Treatment for displaced Tillaux fractures in adolescent age group.

BACKGROUND: Around age 11-15 years, a forced external rotation of the foot in a supination or a medial rotation of the leg on the fixed foot usually is responsible for an avulsion injury to the anterolateral epiphysis, known as Tillaux fracture. Ligamentous injuries are rare in children because ligaments are stronger than is the growth plate that frequently is injured. OBJECTIVE: The aim of this study was to present the clinical outcome until the end of growth after surgical treatment for displaced adolescent Tillaux fractures. PATIENTS AND METHODS: 13 patients with Tillaux fractures in the adolescent age group. Patient`s age ranged (12-17 years) with an average 13.4 years. Of those 13 patients, there were 9 females and 4 males. RESULTS: Fracture union was obtained in all cases (100%) and was assed radiologically when X-ray check-ups in all projections showed the significant presence of trabeculation crossing the fracture, without pain and functionally using the American Orthopedic Foot and Ankle Society (AOFAS) score of the ankle joint. Overall average score was 97 ranged 95-100. There was no recorded post-operative complication. CONCLUSION: The plain radiographs of patients with an avulsion injury of anterolateral tubercle (Tillaux fragment) should be carefully examined for evidence of syndesmotic widening. If there is any doubt, CT scans is helpful. If fracture displacement was greater than 2 mm, a surgical intervention is recommended to restore the normal anatomy of the ankle joint. Anatomically reduced Tillaux fractures at adolescent age group either by closed or opened means, followed by post-operative plaster cast immobilization will lead to excellent results.

Endoscopic Plantar Fasciotomy Through Two Medial Portals for the Treatment of Recalcitrant Plantar Fasciopathy.

Plantar fasciopathy is a common cause of heel pain. Endoscopic plantar fasciotomy has the advantage of less surgical trauma and rapid recovery. The aim of the present prospective study was to delineate the results of endoscopic plantar fascia release through 2 medial portals. The present study included 2 groups. The first group included 27 feet in 25 patients that had undergone endoscopic plantar fascia release followed up for 19.7 (range 12 to 33) months. The second group, the control group, included 20 feet in 16 patients treated conservatively and followed up for 16.4 (range 12 to 24) months. The results of endoscopic plantar fascia release were superior to the conservative methods. The surgically treated group experienced significantly less pain, activity limitations, and gait abnormality. The presence of a calcaneal spur had no effect on the final postoperative score. In conclusion, endoscopic plantar fascia release through 2 medial portals is an effective procedure for treatment of resistant plantar fasciopathy that fails to respond to conservative management options.

"ORIF" for displaced intra-articular calcaneal fractures in children.

BACKGROUND: Calcaneal fractures in children are rare injuries, and those with displaced intra-articular fracture patterns are found even less frequently. Recent data in the adult literature have suggested operative treatment of displaced intra-articular calcaneal fractures leads to a more favorable outcome. OBJECTIVE: The aim of this study is to analyze the outcomes of displaced intra-articular calcaneal fractures in children treated by open reduction and internal fixation. METHODS: Ten displaced intra-articular calcaneal fractures in 10 patients were treated by open reduction and internal fixation. Mean age was 10.2 (6-12 years). According to Sanders' classification, there were 8 patients who had Sanders' Type II fractures, and 2 children sustained Type III fracture. All patients were followed up with a mean 20.3 months (range 6-30). Clinical score according to the (AOFAS) was 95.8 (range 78-100). CONCLUSION: The characteristics of intra-articular calcaneal fractures in children are similar to those in adults and, from our experience, operative treatment of these fractures, to restore calcaneal anatomical alignment yields good short-term results.

A simple surgical technique for treatment of Freiberg's disease.

BACKGROUND: Of all the osteochondrosis, Freiberg's disease is reported to be the fourth most common, exceeded by Köhler's disease, Panner's disease, and Sever's disease. This disease usually occurs in the 2nd metatarsal head and relatively in the 3rd and 4th metatarsal heads. OBJECTIVE: The purpose of this study was to evaluate the outcome of debridement, synovectomy, dorsal closing wedge osteotomy and pin fixation for Freiberg's disease treatment. METHODS: Ten female patients, mean age 18.3 years; (ranged 14-24 years) were treated by the above mentioned technique. The main presenting symptom was pain on walking or sport; affected their daily life and activities and was not improved by non-surgical treatment. The second metatarsal head was affected in all patients. Halve of patients had a history of trauma. According to Smillie's classification, four patients were type V and six patients were type IV. Mean follow-up period was 19.2 months (range 6-36 months). RESULTS: Were assessed by the Lesser Metatarsophalangeal-Interphalangeal (LMPI)Scale by Kitaoka et al. At the final follow up, scoring was changed from (44-76) with an average 57 to (66-100) with an average 80. There was no case of infection, avascular necrosis, arthritis or pseudoarthrosis. CONCLUSION: We founded that dorsiflexion osteotomy of the metatarsal head is presented as a logical procedure that is simple, reliable, not destructive, and capable of good results regardless of the stage of the disease.

Treatment for calcaneal malunion.

BACKGROUND: Pain, limping, and deformity are the most common complications following calcaneal malunion which results from non-operative treatment for calcaneal fractures. OBJECTIVE: To introduce the experience of treating calcaneal fracture malunion. METHOD: Between December 2009 and April 2011, eleven patients with calcaneal malunion were treated operatively. Age of patients ranged between 23 and 40 years with an average 28.7. All of them were followed up with a mean 13.5 (9-18 months). Eight of them were right-sided and the other three were left-sided. All of them were male. The mechanism of trauma was fall from a height in all patients. All of them were treated non-operatively since the prime trauma. According to Stephens and Sanders classification, all of cases were type II. The extended lateral calcaneal "L" approach was used in all cases. Lateral wall exostectomy and peroneal tendons are decompressed below the tip of the lateral malleolus and in situ subtalar bone block arthrodesis was done. RESULT: The mean of American Orthopedic Foot and Ankle Society and pain score systems score was improved from 33 (19-44 points) preoperatively to 69 (42-83 points) postoperatively. The reported complications were superficial wound infection in two cases (18.18%) and reflex sympathetic dystrophy in three cases (27.27%). CONCLUSION: Calcaneal lateral wall exostectomy, peroneal tenolysis and subtalar joint arthrodesis is an efficient method to treat calcaneal malunion type II after calcaneal fracture by reshaping the calcaneal contour and recovering the hind foot function. LEVEL OF EVIDENCE: IV.