Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability.

Category: Ankle Introduction/Purpose: Although previous studies have demonstrated the potential of conventional computed tomography (CT) as a screening tool for osteoporosis, the assessment correlation of BMD in those studies was limited to the spine. This study aimed to evaluate the reliability and validity of CT as a screening tool for osteoporosis and to estimate the correlation between central BMD and peripheral bone attenuation using lower extremity CT. Methods: In total, 292 patients who underwent a lower extremity, lumbar spine, or abdomen and pelvic CT scan within a 3- month interval of a dual-energy X-ray absorptiometry (DEXA) examination were included (Fig 1). Following reliability testing, bone attenuation of the L1, L2, L3, L4, femoral head, femoral neck, greater trochanter, distal femur, proximal tibia, distal tibia, and talus was measured by placing a circular region of interest on the central part of each bony region on a coronal CT image (Fig 2 and 3). Partial correlation was used to assess the correlation between CT and DEXA, after adjusting for age and body mass index. Results: In terms of reliability, all bone attenuation measurements, except the femoral neck, showed good to excellent interobserver reliability (intraclass correlation coefficients, 0.691–0.941). In terms of validity, bone attenuation of the L1 to L4, femoral neck, and greater trochanter on CT showed significant correlations with BMD of each area on DEXA (correlation coefficients, 0.399–0.613). Bone attenuation of the distal tibia and talus on CT showed significant correlations with BMD of all parts on DEXA (correlation coefficients, 0.493–0.581 for distal tibia, 0.396–0.579 for talus). Conclusion: Lower extremity CT is a useful screening tool for osteoporosis, and peripheral bone attenuation on lower extremity CT adequately reflects central BMD on DEXA.

Background Calcaneal lengthening with allograft is frequently used for the treatment of patients with symptomatic planovalgus deformity; however, the behavior of allograft bone after calcaneal lengthening and the risk factors for graft failure are not well documented. Questions/purposes (1) What proportion of the patients treated with allograft bone had radiographic evidence of graft failure and what further procedures were performed? (2) What are the risk factors for radiographic graft failure after calcaneal lengthening? (3) What patient factors are associated with the magnitude of correction achieved after calcaneal lengthening? Methods Between May 2003 and January 2014, we performed 341 calcaneal lengthenings on 202 patients for planovalgus deformity, the etiology of which included idiopathic, cerebral palsy, and other neuromuscular disease. Of these, 176 patients (87%) had adequate followup for graft evaluation, defined as lateral radiographs taken before and at least 6 months after the index procedure (mean, 18 months; range, 6-100 months) and 117 patients (58%) had adequate followup for the assessment of the extent of correction, defined as weightbearing anteroposterior and lateral radiographs taken before and at least 1 year after the index procedure (mean, 24 months; range, 12-96 months). These patients' results were evaluated retrospectively. The Goldberg scoring system was chosen for demonstration of allograft behavior. A score lower than 6 at 6 months after surgery was defined as radiographic graft failure; the highest possible score was 7 points, and this represented graft incorporation with excellent reorganization of the graft and no loss of height. The patient age, sex, diagnosis, graft material, ambulatory status, and use of antiseizure medication were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. Additionally, six radiographic indices were analyzed for their effects on the extent of correction. Results The mean estimated Goldberg score was 6 (SD, 1.14) at 6 months after calcaneal lengthening with 11 feet (4%) classified as radiographic graft failure (Goldberg score \ 6). Of these, four feet (1%) underwent reoperation using an iliac autograft bone resulting from pain and loss of correction. Multivariate analysis showed that the tricortical iliac crest allograft was superior to the patellar allograft (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.1-9.8; p = 0.038) and the possibility of radiographic graft failure was found to increase along with age (OR, 1.2; 95% CI, 1.0-1.3; p = 0.006). Radiographically, the extent of correction was found to decrease with patient age, as

Level III, comparative series.