than previously thought and should be considered in patients with posterior ankle pain especially if a history of ankle trauma exists.

Background: The tarsal navicular bone plays a pivotal role in hindfoot motion and gait and is considered as a keystone of the foot’s medial longitudinal arch. Despite being relatively uncommon, navicular fractures are difficult to treat and may end up with devastating complications. The purpose of this study was to evaluate the effectiveness of fracture reduction with ligamentotaxis and maintenance of the reduction through percutaneous screw fixation. Methods: Twelve patients with comminuted navicular fractures were surgically treated and enrolled in this prospective study. Patients were evaluated through Foot and Ankle Outcome score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the EuroQol-5D (EQ-5D) and Visual Analog Scale (VAS) for pain and satisfaction with the surgical result was executed. Results: All patients returned to their preinjury activity level at their final follow-up. Eleven patients presented excellent FAOS score of ≥90. The mean FAOS score for all patients included in the study was 92.91 (SD; 3.26, range 86 to 98), and the mean Ankle-Hindfoot scale was 92.67 (SD 2.84). The mean health-related quality of life (EQ-5D) index score was 9.50, with an overall satisfaction scale of 9.83 (SD 0.39). Conclusions: Adequate reduction of navicular fractures can be achieved with axial traction through temporary Steinmann pins in the calcaneus and medial cuneiform. Minimally invasive percutaneous screws can maintain reduction, with excellent functional outcome