Medial swivel dislocation with impacted navicular bone into the talar head: A case report.

Medial swivel dislocation is a rare subtype of midtarsal bone dislocation, mostly associated with fracture rather than isolated dislocation. It is caused by medially or laterally direct forces to the midfoot. In case of failed closed reduction of the deformity, the patient should undergo open reduction and stabilization of the injury as soon as possible. We are presenting a 17-year-old, male, who sustained a left ankle injury and presented with a deformity, closed reduction of the deformity failed multiple times, and the patient was taken for open reduction and stabilization of the deformity in the operating theater. Intra-operatively, the dislocation was locked with the lateral process of the navicular being impacted into the taller head. Six months following the injury the patient was back to his pre-injury status and did not have any recurrent dislocation of the midfoot.

Donor site morbidity of calcaneal, distal tibial, and proximal tibial cancellous bone autografts in foot and ankle surgery. A systematic review and meta-analysis of 2296 bone grafts.

PURPOSE: This study aims to report on the safety and donor site morbidity of the distal lower extremity (calcaneal, proximal, and distal tibial) cancellous bone autografts. We summarized the findings in a comprehensive infographic illustration. We are unaware of any similar meta-analyses to date. METHODS: Following the PRISMA guidelines, two independent investigators searched MEDLINE (PubMed), EMBASE, SCOPUS, Google Scholar, and Cochrane databases in December 2020 using the following keywords and their synonyms: ("bone graft", "donor site morbidity", "calcaneal graft", "proximal tibia graft", and "distal tibia graft"). Besides, the reference lists from previous review articles were searched manually for eligible studies. The primary outcomes of interest were (1) chronic pain, (2) fracture, and (3) infection, whereas the secondary outcomes were (1) neurological complications, (2) sensory disturbance and hypertrophic scars, (3) other complications such as shoe-wear difficulties and gait disturbance. Inclusion criteria were: studies on complications and adverse events of lower extremity bone autografts (calcaneal, proximal tibial, and distal tibial bone autografts) reporting at least one of the desired outcomes. Studies not reporting any of the outcomes of interest or if the full text is not available in English were excluded. Studies reporting on bone marrow aspirate or autografts for non-orthopedic indications were also excluded. RESULTS: After the removal of duplicates, a total of 5981 studies were identified. After screening those records, 85 studies remained for full-text assessment. Out of those, 15 studies qualified for the meta-analysis with a total of 2296 bone grafts. Out of those grafts, 1557(67.8%) were calcaneal grafts, 625 (27.2%) were proximal tibial grafts, and 114 (5%) were distal tibial grafts. In calcaneal bone grafts, there were 28 cases of chronic pain [1.97%, CI:1.10-2.50%, I2 = 66%], 5 fractures [0.32%, CI: 0.10-0.60%,I2 = 0%], 20 sural neuritis [1.28%, CI:0.70-1.80%, I2 = 0%), and no wound infections. In proximal tibial grafts there were 13 cases of chronic pain [2.08%, CI: 1.01-3.2%, I2 = 34.5%], 1 fracture [0.16%, CI:0.10-0.50%, I2 = 0%], and 3 superficial wound infections [0.48%, CI: 0.10-1.01, I2 = 0%]. In the distal tibial grafts there were no cases of chronic pain or wound infections, 1 fracture [0.90%, CI: 0.80-2.6%, I2 = 0%], and 5 saphenous neuritis [4.5%, CI: 0.70-8.40%, I2 = 65%]. CONCLUSION: Calcaneal, distal tibial, and proximal tibial bone autografts are safe with a low rate of overall and major complications. We report an overall complication rate of 6.8%, which is less than half of that previously reported for iliac crest grafts. The authors recommend using distal lower extremity grafts for foot and ankle primary surgeries instead of iliac crest grafts when indicated. Clinical trials with a large sample size are required.

Failure Rates of 5-Strand and 6-Strand vs Quadrupled Hamstring Autograft ACL Reconstruction: A Comparative Study of 413 Patients With a Minimum 2-Year Follow-up.

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) with hamstring autograft has gained popularity. However, an unpredictably small graft diameter has been a drawback of this technique. Smaller graft diameter has been associated with increased risk of revision, and increasing the number of strands has been reported as a successful technique to increase the graft diameter. PURPOSE: To compare failure rates of 5-strand (5HS) and 6-strand (6HS) hamstring autograft compared with conventional 4-strand (4HS) hamstring autograft. We describe the technique in detail, supplemented by photographs and illustrations, to provide a reproducible technique to avoid the variable and often insufficient 4HS graft diameter reported in the literature. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively reviewed prospectively collected data of all primary hamstring autograft ACLRs performed at our institution with a minimum 2-year follow-up and 8.0-mm graft diameter. A total of 413 consecutive knees met the study inclusion and exclusion criteria. The study population was divided into 5HS and 6HS groups as well as a 4HS control group. The primary outcome was failure of ACLR, defined as persistent or recurrent instability and/or revision ACLR. RESULTS: The analysis included 224, 156, and 33 knees in the 5HS, 6HS, and 4HS groups, respectively. The overall ACLR failure rate in this study was 11 cases (8%): 5 cases for 5HS, 3 cases for 6HS, and 3 cases for 4HS. No statistically significant differences were found among groups (P = .06). The mean graft diameter was 9 mm, and the mean follow-up was 44.27 months. CONCLUSION: The 5HS and 6HS constructs have similar failure rates to the conventional 4HS construct of 8.0-mm diameter and are therefore safe and reliable to increase the diameter of relatively smaller hamstring autografts. We strongly recommend using this technique when the length of the tendons permits to avoid failures reportedly associated with inadequate graft size.

Usability of the AAOS Appropriate Use Criteria (AUC) for the surgical management of knee osteoarthritis in clinical practice.

PURPOSE: The Appropriate Use Criteria (AUC) for the surgical treatment of knee osteoarthritis were developed by the American Academy of Orthopedic Surgeons (AAOS) to guide surgeons in selecting the most evidence-based surgical option. This study aimed to assess the usability of the AUC by comparing the actual surgical treatment provided at our institution with that recommended by the AUC. METHODS: A retrospective review of the medical charts and radiographs of all patients who underwent surgery for knee osteoarthritis (OA) at our hospital was performed between January and December 2017. Data including each patient's age, gender, pain level, mechanical symptoms, range of motion (ROM) and instability, radiographic pattern and severity, limb alignment, and type of surgical interventions received were collected. The collected data were input into the AUC application to determine the rate of appropriateness of the treatments. Afterwards, the agreement between the actual treatment provided and the AUC recommendation was assessed. RESULTS: A consecutive series of 100 patients were included. The mean age was 63.1 years, with the majority of the patients aged (73%) between 50 and 69 years. Most of the patients were females (74%), and 61% had left knee OA. The most frequent type of patient was a middle-aged patient with function-limiting pain at short distances, no mechanical symptoms or functional instability with full ROM, severe knee multicompartmental radiographic features, and varus or valgus malalignment. Out of the 100 patients, total knee arthroplasty (TKA) was performed in 85 patients, unicompartmental knee arthroplasty (UKA) was performed in 11 patients, and high tibial osteotomy (HTO) was performed in four patients. According to the AUC, 90 (90%) cases were treated with an appropriate surgical treatment, whereas 10 (10%) cases were treated with a maybe appropriate treatment. The actual surgical treatment performed at our hospital was in agreement with the AUC recommendation in 100% of the TKA cases, 90.9% of the UKA cases, and 100% of the HTO cases. Thus, the agreement rate with the AUC was 99% in all surgical cases. CONCLUSION: This study demonstrated that the AUC for the surgical treatment of knee OA can be applied easily in a clinical setting. Most of the treatments provided at our institution were appropriate and in agreement with the AUC recommendations. Additionally, the AUC had a web-based application that was easy to use and simple for identifying treatment recommendations. LEVEL OF EVIDENCE: Retrospective study, level IV.