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Objective: The goal of the study is to diagnose and accurately correct malrotation of femur fractures after intramedullary (IM) nailing.Materials and methods: An institutional review board (IRB) approved prospective study that was performed at a U.S. level 1 trauma center. After IM nailing of comminuted femur fractures, a computed tomography (CT) scanogram was routinely performed to detect the difference in the postoperative femoral version. Patients with malalignment greater than 15 degrees compared to the contralateral side were informed about the discrepancy and offered to have it acutely corrected. A four-pin technique was used: two Schanz pins were used for measuring angles and two different pins were used to turn and correct the malalignment. The pin in the distal fragment is placed directly under the nail to prevent shortening in comminuted fractures. The nail was unlocked either proximally for retrograde nails or distally for antegrade nails. The Bonesetter Angle application was used as a digital protractor to intraoperatively measure the two reference pins and correct the malrotation. Alternate holes were used for relocking the nail. All patients received a CT scanogram after correction.Results: 19/128 patients with comminuted femoral fractures over five years with malrotations between 18 and 47 degrees were included in the study with an average malrotation of 24.7 + 8 degrees. All patients were corrected to an average of 4.0 +/-2.1 degrees difference, as compared to the contralateral side (range 0-8). No patients required further surgeries to correct malrotation. Conclusion: Comminuted fractures with malrotation >15 degrees after femoral nailing have an incidence of 15% at our institution. This technique provides an efficient and accurate correction method with the use of an intraoperative digital protractor, avoiding the need for revision IM nailing or osteotomies.
Category: Ankle Introduction/Purpose: Ankle arthrodesis can be approached anteriorly, laterally, medially, or posteriorly, and debate remains as to which approach is most advantageous. Although an anterior approach using the interval between the extensor hallucis longus and tibialis anterior is commonly performed, there is a paucity of studies showing the clinical outcomes after this procedure. This study aims to evaluate the functional outcomes and patient satisfaction at mid-term follow-up after ankle arthrodesis via an anterior approach. Methods: All isolated primary ankle arthrodeses performed with the anterior approach by a single fellowship-trained foot and ankle surgeon between May of 2011 and December of 2015 were retrospectively included. Chart review was performed and patient reported outcomes were collected including FAAM ADL, FAAM Sports, VAS, and SF-12 scores pre-operatively and at a minimum of two-years post-operatively. At final follow-up, a survey was distributed via phone or email inquiring about level of satisfaction and whether they would undergo the procedure again. A total of 108 patients were included, of which only 45 (41.67%) had pre-operative functional scores, 24 (22.2%) completed both pre- and post-operative functional scores, and 20 patients (18.5%) had satisfaction results. The average length of follow-up was 4.4 years (range: 1.7 – 7.9, SD 1.6). Results: FAAM ADL scores improved from a mean of 48.1 to 67.6, FAAM Sports increased from 18.1 to 34.9, VAS Pain decreased from 73.2 to 44.9, SF-12 MCS changed from 44.2 to 46.7, and SF-12 PCS increased from 31.0 to 42.2. Using a linear mixed effects model and controlling for length of follow-up, all functional and pain score improvements were significant except SF- 12 MCS (Table 1). Overall, 65% of patients were satisfied with their results and 85% of patients would consider the same surgery if needed. Patients who were more satisfied with their surgery were more likely to say that they would consider the same surgery given similar circumstances (p = 0.001). Conclusion: Post-operative functional scores were significantly improved and pain scores were significantly decreased compared to pre-operative scores in a cohort of patients who underwent ankle arthrodesis using an anterior approach. Satisfaction with the surgery was lower than expected given the improvement in functional scores. Further study is indicated to determine methods to improve satisfaction. Our study suggests that an anterior approach to ankle arthrodesis is an effective technique to improve function and pain in patients with ankle arthritis, however satisfaction after surgery is no guarantee. The study is limited by the small subset of patients with pre- and post-operative functional scores.
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