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Background: “Failure” is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers. Purpose: To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI. Results: Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure. Conclusion: There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.

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Introduction. Irrigation and debridement of external fixator pin sites is one method utilized by orthopedic surgeons to prevent surgical site infections in patients undergoing definitive internal fixation after temporization in an external fixation device. This study aims to determine if irrigation and debridement of external fixator pin-sites leads to fewer deep surgical site infections, compared to simply scrubbing the external fixator pin sites with a chlorhexidine scrub-brush. Methods. This single center retrospective cohort study was performed at a University Level I Trauma Center. All cases in which a single surgeon removed an external fixator and followed this with definitive open reduction and internal fixation (ORIF) in the same operative setting between October 2007 and October 2018 were reviewed. 313 patients were temporized in 334 external fixators prior to ORIF and were included in the study. Results. 18 of the 179 Irrigation and Debridement cohort (10.0%) and 8 of the 155 Simple Scrubbing cohort (5.2%) resulted in infections that required return to the operating room. We found no statistical difference (p=0.10) or meaningful effect size (Cohen’s d= 0.18) between irrigation and debridement and simple scrubbing of external fixator pin-sites. Conclusions. Given no significant difference was found between debridement of pin sites versus simply scrubbing, the authors propose further studies should focus on the time and resources required for debriding external fixator pin sites.

FlgL, respectively. FliJ is a general chaperone that assists and regulates the export process. FlhA and FlhB constitute the export gate and determines the hierarchy of the export process. Despite detailed understanding of the morphology of flagellum, flagella export process is poorly understood. We have determined the solution structure of FliT in its apo form along with its complex with FliD, FliI, and FliJ. Solution structure of FliT differs from its crystal structure and explains the regulatory role of FliT. FliT stays in an auto-inhibitory form in the absence of substrates to avoid any unwanted interaction with export gate. Substrate binding activates FliT-substrate complex to bind to the export gate. This targeting mechanism of FliT is appeared to be shared among all export chaperones, FlgN and FliS. We further characterized the interactions among export chaperones and showed that strict binding sequence among chaperones determines chaperone recycling process and regulate subsequent export events.