Percutaneous distal chevron osteotomy is associated with lower immediate postoperative pain and a greater range of motion than the open technique: A prospective randomized study.

PURPOSE: The results of past studies comparing percutaneous techniques with traditional open techniques for hallux valgus are controversial. Therefore, this study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies. METHODS: Seventy-one patients with mild to severe hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35) between October 2019 and September 2020. Radiological and clinical outcomes were assessed preoperatively and postoperatively. Outcome measures included the foot and ankle outcome score, foot functional index, visual analogue scale (VAS) scores for pain, range of motion (ROM) of the first metatarsophalangeal (MTP) joint, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening. Additionally, the first metatarsal declination angle was measured to evaluate sagittal malunion. RESULTS: The mean first metatarsal declination angle decreased significantly at 12 months postoperatively in both groups (p = 0.021 and p < 0.001 in the percutaneous and open groups, respectively), and the decrement was significantly greater in the open group (p = 0.033). The mean VAS score for pain on postoperative day one was 4.2 ± 1.9 and 5.3 ± 1.7 in the percutaneous and open groups, respectively (p = 0.019). The mean ROM of the first MTP joint did not change significantly after surgery, from 72.5 ± 7.5 preoperatively to 71.0 ± 9.5 at 12 months postoperatively in the percutaneous group (p = 0.215); however, it decreased significantly from 70.6 ± 7.3 preoperatively to 63.4 ± 10.4 at 12 months postoperatively in the open group (p < 0.001). There were no significant differences between the groups regarding other clinical outcomes. CONCLUSION: The percutaneous group showed a lower immediate pain level at postoperative day 1 and better ROM of the first MTP joint at 12 months postoperatively.

Silent struggles to self-manage high blood pressure among deaf sign language users: a qualitative study.

AIMS: Tailored self-management support of hypertension, considering language and communication, is important for minorities, specifically in the deaf community. However, little is known about the experiences of hypertension self-management in deaf individuals who use sign language. This study aimed to explore the factors and processes of self-management in deaf sign language users with hypertension. METHODS AND RESULTS: Ten men and women who used sign language participated in this study. Data were collected using in-depth personal interviews conducted in the presence of a sign language interpreter between November 2022 and February 2023. All interviews were recorded and transcribed for conventional content analysis. Qualitative analyses identified four categories related to the self-management of hypertension among participants: personal factors (chronic hand pain, unique language and communication, and efforts to turn crisis into opportunities), family and socioeconomic factors (family support and financial burden of living), challenges (limited health literacy and alienation from health education), and desire for health education considering the deaf community. CONCLUSION: The results of this study suggest that family support, socioeconomic status, hand pain, and health literacy should be considered for the planning and development of health education on self-management of hypertension in deaf individuals. In addition, this health education requires cooperation with qualified sign language interpreters in healthcare settings.

Understanding health literacy of deaf persons with hypertension in South Korea: A cross-sectional study.

BACKGROUND: Health literacy is strongly associated with health inequality among persons with deafness, and hypertension (HTN) is the most prevalent chronic disease among persons with deafness in South Korea. Despite its importance, research regarding the health literacy levels of persons with deafness with HTN in South Korea is lacking. This study aimed to comprehensively assess the health literacy levels of persons with deafness with HTN in South Korea, including linguistic, functional, and internet health literacy. METHODS: In this descriptive cross-sectional study, 95 persons with deafness with HTN were recruited through facilities associated with the deaf community. From August 2022 to February 2023, data were collected through face-to-face surveys attended by a sign language interpreter and online surveys. The data were analyzed using descriptive statistics and Spearman's correlation. RESULTS: Approximately 62.1% of the participants exhibited a linguistic health literacy level corresponding to less than that of middle school students, and the total percentage correct of functional health literacy was 17.9%. Each domain of internet health literacy was low. Significant correlations were found between some aspects of health literacy. CONCLUSIONS: The study's findings highlight the low health literacy levels across various facets among persons with deafness with HTN in South Korea. Based on these findings, several strategies are suggested for developing HTN self-management interventions for persons with deafness. This study contributes to the foundational understanding of health literacy among persons with deafness with HTN in South Korea and provides valuable insights and guidance for developing HTN self-management interventions.

Similarities and Differences of Interventions to Promote Physical and Psychological Health Between Prefrail and Frail Older Women: A Systematic Review.

The current review aimed to explore similarities and differences in the properties of interventions that promote physical and psychological health between prefrail and frail older women. Ten databases were searched for studies published from database inception to May 2023. Two Cochrane tools were used to assess the risk of bias in experimental and quasi-experimental studies. Twenty-three studies were selected, including 11 studies on prefrailty and 12 studies on frailty. Exercise interventions were predominant, but the contents and standards of exercise intensity were inconsistent between prefrail and frail women. For the main outcomes of the interventions, balance ability and biochemical factors were measured more frequently for frail older women than prefrail older women. Psychological health was less measured for prefrail and frail older women compared to physical health. Future research needs to consider balance training, as well as the evaluation of biochemical factors and psychological health among prefrail or frail older women. [Journal of Gerontological Nursing, 49(10), 20-28.].

Correlation of health-related quality of life for older adults with diabetes mellitus in South Korea: theoretical approach.

BACKGROUND: While some studies have explored the health-related quality of life (HRQOL) of older adults with diabetes mellitus (DM) in South Korea using a theoretical framework, these studies suffer sample-related limitations, as they focus only on a specific subgroup of older adults. To address this gap, this study aimed to investigate the predictors of HRQOL of older adults with DM in South Korea, using extensive national data and based on the theory of Health-Related Quality of Life in South Korean Older Adults with Type 2 Diabetes (The HIKOD theory). METHODS: A secondary data analysis was conducted using data from 1,593 participants aged 65 years and older with DM sourced from the 2015-2019 Korea National Health and Nutrition Examination Survey (KNHANES). The variables included in this study are as follows: demographic factors (gender, age, household income, and education level), disease-specific factors (duration of DM, treatment of DM, and control of HbA1c), barriers (number of comorbidities), resources (living alone status), psychosocial factors (perceived stress), and health-promoting behaviors (physical activity and fundus examination). Considering the complex sampling design employed in this study, statistical analyses including Rao-Scott chi-square tests, correlation analysis, and hierarchical multiple regression analysis were conducted. RESULTS: Mobility (45.0%) was the HRQOL dimension with which participants experienced the highest number of problems. Number of comorbidities (r = -0.36, p < 0.001), living alone status (rpb = 0.16, p < 0.001), perceived stress (rpb = 0.14, p < 0.001), and physical activity (rpb = 0.12, p < 0.001) were correlated with HRQOL. While adjusting for background factors, HRQOL was negatively predicted by higher number of comorbidities (estimate B = -0.03, p < 0.001), living alone (estimate B = -0.03, p = 0.043), higher perceived stress (estimate B = -0.09, p < 0.001), and lower physical activity (estimate B = -0.03, p < 0.001). CONCLUSION: Complex and diverse factors influence HRQOL among older adults with DM in South Korea. To improve their HRQOL, intervention programs that integrally regard HRQOL, along with various predictors, are necessary.

Health education interventions for individuals with hearing impairment: A systematic review.

OBJECTIVES: This study aims to systematically review health education interventions targeting individuals with hearing impairment. METHODS: A total of 18 studies were selected based on search results from five databases, and quality appraisal was conducted using an appropriate tool based on the study design. The extracted results were described using qualitative analysis. RESULTS: Among the selected studies, most interventions focused on specific cancers, and video materials were the most common delivery method. Various strategies were applied depending on the type of materials provided, in addition to sign language interpretation and the involvement of hearing-impaired related personnel. The interventions primarily resulted in a significant increase in knowledge. CONCLUSION: This study suggests several recommendations, including expanding the scope of interventions to cover various chronic diseases, actively utilizing the features of video materials, considering health literacy, using peer support groups, and measuring behavior-related factors alongside knowledge levels. PRACTICE IMPLICATIONS: This study makes a significant contribution to understanding the unique characteristics of the population with hearing impairment. Furthermore, it has the potential to facilitate the development of high-quality health education interventions for individuals with hearing impairment by providing insights into future research directions based on existing health education interventions.

Feasibility of Loop-Mediated Isothermal Amplification for Rapid Detection of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus in Tissue Samples.

Background: To date, few studies have investigated the feasibility of the loop-mediated isothermal amplification (LAMP) assay for identifying pathogens in tissue samples. This study aimed to investigate the feasibility of LAMP for the rapid detection of methicillin-susceptible or methicillin-resistant Staphylococcus aureus (MSSA or MRSA) in tissue samples, using a bead-beating DNA extraction method. Methods: Twenty tissue samples infected with either MSSA (n = 10) or MRSA (n = 10) were obtained from patients who underwent orthopedic surgery for suspected musculoskeletal infection between December 2019 and September 2020. DNA was extracted from the infected tissue samples using the bead-beating method. A multiplex LAMP assay was conducted to identify MSSA and MRSA infections. To recognize the Staphylococcus genus, S. aureus, and methicillin resistance, 3 sets of 6 primers for the 16S ribosomal ribonucleic acid (rRNA) and the femA and mecA genes were used, respectively. The limit of detection and sensitivity (detection rate) of the LAMP assay for diagnosing MSSA and MRSA infection were analyzed. Results: The LAMP result was positive for samples containing 103 colony-forming unit (CFU)/mL for 16S rRNA, 104 CFU/mL for femA, and 105 CFU/mL for mecA. The limits of detection for 16S rRNA and femA were not different between MSSA and MRSA. For the 10 MSSA-positive samples, the LAMP assay showed 100% positive reactions for 16S rRNA and femA and a 100% negative reaction for mecA. For the 10 MRSA-positive samples, the LAMP assay showed 100% positive reactions for 16S rRNA and mecA but only 90% positive reactions for femA. The sensitivity (detection rate) of the LAMP assay for identifying MSSA and MRSA in infected tissue samples was 100% and 90%, respectively. Conclusions: The results of this study suggest that the LAMP assay performed with tissue DNA samples can be a useful diagnostic method for the rapid detection of musculoskeletal infections caused by MSSA and MRSA.

Analysis of correlation between the consumption of beverages and the risk of radiographic knee osteoarthritis in Korean people: A cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1, 2).

The purposes were to analyze correlations between the frequency of beverage drinking (coffee, green tea, milk, and soft drinks) and the presence of radiographic knee osteoarthritis (OA) in relation to sex. We performed this study using the Korea National Health and Nutrition Examination Survey (KHANES V-1, 2). We examined data from 5503 subjects after exclusion. We utilized the food frequency questionnaires from KHANES, and reorganized them into 2 or 3 groups according to the frequency of beverage consumption. We analyzed the relationship between radiographic knee OA and beverage consumption statistically after adjusting confounding factors with multivariable logistic regression analysis. Knee OA was inversely associated with coffee consumption only in women (P < .05). The odds ratio of knee OA was lower in those who drank at least a cup of coffee than in those who did not drink coffee in women (P for trend < .05). However, there was no significant linear trend of the odds ratio of each group in both sexes for drinking other beverages. As the coffee consumption increased, the radiographic knee OA group showed decreasing linear trend only in women. However, other beverages did not show a significant relation to the radiographic knee OA in both sexes.

The Influence of Ankle Position on Radiographic Diagnosis of Acute Achilles Tendon Rupture.

No previous study has demonstrated the relationship between the ankle position and radiographic diagnosis of acute Achilles tendon rupture. The purpose of this study was to investigate the influence of ankle position in the presence of diagnostic radiographic signs in acute Achilles tendon rupture. A retrospective review of 154 ankle lateral radiographs of acute Achilles tendon rupture was performed. Ankle position was classified as dorsiflexion, neutral, or plantar flexion by measurement of the tibiotalar angle. Kager's triangle, Toygar's angle, Arner's sign, and thickening of the Achilles tendon were assessed as diagnostic radiographic signs, and their relations to ankle position were analyzed. Interobserver reliabilities of radiographic signs were moderate to substantial (kappa value, range 0.41-0.68). All 4 signs were significantly more visible in ankle plantar flexion than dorsiflexion. The presence of Toygar's angle and positive Arner's sign were significantly increased in ankle plantar flexion compared to neutral, while the presence of Kager's triangle, and thickening of the Achilles tendon did not differ according to ankle position. The diagnostic radiographic signs of acute Achilles tendon rupture were better presented in ankle plantar flexion position than neutral and dorsiflexion positions. Neutral and dorsiflexion ankle positions should be avoided when performing lateral radiographs of patients with suspected acute Achilles tendon rupture.

How accurately can surgeons perform angle manipulation? Quantitative assessment of the accuracy of manual angle manipulation of orthopedic surgery: a cadaver study.

INTRODUCTION: To date, only few studies have been performed on the accuracy of manual angle manipulation during orthopedic surgery. This cadaver study was aimed at quantitatively assessing the accuracy of manual angle manipulation performed by orthopedic surgeons according to their surgical experience and comparing it with manipulation performed with the assistance of a digital goniometer. MATERIALS AND METHODS: Six lower-leg specimens of fresh-frozen human cadavers were subjected to angle manipulation performed via Kirschner wire (K-wire) insertion. K-wires were inserted manually and with the assistance of a digital goniometer at target angles of 0°, 30°, and 60° by three operators who had different levels of experience in orthopedic surgery. The accuracy of the insertion angles at the target angles was evaluated using computed tomography. RESULTS: The mean angle error in the manual angle manipulation was 8.8° (standard deviation [SD] 6.0). When the target angles were set to 0°, 30°, and 60°, the identified angle errors were 6.1° (SD 4.3), 8.8° (SD 6.6), and 11.7° (SD 5.6), respectively, and each value did not show any significant difference among the operators. With the assistance of a digital goniometer, the mean (SD) angle error was significantly improved to 2.1° (1.1°) (p < 0.001). The amount of improvement in accuracy significantly increased as the target angle increased (p = 0.01). CONCLUSION: This cadaver study quantified the inaccuracy of manual angle manipulation in orthopedic surgery and showed that these inaccuracies ​​can be improved using an assistive device. These results support the need to develop a device that can compensate manual angle manipulation in orthopedic surgery.

Learning curve of the Krackow suture technique for the repair of Achilles tendon rupture.

INTRODUCTION: Knowledge on the learning curve for the repair of Achilles tendon rupture is limited. The aim of this study was to quantify the learning curve for the Krackow suture technique for the repair of Achilles tendon rupture and to identify the correlation between the cumulative volume of cases and clinical outcome measures. MATERIALS AND METHODS: A total of 226 cases of Achilles tendon repair using the Krackow suture technique were reviewed. Each surgery was independently performed by four surgeons who started a foot and ankle specialty career after fellowship training. After logarithmic transformation of the operative time and cumulative volume of cases, a linear regression analysis was performed to determine the best-fit linear equations to predict the required time for the Krackow suture technique according to the cumulative volume of cases. The correlation between the cumulative volume of cases and clinical outcome measures was analyzed using Pearson correlation coefficients. Receiver operating characteristic curves were constructed to determine the minimum number of cases with an operative time shorter than the average in the first 30 cases. RESULTS: In all four surgeons, significant log-linear correlations were observed between the operative time and cumulative volume of cases. The best-fit linear equations showed estimated learning rates of 90%, 87%, 92%, and 86% for each of the four surgeons, indicating that the necessary operative time decreased by 10%, 13%, 8%, and 14%, respectively, when the cumulative volume of cases had doubled. The minimum number of cases with an operative time shorter than the average was 9 (91% sensitivity and 59% specificity). The clinical outcome measures at 6 and 12 months postoperatively were available for one surgeon; however, no correlation was found with the cumulative volume of cases. CONCLUSION: The learning rate for the Krackow suture technique for the repair of Achilles tendon rupture was approximately 89%, indicating that the required operative time can decrease by up to 11% when the cumulative volume of cases doubles. Therefore, it is important to rapidly accumulate surgical experience during the early phase of training.

Clinical Impact of Metabolic Syndrome on Eccentric Exercises for Chronic Insertional Achilles Tendinopathy.

Metabolic syndrome is one factor known to contribute to the development of tendinopathies. The aim of this study was to compare the clinical outcomes of eccentric calf-muscle exercise for treatment of chronic insertional Achilles tendinopathy in patients with or without metabolic syndrome. Twenty-eight patients with chronic insertional Achilles tendinopathy and metabolic syndrome who performed eccentric calf-muscle exercise were retrospectively compared with 28 age- and sex-matched controls without metabolic syndrome. Comparisons between the 2 groups were made by evaluating the Visual Analog Scale for pain, patient satisfaction, and amount of pain medications needed during 3 months of follow-up. Two-way analysis of variance with repeated measures showed that the pain scales in the metabolic syndrome group were higher than those in the control group during the follow-up period (F[1,54] = 24.45, p < .001). The patient satisfaction ratings were lower and the amount of required pain medication was higher in the metabolic syndrome group (p < .001 and p < .001, respectively). Eccentric calf-muscle exercises for chronic insertional Achilles tendinopathy were less effective in patients with metabolic syndrome. Therefore, these patients should be managed with a combination of other treatment modalities rather than eccentric exercise alone.

Arthroscopic All-Inside Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinacular Reinforcement: A Prospective Randomized Study.

BACKGROUND: The utility of inferior extensor retinacular (IER) reinforcement for arthroscopic repair of a lateral ankle injury is debatable. We hypothesized that the outcomes would not differ significantly between arthroscopic all-inside anterior talofibular ligament (ATFL) repair with and without IER reinforcement. METHODS: We prospectively randomized 73 patients who had arthroscopic all-inside ATFL repair into 2 groups: those who had IER reinforcement (37 patients) and those who had no IER reinforcement (36 patients). The primary outcome was the Karlsson Ankle Functional Score (KAFS). The secondary outcomes included the Foot and Ankle Outcome Score (FAOS), Tegner activity score (TAS), ankle range of motion, and radiographic parameters. The functional outcomes were evaluated preoperatively and at 6 and 12 months postoperatively. Stress radiographs were obtained preoperatively and at 12 months postoperatively. RESULTS: The KAFS, all FAOS subscale scores, and TAS improved significantly at 1 year postoperatively in both groups, with no significant differences between the groups with respect to the preoperative and postoperative values. Significant differences were not observed between the ankle range of motion values recorded preoperatively and at 1 year postoperatively in both groups; the preoperative and postoperative range of motion values did not differ significantly between the groups. The mean talar tilt and talar anterior translation decreased significantly at 1 year postoperatively in both groups, with no significant differences between the groups preoperatively and postoperatively. One patient in each group had neuralgia of the superficial peroneal nerve; 2 patients in the IER reinforcement group had knot irritation causing mild discomfort. CONCLUSIONS: Arthroscopic all-inside ATFL repair with and without IER reinforcement showed comparable functional and stress radiographic outcomes at 1 year. Performing IER reinforcement in addition to all-inside arthroscopic direct ATFL remnant repair is not necessary. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Association of Ankle Dorsiflexion With Plantar Fasciitis.

This study aimed to compare the mean ankle dorsiflexion range between individuals with and without plantar fasciitis using passive ankle dorsiflexion with consistent pressure, and to identify the prevalence of an isolated gastrocnemius and gastrocnemius soleus complex contracture in 2 groups. 91 participants were prospectively classified into the plantar fasciitis group (45 subjects) and the control group (46 subjects). Ankle dorsiflexion was measured with the knee extended and with the knee flexed 90° using a standard orthopedic goniometer while a consistent force of 2 kg was applied under the plantar surface of the forefoot using a custom-made scale. Intraclass correlation coefficients (ICC) were calculated to determine the interobserver and intraobserver reliability of the current ankle dorsiflexion measurement. The current ankle dorsiflexion measurement revealed excellent interobserver and intraobserver reliability. The mean ankle dorsiflexion in the knee extended was -9.6° ± 8.1° and -11.2° ± 8.2° in the study and control groups, respectively (p = .353). The mean ankle dorsiflexion in the knee flexed was 7.8° ± 6.5° and 5.1° ± 7.4° in the study and control groups, respectively (p = .068). In the study and control groups, 68.9% and 65.2%, respectively, had an isolated gastrocnemius contracture and 24.4% and 30.4%, respectively, had a gastrocnemius-soleus complex contracture (p = .768). The present study demonstrated that there were no significant differences in passive ankle dorsiflexion and in the prevalence of an isolated gastrocnemius or gastrocnemius soleus complex contracture between individuals with and without plantar fasciitis.

Role of Ultrasound in Early Diagnosis of Stress Fracture: A Case Report of Bilateral Distal Fibular Stress Fracture in a Female Recreational Badminton Player.

A 34-year-old female recreational badminton player presented with left ankle pain 1 week after a recreational badminton game. She reported experiencing a similar pattern of pain in her right ankle 4 months before that had persisted for 3 months. On plain radiography, callus formation was evident on the right distal fibula, and a subtle lesion was observed on the left side. Ultrasound was performed with the clinical suspicion of bilateral, nonsimultaneous, distal fibular stress fracture. Focal hyperechoic thickening of the periosteum with irregularity and hypoechoic periosteal edema over the left distal fibula were identified. These findings were consistent with stress fracture, and an early phase of distal fibular stress fracture was diagnosed. This case report highlights that ultrasound can be an alternative modality to magnetic resonance imaging or bone scan scintigraphy for the early diagnosis of stress fracture.

Risk factors associated with failure of total ankle arthroplasty: a nationwide cohort study.

We conducted a nationwide population-based cohort study to identify the risk factors associated with failure of total ankle arthroplasty (TAA). We included 2,914 subjects who underwent primary TAA between January 1, 2010, and December 31, 2016, utilizing the database of the Korean National Health Insurance Service. Failure of TAA was defined as revision TAA or arthrodesis procedures. An increased risk of TAA failure was observed in the < 65 age group versus the ≥ 75 age group [adjusted hazard ratios (aHR) 2.273, 95% confidence interval (CI) 1.223-4.226 in the 60-64 age group; aHR 2.697, 95% CI 1.405-5.178 in the 55-59 age group; aHR 2.281, 95% CI 1.145-4.543 in the 50-54 age group; aHR 2.851, 95% CI 1.311-6.203 in the < 50 age group]. Conversely, the ≥ 65 age group displayed no increase in the risk of TAA failure. The risk of TAA failure was increased in the severely obese group with body mass index (BMI) of ≥ 30 kg/m2 versus the normal BMI group (aHR 1.632; 95% CI 1.036-2.570). This population-based longitudinal study demonstrated that age < 65 years and BMI of ≥ 30 kg/m2 were associated with increased risk of TAA failure.

Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting.

BACKGROUND: Most intraarticular displaced calcaneal fractures are accompanied by bone defects after surgical treatment, but the concern about negative effects of bone defects has not been resolved yet owing to the few studies on this issue. Therefore, studies on volumetric changes in bone defects over time and the correlation between postoperative outcomes and residual bone defects will be helpful to address the controversy on the necessity of bone grafting in bone defects of calcaneal fractures. QUESTIONS/PURPOSES: (1) Do bone defects change in size in the first year after surgical treatment of displaced intraarticular calcaneal fractures? (2) Does the size of residual bone defects correlate with postoperative radiographic or clinical outcomes? METHODS: Between 2015 and 2019, 99 patients with displaced intraarticular calcaneal fractures visited the investigators' institution, of whom 95 received surgical treatment. Of the patients treated with surgery, 25% (24 of 95) did not undergo open reduction and internal fixation via an extensile lateral approach, and 19% (18 of 95) had multiple fractures, bilateral fractures, open fractures, or a history of previous surgery on the calcaneus; all of these patients were excluded. During the study period, CT was routinely performed for calcaneal fractures immediately after and 12 months after the surgery, but 6% (6 of 95) of the patients had insufficient CT data due to loss to follow-up before 12 months or other reasons, leaving 47 patients for evaluation in this retrospective study. Fractures were fixed with plate and screws, and bone grafting was not performed in all patients. To answer our first question, which was on the changes in bone defects over time, volumetric measurements of the bone defect were performed using CT via the ITK-SNAP software. The percentage of volumetric change was calculated as a fraction of the volumetric change over 12 months from the initial volume. The percentage of the residual bone defect was calculated as a fraction of the volume of the residual bone defect relative to the volume of the entire calcaneus. To answer our second question, which was on the correlation between residual bone defects and postoperative outcomes, we assessed the Böhler angle, Gissane angle, calcaneal height, Olerud-Molander Ankle Score (OMAS), and VAS score for pain and compared these parameters with the size of the residual bone defect using the Pearson correlation coefficient. The OMAS and VAS scores for pain were evaluated and recorded during patient visits, and we obtained the scores through a chart review. All volumetric measurements and radiographic evaluations were performed by two orthopaedic surgeons, and the intraobserver and interobserver reliability were assessed using the intraclass correlation coefficient. RESULTS: The mean volume of the bone defect measured using CT was 4 ± 3 cm3 immediately after surgery and 1 ± 1 cm3 12 months after surgery. During the first 12 months after surgery, the mean volume of the bone defect was reduced by 77% (95% confidence interval 73% to 80%). The mean residual bone defect in the entire calcaneus was 2% (95% CI 1% to 2%), and none of the postoperative outcomes were correlated with the residual bone defect. CONCLUSION: As bone defects substantially resolve without treatment, surgeons do not need to use bone graft for the surgical treatment of displaced intraarticular calcaneal fractures. Future studies that include patients who underwent bone grafting for the treatment of calcaneal fractures are needed to confirm our findings and to further investigate whether bone grafting has additional benefits for the recovery of bone defects. LEVEL OF EVIDENCE: Level III, therapeutic study.

Comparison of the intraoperative efficacy of the powered rasp and conventional burr in arthroscopic resection of anterior ankle osteophytes.

BACKGROUND: The efficacy of the powered rasp, a new reciprocating motion device for arthroscopic resection of osteophytes, has not been verified. The aim of this study was to compare the intraoperative efficacy of the powered rasp in arthroscopic resection of anterior ankle osteophytes to that of the conventional burr. METHODS: A total of 49 consecutive patients who underwent arthroscopic resection of anterior ankle osteophytes (26 patients with the conventional burr and 23 patients with the powered rasp) were retrospectively reviewed. The preoperative volume of each osteophyte was measured using computerized tomography scan and three-dimensional software. The resection time was measured by review of the individual arthroscopy video, and the estimated resection rate was calculated as the volume of osteophytes/resection time. RESULTS: The preoperative volume of osteophytes was not different between the two groups (847.8 ± 685.3 mm3 in the conventional burr and 913.3 ± 605.8 mm3 in the powered rasp, p = 0.726). The resection time was 442.4 ± 216.6 s (seconds) in the conventional burr and 386.4 ± 186.3 s in the powered rasp, and the estimated resection rate was 1.8 ± 1.0 mm3/s with the conventional burr and 2.4 ± 1.3 mm3/s with the powered rasp. These measurements were not significantly different between the two groups (p = 0.340 and 0.083, respectively). CONCLUSION: The intraoperative efficacy of the powered rasp did not show superiority to that of the conventional burr in arthroscopic resection of anterior ankle osteophytes. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Hip-to-calcaneus alignment differs from hip-to-talus alignment in patients with genu varum deformity.

PURPOSE: To (1) compare the weight-bearing line (WBL) ratios of the knee joints measured using the conventional (hip-to-talus radiographs, HTRs) and novel (hip-to-calcaneus radiographs, HCRs) orthoradiograms, (2) compare the hip-knee-ankle (HKA) angle between cases with < 5% and > 5% differences in WBL ratios between two orthoradiograms, and (3) investigate the optimal cutoff value (COV) of the HKA angle causing inconsistency in the orthoradiograms. METHODS: Sixty limbs of 31 patients with HTR and HCR records were retrospectively reviewed. After drawing the mechanical axis on each radiograph, the WBL ratios of the knees were calculated and compared between the conventional and novel orthoradiograms. In subgroup analysis, cases with < 5% and > 5% differences in WBL ratios between two orthoradiograms were classified as consistent and inconsistent groups, respectively. Receiver operating characteristic curve based on the HKA angles of the lower limbs was used to identify the COV causing the inconsistency between the orthoradiograms. RESULTS: Inter- and intra-rater reliabilities of all radiologic measurements were > 0.75. The WBL ratios showed no significant difference between the two orthoradiograms. However, the HKA angle was significantly larger in the inconsistent group than in the consistent group (7.0° ± 1.8° vs. 4.4° ± 2.5°; P < 0.001). The COV of the HKA angle that caused inconsistency in the two orthoradiograms was 4.0° (area under the curve, 0.774). CONCLUSION: The hip-to-calcaneus alignment differed significantly from the hip-to-talus alignment in patients with genu varum deformity. HCR measurement can be a complementary method for planning corrective osteotomy for patients with genu varum deformity. LEVEL OF EVIDENCE: IV.

Comparison of Outcome of Deltoid Ligament Repair According to Location of Suture Anchors in Rotational Ankle Fracture.

BACKGROUND: The suture anchors for the repair of deltoid ligament in rotational ankle fracture are inserted mostly into the medial malleolus, but sometimes are placed into the talus depending on the rupture site. This study sought to compare the radiological and clinical outcomes of deltoid ligament repair according to using these 2 locations for suture anchor placement. METHODS: The cases of 131 patients (114 patients with suture anchors on the medial malleolus and 17 patients with suture anchors on the talus) who underwent deltoid ligament repair along with ankle fracture fixation were retrospectively reviewed. Medial clear space oblique (MCSo), medial clear space perpendicular (MCSp), tibiofibular clear space (TFCS), and tibiofibular overlap (TFO) were measured as radiological outcomes, while the Olerud-Molander Ankle Score (OMAS) and visual analog scale (VAS) score for pain were calculated as clinical outcomes. The follow-up period did not differ between the 2 groups (16.8 ± 10.9 months in the medial malleolus group vs 17.9 ± 14.3 months in the talus group; P = .670). RESULTS: There were no differences in MCSo, MCSp, TFCS, and TFO at 3 months after surgery and final follow-up. The OMAS and VAS for pain did not show intergroup differences at final follow-up. CONCLUSION: The surgical outcome of deltoid ligament repair in rotational ankle fracture did not differ whether the suture anchors were inserted into the medial malleolus or into the talus. LEVEL OF EVIDENCE: Level III, retrospective comparative study.