Objective: To evaluate the accuracy and reliability of a novel fluoroscopic technique for assessing tibial rotation and compare it with a previously described fluoroscopic method.Methods: A multiplanar circular ring external fixator was secured to the tibial diaphysis of 5 cadaveric lower extremity specimens. Using deformity correction software, the frame and tibia were programed to randomly rotate 5, 10, 15, 20, 25, and 30 degrees of internal and external rotation. After each rotation, 2 blinded, independent observers measured the degree of tibial rotation using 2 different fluoroscopic methods: the previously described "mortise" method and the novel "intermalleolar" method. A total of 65 measurements were made by each observer. Accuracy and interobserver reliability were calculated.Results: Both intermalleolar and mortise methods had a mean absolute rotational difference from the true torsion of 3 degrees (standard error 1; range, 0-10 degrees intermalleolar vs. 0-18 degrees mortise). We found that 98.5% (128/130) of measurements using the intermalleolar method were less than 10 degrees from the true rotation compared with 93.8% (122/130) using the mortise method. Both the intermalleolar and the mortise methods had excellent interobserver reliability (intraclass correlation coefficient 0.99 and 0.96, respectively). Conclusion:Measuring tibial rotation fluoroscopically using the intermalleolar method is both accurate and reliable. Compared with the previously described mortise method, it has similar accuracy and provides a value that approximates the true tibial rotation. Also, it can be used reliably and effectively intraoperatively to identify tibial malrotation and assist in intraoperative rotational corrections.

Case: This is the first clinical report of periprosthetic total joint infection caused by Bartonella henselae. A 65-year-old woman developed an acutely painful total knee 3 weeks after a cat scratch. Serial joint aspirations and tissue cultures failed to identify any organism. Diagnosis was performed with polymerase chain reaction analysis. She underwent a 2-stage revision with successful symptom resolution. Conclusions: Bartonella is an unusual cause of total knee infection requiring alternative techniques for diagnosis because cultures are unlikely to be definitive.

Background: The ideal fixation method for the first metatarsophalangeal joint (first MTP) remains uncertain. This study compares nonunion and revision surgery rates of first MTP arthrodesis between nonlocking semitubular plates and precontoured locking plates. Methods: Demographics, fixation technique, and complications of all patients who underwent primary first MTP arthrodesis between 2013 and 2018 were determined from radiographs and clinical records. Cost data were from a 1-year subset of isolated first MTP fusion surgeries. The primary outcome measures of this study were the nonunion and complication rates, with associated costs of patients undergoing first metatarsophalangeal arthrodesis with either a noncontoured semitubular plate or a precontoured locking plate. Results: The study included 189 patients, with a mean follow-up of 18.7 months. The overall nonunion rate was 10.1%, with no difference between the locking and nonlocking plates. The prevalence of a painful implant was also similar. Surgeries using locking plates cost an average of $1,500 more than those using nonlocked plates. Conclusions: Because there was no difference in revision between locking and nonlocking plate fixation for primary first MTP arthrodesis, routine use of the more expensive locking plates may not be justified. Level of evidence: Level III (Retrospective cohort study).