The Ankle Joint: Revision Ankle Fusion Options, Nonunion, Malunion, Protocol for Best Outcome.

Ankle arthrodesis has been a time-tested procedure for osteoarthritis, avascular necrosis of the talus, deformity correction, and significant trauma of the ankle. Technique guides have created dissection pearls, ease of fixation, and arthroscopic techniques to mitigate complications of the procedure. Major complications, such as nonunion, malunion, or implant infection are the most worrisome and cumbersome complications to handle. The aim of this article is to provide the practicing surgeon evidence to provide innovative management techniques for nonunion, malunion, and infection following primary ankle arthrodesis.

Radiographic Comparison of Heterotopic Ossification After Primary Total Ankle Arthroplasty in Fourth-Generation Implants.

LEVEL OF EVIDENCE: Level III: Retrospective comparative.

Outcomes and Complications of the INFINITY Total Ankle: A Systematic Review.

LEVEL OF EVIDENCE: IV.

Abnormally Large Synovial Herniation Resulting in Progressive Rocker Bottom Deformity in a Patient with Idiopathic Midfoot Charcot Neuroarthropathy: A Case Report.

Deformities associated with Charcot neuroarthropathy (CN), a rare and devastating post-diabetic complication, place patients at risk for infection and amputation. In the present case, a 56-year-old male with idiopathic CN presented with complaints of progressively growing plantar soft tissue deformity. Routine hematology, biochemistry, paracentesis, and fluid analysis were conducted. The patient was treated conservatively and will continue to be monitored for progression of the condition.

Charcot Pathogenesis: A Study of In Vivo Gene Expression.

Charcot neuroarthropathy is a rare but often difficult to manage disease in the neuropathic patient. Early signs such as unremarkable edema, marginal trauma, or minor infection can activate a cascade of bony destruction and lead to gross prominence or deformity, with dire consequences. The exact molecular mechanism is poorly understood. Current theory states that an inflammatory reaction leads to the activation of osteoclasts mediated by specific cytokines. Our study sought to test the genetic expression of certain biomarkers in diabetic patients with and without Charcot neuroarthropathy compared with patients with and without diabetes or neuropathy. A total of 30 patients participated in the study, 17 (57%) males and 13 (43%) females. Peripheral blood samples were drawn, and gene expression was measured using real-time polymerase chain reaction. The expression levels of receptor activator of nuclear factor kappa-B ligand and osteoprotegerin showed no significant increase in the Charcot neuroarthropathy group compared with the healthy control group. We determined that the levels of receptor activator of nuclear factor kappa-B ligand and osteoprotegerin were not significantly increased in Charcot neuroarthropathy patients compared with healthy control patients. These results demonstrate a need for further investigation into alternative molecular pathways to determine the exact mechanism of the disease process.

A Novel Thermochromic Liquid Crystal Fabric Design for the Early Detection of High-Risk Foot Complications

Background: We developed a prototype of a novel thermochromic liquid crystal (TLC)­coated fabric with an extended temperature range and enhanced sensitivity. By incorporating color and pattern recognition into the fabric, rapid determination of the underlying pedal temperature is facilitated. The purpose of this study was to evaluate the accuracy of the TLC fabric as a potential diagnostic aid for identifying complications in the high-risk foot. Methods: The hands of 100 individuals were used to compare the mean maximum temperatures indicated by the fabric versus standard thermal camera images. Findings were statistically analyzed using a paired t test, with significance defined as P < .05. Results: Except for the tip of the thumb and regions in the palm, there were no statistically significant differences between mean maximum temperatures measured with the thermal camera and those detected with the TLC fabric. Minor differences were relatively consistent in all nine regions of the hand and were not considered to be clinically significant. Conclusions: Using direct visual analysis, we demonstrated that a novel TLC fabric could accurately map temperatures in the palmar surface of the hand. The findings support the continued development of a temperature-sensitive sock that can be used in the home to monitor for temperature changes that may indicate the onset of complications in the high-risk foot.