Background:Percutaneous screw fixation can provide stable fixation with a minimally invasive surgical technique for posterior talar process fracture.Objectives:The purpose of this study was to investigate the optimal posterior screw placement and the geometry of safe zone for screw insertion in the posterior talar process by analyzing with 3-dimensional (3D) technology.Methods:100 adult feet computed tomography (CT) scans were evaluated. CT data were imported into Materiaise's interactive medical image control system (MIMICS) 18.01 software for 3-dimensional reconstruction. Two 3.0mm-diameter screws were simulated from the posterior to anterior position for posterior talar process. The morphology parameters of posterior talar process were also quantitatively measured. The safe zone and the length and entry point of screw were defined.Results:The optimal entry point of screw for posterior talar process fracture was lateral tubercle from the posterior to anterior position. The safe zone of medial tubercle entry point was smaller in lateral tubercle. These gender-specific measurements were all significant (P <.001).Conclusions:The predefined zone with computer-assisted 3D techniques for the most frequently positioned percutaneous screws may aid in preoperative planning, shorten the operation time and reduce the incidence of surgical complications.

Knowing FHL muscle morphology, variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. With posterior arthroscopic for the treatment of various ankle pathologies, posteromedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures because of the gap between the neurovascular bundle and FHL tendon.

The purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using open reduction and internal fixation (ORIF) through posteromedial approach and percutaneous screw fixation. From January 2014 to December 2018, 12 cases with displaced fracture of talar posterior process were treated in our department. The clinical and radiological results were assessed after 4 and 12 months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. The average follow-up period was 13 months. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12 months postoperatively for both techniques. There was no significant difference for AOFAS scores and VAS scores between the two techniques (p > 0.05). Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications.

Background: Proximal crescentic metatarsal osteotomy and distal soft tissue reconstruction have been introduced to correct severe hallux valgus (HV). The intrinsically unstable proximal first crescentic osteotomy depends on enough force fixation for stability. It is necessary to judge the number of fixation’s screw for osteotomy.Methods: Fifty two feet from 50 adult patients with severe HV were included in this study. The treatment was proximal crescentic metatarsal osteotomy with a single screw and distal soft tissue reconstruction in Group 1. The fixation with two screws with distal soft tissue reconstruction in Group 2. Clinical and radiological follow-ups were assessed after 4 and 12 months of operation.Methods: In Group 1, hallux valgus angle (HVA) was decreased from 46.4 ±3.28 to 19.9 ±4.70 after 12 months of operation. HVA was decreased from 45.1 ±3.45 to19.1 ±4.70 for group 2. For intermetatarsal angle (IMA) in Group 1, it was changed from 18.5 ±1.98 to 9.25 ±1.11 after 12 months of operation. For group 2, it was decreased from 18.3 ±1.81 to 9.53 ±1.70. Meanwhile, the American Orthopedic Foot and Ankle Society (AOFAS) score was improved from 63.1 to 83.9 after 12 months of operation for group1, and was improved from 64.3 to 82.8 for group2. Furthermore, the visual analogue scale (VAS) score was reduced from 4.5±1.01 to 1.7± 0.43 for group 1, and it was reduced from 4.7±0.92 to 1.7±0.55 for group 2 after 12 months of operation.Conclusions: The first metatarsal dorsal elevation was occurred in 4 feet in Group1, and no metatarsal dorsal elevation was occurred in Group 2. There were no significant differences identified among Group1 and Group 2 in terms of VAS and AOFAS scores, and HVA and IMA measurements. However, there is less complication in two-screw fixation for crescentic osteotomy compared to a single screw fixation.

Proximal crescentic metatarsal osteotomy and distal soft tissue reconstruction have been introduced to correct severe hallux valgus (HV). The intrinsically unstable proximal first crescentic osteotomy depends on enough force fixation for stability. It is necessary to judge the number of fixation’s screw for osteotomy. Fifty two feet from 50 adult patients with severe HV were included in this study. The treatment was proximal crescentic metatarsal osteotomy with a single screw and distal soft tissue reconstruction in Group 1. The fixation with two screws with distal soft tissue reconstruction in Group 2. Clinical and radiological follow-ups were assessed after 4 and 12 months of operation. In Group 1, hallux valgus angle (HVA) was decreased from 46.4 ±3.28 to 19.9 ±4.70 after 12 months of operation. HVA was decreased from 45.1 ±3.45 to19.1 ±4.70 for group 2. For intermetatarsal angle (IMA) in Group 1, it was changed from 18.5 ±1.98 to 9.25 ±1.11 after 12 months of operation. For group 2, it was decreased from 18.3 ±1.81 to 9.53 ±1.70. Meanwhile, the American Orthopedic Foot and Ankle Society (AOFAS) score was improved from 63.1 to 83.9 after 12 months of operation for group1, and was improved from 64.3 to 82.8 for group2. Furthermore, the visual analogue scale (VAS) score was reduced from 4.5±1.01 to 1.7± 0.43 for group 1, and it was reduced from 4.7±0.92 to 1.7±0.55 for group 2 after 12 months of operation. The first metatarsal dorsal elevation was occurred in 4 feet in Group1, and no metatarsal dorsal elevation was occurred in Group 2. There were no significant differences identified among Group1 and Group 2 in terms of VAS and AOFAS scores, and HVA and IMA measurements. However, there is less complication in two-screw fixation for crescentic osteotomy compared to a single screw fixation.