Open Reduction and Fixation of Lateral Malleolus and Syndesmosis for Ankle Re-Fracture.

SUMMARY: Rotational ankle fractures are often accompanied with a syndesmotic injury. Furthermore, malreduction of syndesmosis and fibular shortening are frequent errors observed in these cases and often lead to poor functional outcomes. We present a case of Weber C lateral malleolus fracture and distal tibiofibular syndesmotic injury in an active 23-year-old patient. Various techniques for syndesmotic reduction and restoration of fibular length are discussed and demonstrated.

An Interesting Case of Osteolysis With Accompanying Metallosis in a Primary Total Knee Arthroplasty.

Arthroplasty implants are comprised of metal alloys designed to function within the human body. Implant-related issues and associated soft-tissue reactions have been well documented for modular revision hip and knee constructs. This case highlights findings of metallosis in the context of polyethylene wear in a failed primary total knee arthroplasty. Fretting of a polyethylene reinforcement pin within the tibial baseplate as a direct result of knee joint instability appears to be the root cause of observed periprosthetic metallosis. Enhanced design principles and improved polyethylene locking mechanisms may be useful to potentially mitigate fretting-related issues in future knee replacement designs. The authors recommend surveillance in patients with this construct especially when prosthetic instability is present.

Meta-Analysis: Functional Outcome of ORIF Versus Primary Subtalar Arthrodesis of Sanders Type II and Type III Calcaneal Fractures.

The choice of treatment for Sanders Type II and Type III calcaneal fractures remains controversial with unclear patient functional outcomes. A meta-analysis was done to compare the functional outcome of ORIF vs primary subtalar arthrodesis (PSA) according to American Orthopedic Foot and Ankle Score (AOFAS) hindfoot-ankle scores. The PubMed, Embase, and Cochrane Library Databases were searched by two independent evaluators. Fourteen studies met the eligible criteria. ORIF of 501 Type II and Type III fractures was compared to primary subtalar arthrodesis treatment of 57 Type II and Type III fractures. AOFAS for a mixed ORIF group of "Type II and III" fractures was 82.16 ± 1.58 at average follow-up of 25.3 months. For a mixed PSA group of "Type II and III" fractures, the AOFAS was 74.22 ± 2.45 at average follow-up of 28.0 months. This showed a difference between ORIF and primary subtalar arthrodesis of 7.94 points (95% confidence interval [CI] = 7.75-7.98; p value .004) favoring ORIF when adjusting for minimally invasive and percutaneous methods. Without adjustment, there was a difference of 6.54 points favoring ORIF (95% CI = 6.22-6.46; p value .017). In conclusion, while high-quality randomized controlled trials comparing ORIF to primary subtalar arthrodesis for Type II and Type III fractures would further elucidate superior treatment outcomes, this meta-analysis of available data shows a tendency for ORIF of Type II and Type III Sanders calcaneal fractures to have a better functional outcome at approximately 2 years postoperatively compared to primary subtalar arthrodesis.

Anterior Cruciate Ligament (ACL) Reconstruction Augmented With Bone Marrow Concentrate, Demineralized Bone Matrix, Autograft Bone, and a Suture Tape (The Fertilized ACL).

PURPOSE: To examine the early clinical outcomes as well as safety of the Fertilized anterior cruciate ligament (ACL) reconstruction procedure. METHODS: A total of 16 consecutive patients with a mean age of 24 years (range, 16-45 years), who had been treated with the fertilized ACL were evaluated and followed over 2 years. Four patients underwent reconstruction using an FGL GRAFTLINK allograft (LifeNet Virginia Beach, VA) and 12 using quadriceps autografts. All patients received the fertilized ACL as previously described using bone marrow composite, demineralized bone matrix, and an internal brace (Arthrex, Largo, FL). Clinical outcomes at 2 years including International Knee Documentation Committee and Marx scores were evaluated. Complication rates, including return to operating room, arthrofibrosis, infection, and rerupture rates, were also assessed. RESULTS: All patients were followed for 6 months and all were released to full activity. In total, 11 of 16 patients were available for 2-year follow-up after the fertilized ACL reconstruction. At 2 years, the average International Knee Documentation Committee and Marx scores were 81 (standard deviation, 5.9) and 9 (standard deviation, 5.7), respectively. One patient required a return trip to the operating room for manipulation under anesthesia. No reruptures were observed at the 2-year mark. Nine of 11 patients had returned to their preinjury activity status at 2 years. CONCLUSIONS: The fertilized ACL, which adds biology and an internal brace to an ACL reconstruction, is a reliable and safe option when performing an ACL reconstruction. Very low complication risks were seen in this consecutive series followed for 2 years. Patients consistently returned to their preinjury activity status. LEVEL OF EVIDENCE: Level IV, therapeutic case series.