A Comparison of Trans-Articular Screw Versus Dorsal Bridge Plate Versus Compression Locking Plate Fixation in B2 Lis Franc Injuries: A 5-Year Experience in a Level 1 Trauma Center, in the United Kingdom.

This retrospective case series aimed to identify whether trans-articular screws, dorsal bridging plates or if a 4-corner compression plate offers better functional outcome after B2 Lis Franc injuries. Thirty-eight patients underwent surgical fixation for these injuries over 5 years in a Level 1 Trauma Centre. Patients were treated in 1 of 3 treatment arms: trans-articular screw, dorsal bridge plate, or 4-corner compression plate fixation. The primary outcome measures were the Manchester Oxford Foot and Ankle Questionnaire and the Euroqol- 5DL score and surgical results included postoperative complications and further surgery. Injury type, energy of mechanism, and open versus closed status were not significantly different within any fixation group. We achieved 94.7% (n = 36) good anatomical reduction. Finding significant improvement between plate fixation (both types) versus trans-articular screw groups treatment functional outcomes. A clinically crucial improvement in Manchester Oxford Foot & Ankle Questionnaire scores, and improved Euroqol- 5DL outcomes between 4-corner compression plate and trans-articular screw group. Overall, there was no significant difference in metalware failure, metalware removal and soft tissue complications. This study concludes that functional outcomes after Lis Franc fractures are not just dependent on the quality of anatomical reduction but are affected by fixation type. Further studies are required to provide qualitative analysis and assessment of dorsal bridge plate fixation versus 4-corner plate. Significantly, we have seen the 4-corner compression plate group reached the minimum clinically meaningful difference in the Manchester Oxford Foot and Ankle Questionnaire when compared to trans-articular screw fixation.

Have advances in surgical implants and techniques in hemiarthroplasty for intracapsular hip fractures improved patient outcomes compared to THA? A systematic review and meta-analysis of the evidence.

INTRODUCTION: Hip fractures are common orthopaedic hospital admissions and result in considerable morbidity and mortality in the patients affected. The aim of this study is to review how advances in surgical implants and techniques have impacted on outcomes of Hemiarthroplasty (HA) vs Total Hip Arthroplasty (THA) for displaced intracapsular neck of femur fractures. METHODS: A systematic review and meta-analysis of randomised controlled trials was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews & Meta-analyses (PRISMA) statement. We included all studies that were prospective randomised controlled trials comparing the outcomes THA versus HA in patients with displaced intracapsular neck of femur fractures. RESULTS: 13 randomised controlled trial met the eligibility criteria; the overall pooled sample size was 3050 patients. The evidence suggests that the short-term functional outcomes favour THA, without strong evidence of a clinically significant benefit. More recent larger RCTs suggest limited functional improvement conferred by THA vs. HA, whilst the risks of complications may outweigh these small gains. Overall, THA is associated with higher dislocation rates without a significant need for re-operation, but no increase in infection or need for transfusion over HA. Consultant or equivalent supervision has a positive effect on outcomes in both groups. CONCLUSION: The literature supports a change in direction, this meta-analysis confirms HA surgery has equivalent clinical outcomes and possibly a lower mortality in octogenarians and provides further evidence for the stratification of THA treatment in displaced intracapsular neck of femur fractures is urgently required.

Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review.

Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications.A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on.Post-operative patient-reported outcome measures recorded marked improvement. Patient satisfaction was reported as excellent in 79.9%, and poor in 5.3%. All radiological measurements demonstrated improvement towards the normal range following arthroereisis, as did hindfoot valgus, supination, dorsiflexion and Viladot grade.Complications were reported in 7.1% of cases, with a reoperation rate of 3.1%.Arthroereisis as a treatment for symptomatic paediatric flexible pes planus produces favourable outcomes and high patient satisfaction rates with a reasonable risk profile. There is still a great deal of negativity and literature highlighting the complications and failures of arthroereisis, especially for older implants.The biggest flaws in the collective literature are the lack of high-quality prospective studies, a paucity of long-term data and the heterogeneity of utilized outcome measures between studies. Cite this article: EFORT Open Rev 2021;6:118-129. DOI: 10.1302/2058-5241.6.200076.

Is the Gothic Arch a reliable radiographic landmark for migration percentage in children with cerebral palsy?

INTRODUCTION: Reimers migration percentage (MP) is the gold standard for measuring hip displacement in children with cerebral palsy (CP). Hip surveillance registries proposed using the top of the Gothic arch (GA) as a modification in patients with acetabular dysplasia because the classical method (CM) described by Reimers may underestimate hip migration. The aim of this study is to assess the inter- and intra-observer reliability of the modified method (MM) versus the CM and identify their effect on the MP. METHODS: We performed a retrospective review of 50 children with CP, who had a hip radiograph at our institution between 1st April 2014 and 28th February 2018. All hip radiographs were carefully selected to show the presence of a GA. Four observers measured the MP using the CM and MM for each patient. Interclass coefficient was used to estimate inter- and intra-observer reliability. RESULTS: Inter-observer reliability was excellent for the CM with ICC 0.96 (95% CI 0.94 to 0.97) and good for the MM, ICC 0.78 (95% CI 0.51 to 0.89) p < 0.001. Intra-observer reliability was excellent for both methods raging from ICC 0.94 to 0.99 for the CM and ICC 0.89 to 0.95 for the MM. The mean MP was 19% for the CM and 28% for the MM (p < 0.001). CONCLUSION: The CM is more reliable than the MM to measure hip migration in children with CP. If the CM is used and acetabular dysplasia with a GA are present on the hip radiograph, then a 9% hip migration underestimation should be considered on decisions for both referral and surgical management. LEVEL OF EVIDENCE: II.

Plantar fascia calcification a sequelae of corticosteroid injection in the treatment of recalcitrant plantar fasciitis.

We report the case of a 72-year-old woman suffering with severe plantar fasciitis who received a therapeutic corticosteroid injection. Two-and-a-half years after the injection she developed a small calcified lump under the skin which subsequently caused ulceration and infection. She went on to develop a diabetic foot infection requiring an extended course of intravenous antibiotics.