Background: Ankle fractures are a common cause of morbidity that have increased in incidence over the past decade. The purpose of this study was to compare the outcomes and prognosis of various fracture subtypes by using 2 validated patient-reported outcome measures: the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: Twelve-month postoperative PF and PI CATs were collected for 126 ankle fracture patients presenting between 2014 and 2017. Patients were stratified by ankle fracture subtype and refined by the presence/absence of concomitant deltoid injury or posterior malleolar fracture. Patients defined as members of vulnerable populations and patients presenting more than 2 weeks from time of injury or with prior acute ipsilateral fracture were excluded. The distribution of PF and PI T scores were assessed via a Shapiro-Wilk test and a 1-way analysis of variance. If significant differences were found between groups, pairwise comparisons were tested via Dwass, Steel, and Critchlow-Fligner multiple comparison analysis. Results: Mean values for the PROMIS PF and PI for each fracture subtype were calculated and compared to reference population mean (SD) T scores of 50 (10): isolated lateral malleolar (PF: 50/PI: 51), isolated medial malleolar (PF: 52/PI: 49), bimalleolar (PF: 48/PI: 50), trimalleoar (PF: 47/PI: 51), isolated posterior malleolar (PF: 53/PI: 44), and isolated syndesmotic injury (PF: 60/PI: 46). Shapiro-Wilk test indicated a nonnormal distribution for the postoperative PROMIS PF T scores across all fracture patients ( P = .0421). Conclusion: Operative fixation of an ankle fracture was able to return most patients to the population mean with regard to PROMIS function and pain regardless of fracture type. Level of Evidence: Level II, prospective comparative study.
Failure of the spring ligament is a known pathologic process in the setting of adult acquired flatfoot deformity (AAFD). Many surgical techniques have been described to correct the deformity associated with adult acquired flatfoot deformity; however, there are limited techniques available to reconstruct the spring ligament. The goal of spring ligament reconstruction is to restore the primary ligamentous stabilizer of the talonavicular joint and restore the stability of the hindfoot without creating secondary deformity and hindfoot rigidity. Stage IV flatfoot deformity may result in ankle valgus that places asymmetric stress on the tibiotalar joint that is ideally treated with a secondary reconstruction to avoid ankle arthrodesis or arthroplasty. Despite involving the tibiospring and deep deltoid in the Deltoid reconstruction, restoration of the normal tibiotalar relationship has proven difficult, particularly in the setting of hindfoot arthrodesis, where increased stress on the medial collateral ligament complex worsens the deformity. Spring ligament reconstruction is an evolving technique and we describe a reproducible technique with promising early clinical results.
Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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