Background Triangular fibrocartilage complex (TFCC) injury is common in distal radius fractures. The purpose of this study was to compare the conservative and surgical treatments of TFCC injury of the wrist associated with distal radius fractures. Methods A retrospective study was conducted on 39 patients who received treatment for TFCC injury with distal radius fractures. All patients were treated using a volar locking plate for distal radius fractures. Twenty-six patients who received conservative treatment for TFCC through long arm splinting were classified into group 1, and 13 patients who received surgical treatment for TFCC were classified into group 2. The splint was maintained for 6 weeks in both groups. For clinical evaluation, the range of motion (ROM) of the wrist joint, patient-rated wrist evaluation (PRWE) score, Disabilities of the Arm, Shoulder and Hand (DASH) score, and grip strength were measured. Distal radioulnar joint (DRUJ) stability was evaluated through a stress load test and graded between grade 0 and 3 intraoperatively after fixation and at the final follow-up. Results In group 1, the average DASH score was 11.1 ± 4.4, the average PRWE score was 10.2 ± 4.6, the grip strength was 89.4% relative to the unaffected side, the average ROM of the wrist joint was 65° ± 7.0° for extension, 51.5° ± 8.1° for flexion, 86° ± 5.1° for supination, and 85° ± 5.2° for pronation, and DRUJ stability at the final follow-up was grade 0 in 58.62%, grade 1 in 31.03%, grade 2 in 10.34%, and grade 3 in 0%. In group 2, the average DASH score was 13 ± 5.0, the average PRWE score was 12.4 ± 3.7, the grip strength was 87.3% relative to the unaffected side, and the average ROM of the wrist joint was 60° ± 9.8° for extension, 53.1° ± 7.0° for flexion, 85° ± 5.3° for supination, and 86.8° ± 4.5° for pronation. At the final follow-up, DRUJ stability was grade 0 in 66.67%, grade 1 in 25%, grade 2 in 8.3%, and grade 3 in 0%. The 2 groups showed no statistically significant differences in DASH score, PREW score, grip strength, ROM, and final follow-up DRUJ stability. Conclusions There were no statistically significant differences in the clinical outcomes between the surgical and conservative treatment groups. Therefore, when normal radiological indices are achieved after treatment of distal radius fractures, DRUJ stability can be obtained by conservative treatment.
The supramalleolar osteotomy is a joint-preserving surgical procedure. It is a very good treatment option for the asymmetric varus ankle and medial compartment osteoarthritis. The primary objective of the procedure is to shift medial concentration of stress toward the lateral intact articular cartilage to redistribute the joint loads during ambulation. Several studies have shown that deformities of the ankle result in uneven load distribution in the ankle joint, which eventually leads to articular cartilage degeneration. Since the lateral articular cartilage is intact, joint-sacrificing procedures such as total ankle replacement or ankle arthrodesis are not the most appropriate treatment choices for medial compartment arthritis. Results of supramalleolar osteotomies are very promising in terms of functional outcome and pain relief. In younger patients with medial compartment varus ankle osteoarthritis or even with a normal tibial anterior surface angle, supramalleolar osteotomies can be performed to realign the ankle to promote regeneration of the asymmetrically damaged cartilage. In this review article, we will discuss the indications, complications, surgical techniques, and outcomes of the supramalleolar osteotomy reported in the current literature.
Background: This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA. Methods: This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA). Results: The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group ( P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group ( P < .001). Conclusion: HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered. Level of Evidence: Level III, retrospective comparative series.
Purpose To evaluate the arthroscopic indings of subtalar joints, including interosseous talocalcaneal ligament (ITCL) tear, in patients with chronic lateral ankle instability (CLAI) and sinus tarsi pain. Methods A total of 118 ankles (109 patients) having CLAI with sinus tarsi pain who had undergone subtalar arthroscopy and lateral ankle ligament surgery were evaluated. The medical records, radiologic images, and the arthroscopic images and videos were reviewed. ITCL tears were classiied into 4 grades: grade 0 (no tear), grade 1 (mild), grade 2 (moderate), and grade 3 (severe). The eicacy of magnetic resonance imaging (MRI) in diagnosing ITCL tears was also evaluated by comparing preoperative oicial readings of MRI to arthroscopic indings. The pre-and postoperative functional scores were also assessed. ResultsThe overall tear rate of ITCL was 107/118 (90.7%). There were 29 ankles (23.6%) with grade 1, 42 ankles (35.6%) with grade 2, and 36 ankles (30.5%) with grade 3 tears. Isolated lateral ankle instability (LAI) was diagnosed in 43 ankles (36.4%), subtalar instability (STI) in 30 ankles (25.4%), and LAI with STI in 45 ankles (38.1%). There was a statistically signiicant relationship between the ITCL tear grade and the inal diagnosis. ITCL tear was conirmed or suspected in 81 ankles (68.6%) on preoperative MRI. Pain Visual Analog Score and functional outcome scores including the American Orthopaedic Foot & Ankle Society and Karlsson-Peterson scores showed signiicant improvement after the surgery. Conclusion A high rate (90.7%) of ITCL tears was noted in CLAI patients with sinus tarsi pain. ITCL damage may play an important role in subtalar instability in patients with CLAI and sinus tarsi pain. Subtalar arthroscopic evaluation for ITCL tear is important for correct diagnosis for CLAI with sinus tarsi pain. Level of evidence IV.
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