First Metatarsal Headphones-Like Lesion: A Case of Unreducible Sesamoid Complex Dislocation.

CASE: A 34-year-old woman sustained a direct trauma to the left hallux during a fall. Radiographs showed a dorsal dislocation of the first metatarsophalangeal joint and a wide separation of sesamoid complex. Closed reduction was tried: postreduction radiographs displayed reduction of first metatarsophalangeal joint and a complete sesamoid complex dislocation. The patient was scheduled for surgery. Through a medial approach, open reduction together with plantar structures release and repair were performed. Functional and radiographic outcomes were satisfactory at the last follow-up. CONCLUSION: In case of a "headphones-like lesion" surgery is required, together with plantar structures repair.

To cast or not to cast? Postoperative care of ankle fractures: a meta-analysis of randomized controlled trials.

Postoperative care of ankle fractures treated with open reduction and internal fixation (ORIF) is a debated topic. A meta-analysis of Randomized Controlled Trials was conducted with the aim of comparing early mobilization and weightbearing to traditional postoperative protocols. A systematic search of electronic databases was conducted according to the PRISMA guidelines. Only randomized clinical trials were included. Data about clinical outcome, time to return to work and complications were extracted and summarized. Meta-analyses were performed. Twenty studies for a total of 1328 patients were included. Early mobilization was compared to immobilization in 724 patients: the two groups did not significantly differ in terms of short- and long-term clinical outcome (p = 0.08 and p = 0.41, respectively). However, early mobilization resulted to be significantly associated with faster return to work (p = 0.047). Early weightbearing was compared to nonweightbearing in 1088 patients. While the clinical difference between the two groups was not significant at short term (p = 0.08), it was significant at long term (p = 0.002). No other significant differences, in particular regarding complications, were highlighted between different groups. Early motion, early weightbearing and traditional postoperative protocols are all safe strategies after ORIF for unstable ankle fractures. Early mobilization is significantly associated with faster return to work and early weightbearing improves long term clinical outcome.Level of evidence: I.

Adipose-derived stem cells applied to ankle pathologies: a systematic review.

The purpose of this systematic review was to analyze the current use of adipose-derived mesenchymal stem cells (ADMSCs) and present the available evidence on their therapeutic potential in the treatment of ankle orthopedic issues, evaluating the applications and results. A literature search of PubMed, Google Scholar, EMBASE and Cochrane Library database was performed. The review was conducted following PRISMA guidelines. Risk of bias assessment was conducted through the Methodological Index for Non-Randomized Studies (MINORS) criteria. Initial search results yielded 4348 articles. A total of 8 articles were included in the review process. No clinical evidence has demonstrated the effectiveness of one isolation method over the other, but nonenzymatic mechanical method has more advantages. In all studies included significant clinical outcomes improvement were recorded in patients affected by osteochondral lesion and osteoarthritis of ankle. All studies performed a concomitant procedure. No serious complications were reported. ADMSC injection, especially through the nonenzymatic mechanical methods, looks to be simple and promising treatment for osteochondral lesions and osteoarthritis of the ankle, with no severe complications. The current scarcity of studies and their low-quality level preclude definitive conclusions presently. LEVEL OF EVIDENCE: III.

Congenital metatarsus varus: early diagnosis and conservative treatment in 112 patients.

PURPOSE: To describe a conservative treatment algorithm to manage Congenital Metatarsus Varus. BACKGROUNDS: Congenital Metatarsus Varus is a congenital disorder with an estimated incidence of 1/1000 newborns. Despite the deformity being mostly an aesthetic problem, residual and incorrect forms may be responsible for abnormal in-toe gait and shoe-wearing issues. No consensus has still been gathered regarding its correct treatment algorithm. METHODS: Between May 2019 and September 2020, 2156 newborn patients underwent an orthopedic examination at birth. Patients affected by Congenital Metatarsus Varus were classified according to Bleck's classification as flexible, semi-flexible or non-flexible deformity. A conservative treatment algorithm was followed, based on the application of manipulations, Bebax-type braces or plaster cast. All patient were followed until the clinical resolution of the deformity. Complications were also recorded. RESULTS: One-hundred twenty-four patients were diagnosed Congenital Metatarsus Varus, with an overall prevalence of 5/1000. One-hundred twenty-two patients presented with a flexible or semi-flexible foot deformity and were firstly treated with manipulations: 52 patients reported good results, while 70 required additional treatment with Bebax-type braces for achieving correction. Two patients presented a non-flexible deformity at birth: one required plaster cast due to a non-flexible deformity, and one patient was firstly managed with Bebax-type braces due to a severe semi-flexible deformity. Only two patients presented superficial skin ulcerations, healed within a week. Two patients were lost during the follow-up. CONCLUSION: An early diagnosis allowed by an orthopedic examination in all newborns may be a valid instrument to avoid Congenital Metatarsus Varus misdiagnosis. Early treatment with manipulation and orthosis resulted in good clinical outcome, with only few complications.

A novel retrograde technique for ankle osteochodral lesions: the sub-endo-chondral regenerative treatment (secret).

PURPOSE: To describe a new surgical technique for osteochondral lesions of the ankle, using bone marrow concentrate on a scaffold and homologous bone graft positioned through a retrograde approach. Many surgical options for ankle osteochondral lesions have been described, and the ideal treatment is still debated. Bone marrow stimulating techniques are recommended for cystic lesions, with some concerns regarding the healing potential of the subchondral bone. In case of wide osteochondral defects, regenerative solutions are preferred but a massive chondral debridement is usually required. To overcome these problems, a novel technique is proposed. METHODS: The proposed technique was performed on patients affected by osteochondral lesions of the talus, either cysts with intact cartilage or wide osteochondral defects. A preoperative magnetic resonance imaging was obtained to localize the lesion. A 6-mm tarsal tunnel was retrogradely created toward the lesion, to allow a complete sub-endo-chondral debridement preserving the healthy cartilage. A hyaluronan scaffold soaked with a previously prepared bone marrow concentrate was retrogradely positioned under the cartilage surface and the tunnel was filled with homologous bone graft. Preoperative clinical scores and postoperative x-rays were registered. RESULTS: Four patients were treated using this technique. No intraoperative and postoperative complications occurred. Good bone remodeling was observed at 12-week postoperative x-rays. CONCLUSIONS: This technique combines the mini-invasiveness of retrograde drilling with the regenerative properties of biological scaffold soaked with bone marrow concentrate. Despite further research being needed, it seems a new viable solution to treat both subchondral cysts and large osteochondral defects of the ankle, whose management is still controversial.