Deep vein thrombosis (DVT) is a common postoperative complication in orthopedic surgery and may result in life-threatening events such as pulmonary thromboembolism (PTE). However, evidence on the optimal prophylactic strategy for DVT following foot and ankle surgery remains limited. This study aimed to assess the effect of pharmacologic thromboprophylaxis in patients undergoing foot and ankle surgery with postoperative immobilization. A retrospective review was conducted of 451 patients who underwent foot and ankle surgery followed by short-leg splint immobilization with restricted ankle motion for more than 2 weeks between April 2022 and February 2024. All patients underwent routine screening duplex ultrasonography at 2 weeks postoperatively, regardless of symptom status. Patients were categorized into 3 groups based on postoperative pharmacologic thromboprophylaxis: no anticoagulation, aspirin (Aspirin Protect, Bayer AG) 100 mg once daily for 14 days, and enoxaparin (a low-molecular-weight heparin; Clexane, Sanofi) 40 mg once daily during hospitalization followed by aspirin after discharge to complete a total of 14 days. The incidence of DVT was compared using the chi-square test, and multivariate logistic regression analysis was performed to adjust for potential confounders. Of the 451 patients, 73 patients (16.2%) developed DVT. The incidence of DVT was comparable among the 3 groups, with no statistically significant differences observed (no-anticoagulation group: 24 of 147 [16.3%]; aspirin group: 25 of 145 [17.2%]; enoxaparin group: 24 of 159 [15.1%]; p = 0.34). Most DVTs were asymptomatic (66 / 73, 90.4%) and confined to the distal calf veins (70 / 73, 95.9%), while proximal DVT was rare (3 / 73, 4.1%), occurring in 1 patient in each group. Multivariate logistic regression analysis demonstrated no significant association between pharmacologic thromboprophylaxis and postoperative DVT after adjustment for confounding variables. In this retrospective cohort, pharmacologic thromboprophylaxis with enoxaparin or aspirin was not associated with a reduced incidence of postoperative DVT following foot and ankle surgery with immobilization. These findings should be interpreted cautiously given the observational design and short duration of prophylaxis. A uniform anticoagulation strategy may not be appropriate for all patients.
Ankle osteoarthritis (AOA) is a progressive condition that impairs mobility and reduces quality of life. Conservative treatments like rocker bottom (RB) shoes and ankle-foot orthoses (AFOs) are commonly prescribed, but their effectiveness in managing AOA is not well understood, and patient preferences are underexplored. This is a pilot study aimed to evaluate the effect of RB shoes and AFOs in managing AOA and to identify factors influencing patient preferences for these conservative treatments. This was a cross-over telehealth study involving 10 participants with doctor-diagnosed AOA. Each participant wore three footwear conditions: control shoes, RB shoes, and AFOs, each for 3 weeks. Participants completed baseline pain ratings and functional assessments using PROMIS and FAAM questionnaires. After each 3-week footwear session, participants reported pain levels and provided feedback on their preferred footwear. Younger participants (aged 56-63) preferred AFOs for pain relief and improved mobility, while older (aged 66-75) and taller participants preferred RB shoes for their comfort. No significant differences were found in pain or function across footwear conditions, but AFO-preferred participants experienced significant reductions in maximum pain compared to the RB group. Footwear preferences were influenced by age and activity level. Younger participants preferred AFOs for functional benefits, while older participants prioritized comfort and selected RB shoes. These findings emphasize the need for personalized conservative treatment strategies in managing AOA. This pilot study highlights the importance of tailoring conservative treatments for AOA based on age and activity level. Understanding patient preferences can help guide clinical decisions and improve patient outcomes.
The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) is a validated foot- and ankle-specific patient-reported outcome measure. However, minimal clinically important difference (MCID) values have not been established for SAFE-Q after surgery for ankle osteoarthritis. To determine anchor-based and distribution-based MCIDs for SAFE-Q subscales in patients undergoing surgery for ankle osteoarthritis. Retrospective cohort study. We analyzed 88 patients with ankle osteoarthritis undergoing surgery who completed SAFE-Q preoperatively and ≥12 months postoperatively. The SAFE-Q subscales included pain and pain-related (PP), physical function and daily living (PF), social function (SF), shoe-related problems (SH), and general health and well-being (GH). Anchor-based MCIDs were derived using receiver operating characteristic (ROC) curves, with patient satisfaction as the external anchor. Distribution-based MCIDs were estimated using one-half standard deviation of baseline scores. SAFE-Q scores improved significantly across all domains. Eighty patients (91%) reported satisfaction. Anchor-based MCIDs were +13.9 for PP and +9.1 for PF, with acceptable discriminative accuracy (area under the ROC curve 0.759 and 0.743, respectively). In contrast, GH was affected by ceiling effects, and SF and SH showed limited discriminative ability. Distribution-based MCIDs ranged from 9 to 13 points and closely matched anchor-based values for PP and PF. This study provides the first MCID estimates for SAFE-Q in ankle osteoarthritis surgery. PP and PF demonstrated clinically meaningful MCIDs of approximately 9-14 points, indicating that these subscales are most appropriate for assessing meaningful postoperative improvement. These thresholds offer practical guidance for clinical interpretation and future trial design.
Tumors of the foot and ankle are uncommon, accounting for approximately 4%-10% of all musculoskeletal tumors; most are benign soft-tissue lesions. Osteochondrolipoma is an exceptionally rare histological variant of lipoma characterized by mature adipose tissue with cartilaginous and osseous differentiation. It is typically reported in the head, neck, and upper extremities, whereas its occurrence in the lower extremity, particularly the hindfoot, is exceedingly rare. We report a case of osteochondrolipoma of the lateral aspect of the hindfoot of a 54-year-old female who presented with a painless, slowly enlarging mass causing difficulty with footwear. Imaging demonstrated a well-defined, heterogeneous soft tissue lesion with ossified components, without bone attachment. Complete surgical excision was performed. Histopathological examination revealed mature adipose tissue interspersed with hyaline cartilage and mature bony trabeculae with evidence of endochondral ossification, confirming the diagnosis of osteochondrolipoma. The postoperative course was uneventful. At 3 months of follow-up, the patient reported complete resolution of symptoms and no difficulty wearing footwear. Functional outcome improved, with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score increasing from 81 preoperatively to 88. No clinical evidence of recurrence was observed. Osteochondrolipoma is a benign entity with an excellent prognosis after complete excision. Given its rarity in the hindfoot and its potential to mimic other calcified soft tissue tumors, clinicians and pathologists should consider osteochondrolipoma in the differential diagnosis of well-circumscribed ossified masses of the foot and ankle.
Hallux valgus is the most prevalent forefoot condition and is associated with substantial pain, functional impairment and reduced health-related quality of life. Despite established clinical effectiveness, since 2021 an increasing number of Integrated Care Boards in the UK have classified surgical correction as a procedure of limited clinical benefit, citing a perceived absence of population-level cost-effectiveness data. National-scale evidence is required to inform commissioning decisions and ensure equitable access to care. A cost-utility analysis was performed from the perspective of the UK National Health Service (NHS) using British Orthopaedic Foot and Ankle Society (BOFAS) Registry data for adults undergoing primary hallux valgus correction by osteotomy (open or minimally invasive surgery, MIS). Fusion procedures were excluded. EuroQol-5 Dimension five-level (EQ-5D-5L) utility scores at baseline and 12 months were used to estimate quality-adjusted life year (QALY) gains. A six-state Markov model simulated lifetime costs and outcomes over 40 annual cycles from the UK NHS perspective, with costs and benefits discounted at 3.5% per annum. Incremental cost-effectiveness ratios (ICERs) were calculated against conservative management and deterministic sensitivity analysis was performed across procedural cost, utility gain and benefit duration. A pre-specified subgroup analysis compared open and MIS techniques. From 1111 registry pathways, 306 patients had complete EQ-5D-5L datasets for cost-utility modelling, comprising 129 open and 177 MIS procedures. EQ-5D-5L utility improved from 0.69 (95% CI 0.65-0.72) at baseline to 0.84 (95% CI 0.81-0.88) at 12 months in the open group, and from 0.69 (95% CI 0.66-0.72) to 0.82 (95% CI 0.79-0.84) in the MIS group (both p < 0.001). The base-case lifetime Markov model produced an ICER of £ 8737 per QALY for open correction and £ 11,969 per QALY for MIS correction, both well below the NICE willingness-to-pay threshold. In sensitivity analysis using incremental costs against conservative management, the ICER ranged from cost-saving (-£374 per QALY) to £ 3219 per QALY across all tested scenarios. Open correction was the dominant strategy in the pre-specified subgroup analysis, primarily driven by lower implant costs and higher removal rates in current literature. Hallux valgus correction surgery is highly cost-effective from the UK NHS perspective, with cost per QALY values substantially below those reported for total hip and total knee arthroplasty. The current restriction of access in some UK regions is not supported by national health-economic evidence. III (economic and decision analysis based on prospective registry data).
Fractures of the foot, ankle, and distal leg present unique biomechanical challenges, necessitating careful consideration during implant selection for effective management. In elderly patients, these injuries are further complicated by osteoporosis, poor bone quality, reduced soft tissue resilience, and slower rehabilitation, all of which contribute to higher complication risks and delayed recovery. These injuries disrupt normal load distribution and movement, requiring stabilization and functional restoration through various fixation methods, including screws, plates, intramedullary nails, and external fixators. Biomechanical factors such as weight-bearing capacity, implant flexibility, and alignment play critical roles in maintaining fracture stability and promoting healing. Comparative analyses of fixation techniques are essential to evaluate their respective strengths and limitations, emphasizing the balance between rigidity and adaptability. Postoperative protocols, including rehabilitation strategies and the biomechanics of implant removal, significantly influence patient outcomes. Advances in implant technology, such as bioresorbable materials, 3D printing, and computational modeling, offer promising improvements. These innovations, particularly for osteoporotic bone and anatomically complex regions, drive the development of personalized and functionally optimized solutions for fracture management.
To analyze the clinical effect of modified tibial transverse transport combined with the Masquelet technique in treating diabetic foot with ulcers (Wagner stages 2-4). This study was conducted to explore a novel combined surgical strategy for Wagner 2-4 diabetic foot ulcers that respond poorly to conventional treatments. A total of 46 patients with Wagner 2-4 diabetic foot ulcers were enrolled (23 per group). Both groups received standardized preoperative glycemic control and infection management. The intervention group underwent modified tibial transverse transport (10 × 1.8 cm bone window; distraction starting on day 7 at 1 mm/day for 3 weeks, followed by reverse transport) combined with the Masquelet technique (PMMA spacer implantation at stage I, followed by autologous bone grafting at 6-8 weeks). The control group received conventional treatment, including debridement, VSD, and systemic antibiotics, without bone transport or induced membrane procedures. The primary outcome was limb salvage rate at 6 months. Secondary outcomes included wound healing rate, time to wound healing, MRI-confirmed edema resolution, changes in inflammatory markers, and 6-month recurrence rate. The hierarchical testing procedure was applied with limb salvage as the first endpoint; only if significant would subsequent endpoints be formally tested. With a median follow-up of 6.5 months (range 3-12 months), the complete wound healing rate (defined as complete epithelialization without drainage sustained for ≥ 2 weeks, achieved without or after minor amputation) was 82.6% (19/23) versus 69.6% (16/23) (P = 0.289). The limb salvage rate (avoidance of major amputation above ankle) was 100% (23/23) in both groups (P = 1.000). Among the 19 healed patients in the intervention group, 15 achieved healing without amputation, and 4 achieved healing after minor amputation (toe/ray); among the 16 healed control patients, 9 achieved healing without amputation and 7 achieved healing after minor amputation. Four intervention patients and seven control patients did not achieve wound healing within the study period. Among healed patients with complete 6-month post-healing follow-up (n = 19 intervention, n = 16 control), recurrence rates were 15.8% (3/19) and 31.3% (5/16), respectively (P = 0.113). Four intervention patients and seven control patients did not achieve wound healing or were lost to follow-up before 6 months and were excluded from recurrence analysis. Four patients in the intervention group and seven in the control group did not achieve wound healing within the study period and were excluded from recurrence analysis. Wound healing time showed a trend toward a shorter duration in the intervention group (4.2 ± 2.1 vs. 5.8 ± 2.4 months, P = 0.056). Postoperative inflammatory markers (ESR, CRP), affected foot skin temperature, toe oxygen saturation, and clinical scores (VAS) showed significantly greater improvement in the intervention group compared with control (P < 0.05), while WBC, HbA1c, and TCSS scores improved in both groups without a significant between-group difference. CTA-demonstrated dorsal foot artery recanalization was observed in 78% (18/23) of the intervention group versus 52% (12/23) of the control group (P = 0.068). Clinical dorsal foot artery palpability normalization was observed in 48% (11/23) versus 17% (4/23) (P = 0.068). As an exploratory pilot study, modified tibial transverse transport combined with the Masquelet technique presents potential clinical benefits for the treatment of diabetic foot with ulcers, including tentative trends toward improved limb salvage and accelerated wound healing, without definitive causal associations established.
Total ankle arthroplasty (TAA) has emerged as a motion-preserving alternative to ankle arthrodesis for end-stage ankle osteoarthritis. As use increases, validated patient-reported outcome benchmarks are essential for interpreting functional recovery. The Foot and Ankle Ability Measure activities of daily living subscale (FAAM-ADL) is widely used in foot and ankle surgery; however, the minimal clinically important difference (MCID) following TAA has not been established. This study aimed to determine the MCID for the FAAM-ADL after primary TAA and to identify preliminary predictors of MCID achievement. One hundred sixty-four primary TAAs (1/2015-2/2022) at a single academic center (6 surgeons) with paired preoperative and ≥1-year postoperative FAAM-ADL scores were included. MCID was calculated using 3 established methods: the standard deviation (SD) approach, average change, and change difference methods. Diagnostic performance was evaluated using ROC analysis. Multivariable logistic regression assessed predictors of achieving MCID. The mean age was 62.9 years, and 54.9% of patients were male. FAAM-ADL MCID thresholds varied by methodology, ranging from 12.5 points (SD method) to 26.0 (anchor 2, average change) to 32.3 points (anchor 2, change difference). The SD-derived threshold identified the greatest proportion of patients achieving MCID (73.2%), whereas the anchor 2 change difference method demonstrated the highest area under the curve (0.772) and positive predictive value (0.815). Postoperative FAAM-ADL improvement was significantly greater in satisfied vs dissatisfied patients across both anchors (P < .001). On multivariable analysis, lower preoperative FAAM-ADL was the only independent predictor of achieving MCID (OR 0.93, P < .001). This study provides initial estimates of the first FAAM-ADL MCID thresholds following TAA of approximately 12.5 to 32.3 points. Baseline functional status was associated with MCID achievement, whereas demographic and comorbidity factors were not. These findings provide an initial benchmark for interpreting TAA outcomes and underscore the need for future prospective validation. Level III, retrospective cohort study.
Hardware failure following ankle fracture fixation is an established complication traditionally attributed to fracture pattern, fixation construct, bone quality, and postoperative weight-bearing status. The relationship between community-level social vulnerability and hardware failure requiring removal after ankle open reduction internal fixation (ORIF) remains poorly defined. To evaluate whether patients residing in socioeconomically vulnerable areas experience higher rates of hardware failure following ankle fracture fixation. Retrospective cohort study METHODS: : Patients who underwent unplanned hardware removal after ankle fracture fixation were identified using Current Procedural Terminology (CPT) code 20680. The control group consisted of patients who underwent operative ankle fracture fixation during the study period without subsequent hardware removal. Demographic data and residential zip codes were extracted from the electronic medical record, and zip codes were mapped to counties to assign county-level Social Vulnerability Index (SVI) scores. Patients residing in Lucas County, Ohio, demonstrated greater social vulnerability than those in surrounding counties, particularly within the socioeconomic status and racial and ethnic minority status themes. Age demonstrated a small statistically significant association with hardware removal (OR, 1.014; 95% CI, 1.002, 1.027; P = 0.022), although age was not the primary focus of this analysis. Socioeconomic and environmental factors remain clinically relevant to postoperative care after ankle fracture fixation. The concentration of patients from a higher-socially vulnerable region highlights the need to better characterize how social vulnerability, care access, follow-up adherence, and community-level barriers may affect hardware-related outcomes.
Arthroscopic all-inside ligament repair is a widely used technique for treating chronic lateral ankle instability. This study aimed to evaluate the clinical outcomes of skeletally immature patients who underwent all-inside ligament repair. Skeletally immature patients who underwent surgery for ankle instability between 2018 and 2022 were retrospectively evaluated. All patients were treated arthroscopically using an all-inside ligament repair technique, allowing an all-epiphyseal anatomical repair of the ligament remnant. Clinical outcomes were assessed pre- and postoperatively using Visual Analogue Scale (VAS), Foot Functional Index (FFI) score and Foot and Ankle Ability Measure-Sports subscale (FAAM-SS). Postoperative magnetic resonance imaging (MRI) was routinely performed at 3 months to evaluate ligament repair and detect any physeal violation. At final follow-up, patient satisfaction, complications, lower-limb axial deviations or clinical signs of physeal violation were recorded. Forty patients aged 8-15 years (21 females; mean age 13.8 ± 2.3 years) were included. Mean follow-up was 44.8 months ± 16.5 (range, 24-78). An anterior talofibular ligament (ATFL) tear was identified in all cases, with concomitant calcaneofibular ligament detachment observed in four patients. All clinical scores improved significantly (p < 0.001). Mean FFI and FAAM-SS scores improved from 35.6 ± 14.0 (range, 11-69) and 50.3 ± 14.0 (range, 15-78) preoperatively to 3.9 ± 6.4 (range, 0-26) and 95.4 ± 8.3 (range, 68-100) postoperatively. Mean VAS improved from 5.4 ± 2.5 (range, 1-8) to 0.4 ± 0.8 (range, 0-3). No cases of physeal violation were detected on postoperative MRI. No major complications, axial deviation or clinical signs of growth plate injury were observed. Ankle instability in skeletally immature patients can be successfully treated with arthroscopic all-inside ligament repair. This technique provides an all-epiphyseal anatomical repair of the ligament remnant with a low risk of physeal violation and results in excellent clinical outcomes. Level IV, retrospective case series.
To investigate the effect of tibial rotation on knee and ankle function following intramedullary nail for extra-articular distal tibial fractures. A retrospective analysis was conducted on 72 patients with extra-articular distal tibial fractures who underwent intramedullary nailing treatment between January 2020 and December 2022, including 38 males and 34 females, aged from 20 to 65 years old with an average of (45.1±11.9) years old;30 cases were on the left side and 42 cases on the right side;35 cases were complicated with ipsilateral fibular fractures, and 37 cases were simple tibial fractures. Patients were divided into a malrotation group (postoperative rotation angle ≥10°) and a normal rotation group (postoperative rotation angle <10°) based on the postoperative tibial rotation angle. The malrotation group comprised 20 patients (9 males, 11 females), aged from20 to 65 years with a mean age of(47.2±14.3) years. There were 8 left-sided and 12 right-sided cases. The normal rotation group included 52 patients (29 males, 23 females), aged from 25 to 64 years with a mean age of (44.3±10.9) years. There were 22 left-sided and 30 right-sided cases. The postoperative tibial rotation angle, lower extremity functional scale(LEFS), American Orthopedic Foot and Ankle Society (AOFAS) score, knee injury and osteoarthritis outcome score(KOOS), 36-item short-form health furvey(SF-36) and the range of motion(ROM) of the knee and ankle joints were recorded and compared. The 72 patients were followed up for a period ranging from 12 to 48 months, with an average follow-up time of (23.4±9.3) months. At the final follow-up, the mean tibial rotation angle was (8.2±3.8)°, and malrotation (defined as a rotation angle ≥10°) was observed in 20 patients. Additionally, 35 patients presented with fibula fractures, and the follow-up did not reveal any significant impact on malrotation(P>0.05). There were no significant differences between malrotation group and normal rotation group (defined as a rotation angle <10°) regarding function scores and ROM of knee and ankle joint (all P>0.05). Despite high rates of malrotation after extra-articular distal tibial fractures treated with intramedullary nail, the result of mid-term follow-up showed no significantly negative effect on knee and ankle joint functions. However, careful manipulation and precise evaluation should be performed during surgery to avoid the occurrence of malrotation.
Patients increasingly turn to AI chatbots for medical information, including before complex orthopaedic procedures such as progressive collapsing foot deformity (PCFD) surgery. Whether these tools deliver content of sufficient quality and accessibility for preoperative patient education remains unclear, particularly across competing platforms. This study addressed three questions: (1) Do ChatGPT, Perplexity AI and Google Gemini differ in the accuracy, comprehensiveness and clarity of their responses to PCFD-related patient questions? (2) Do these platforms produce content meeting recommended readability thresholds for patient education? (3) Does the level of agreement among blinded foot and ankle surgeons rating the quality of chatbot responses vary depending on the platform used? The three AI chatbot platforms produce responses of comparable accuracy but differ significantly in readability, with none reaching the recommended readability thresholds for patient education materials. Cross-sectional comparative study. Twenty frequently asked questions regarding PCFD, covering disease understanding, conservative management, surgical planning and postoperative recovery, were submitted verbatim to ChatGPT (GPT-4o mini), Perplexity AI and Google Gemini (free versions, March 25, 2026). The 60 resulting responses were rated by three blinded foot and ankle surgeons on three 5-point Likert scales (accuracy, comprehensiveness, clarity). Readability was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Inter-rater agreement used Kendall's W; differences between platforms were analysed using Kruskal-Wallis tests with Bonferroni-corrected pairwise comparisons. All platforms produced responses rated accurate to very accurate. Perplexity achieved significantly higher accuracy than ChatGPT (p = 0.0003) and higher accuracy and clarity than Gemini (p = 0.0065 and p = 0.0075). No platform reached the recommended FRE ≥ 60 or FKGL ≤ 6 thresholds: median FKGL ranged from 13.1 (ChatGPT) to 21.4 (Perplexity), with ChatGPT producing the most readable and Perplexity the least readable content (p < 0.001). Inter-rater agreement was fair to substantial across platforms, lowest for Perplexity. AI chatbots produce generally accurate baseline information on PCFD surgery, with Perplexity showing significantly higher expert-rated accuracy and clarity than the other platforms-contrary to our hypothesis of comparable accuracy-while readability remains uniformly inadequate for all platforms, as hypothesized. These tools may serve as a supplementary source of information, but their inadequate readability suggests they are not yet suited to replace tailored, surgeon-led patient education. III; cross-sectional comparative study.
Dementia affects more than one in nine adults aged 65 and older (approximately 10-12%) and has been associated with adverse surgical outcomes, yet its impact following ankle fracture fixation remains poorly characterized. This study examined whether pre-existing dementia independently increases the risk of infectious, systemic, and healthcare utilization outcomes compared with matched controls following ankle fracture fixation. Retrospective cohort study with propensity score matching. Adult patients undergoing ankle fracture fixation (2006-2026) were identified from the TriNetX® US Collaborative Network. Patients with dementia (N=3,791) were matched 1:1 to controls, balancing age, race, sex, diabetes, hypertension, and other comorbidities. Outcomes were assessed at 90 days, 2 years, and 5 years and reported as risk ratios (RRs) with 95% confidence intervals. At 5 years, patients with dementia had a significantly higher risk of osteomyelitis (RR 1.613, 95% CI 1.351-1.926) and sepsis (RR 1.956, 95% CI 1.730-2.211) compared with matched controls (both p < 0.001). Pneumonia (RR 1.631, 95% CI 1.466-1.815) and pressure injuries (RR 2.097, 95% CI 1.795-2.450) were also significantly elevated at 5 years (both p < 0.001). Hardware-related infection was significantly more frequent in the dementia cohort at all time points, reaching RR 1.698 (95% CI 1.168-2.468, p = 0.005) at 5 years. Delirium was markedly more common among patients with dementia, with risk ratios ranging from 3.946 (95% CI 2.759-5.644, p < 0.001) at 90 days to 5.124 (95% CI 4.101-6.401, p < 0.001) at 5 years. Hospital readmission was significantly higher at every time point, reaching 71.0% vs. 56.0% at 5 years (RR 1.267, 95% CI 1.223-1.312, p < 0.001). Mortality was significantly elevated at 2 years (RR 1.444, 95% CI 1.266-1.646) and 5 years (RR 1.537, 95% CI 1.397-1.690, both p < 0.001). No significant differences were observed in hardware removal, reoperation, reoperation for nonunion or malunion, or amputation. Dementia independently increases infectious complications, including hardware-related infection, readmission, delirium, and long-term mortality following ankle fracture fixation without elevating most procedure-specific complication rates, suggesting excess morbidity is driven by patient-level vulnerability rather than surgical failure. Enhanced postoperative surveillance and care coordination are warranted for cognitively impaired patients undergoing ankle fracture fixation.
The purpose of this study is to explore the association between D-dimer levels and the likelihood of preoperative deep vein thrombosis (DVT) in patients with ankle fractures. This retrospective study included ankle fracture patients admitted to Xi'an Honghui Hospital's Foot and Ankle Surgery Center from January 2024 to November 2025. Preoperative DVT was identified using Doppler ultrasound, and the relationship between D-dimer levels and DVT was analyzed using multivariate logistic regression and generalized additive models. Among 818 patients, 13.45% developed preoperative DVT. D-dimer was an independent risk factor of preoperative DVT (OR = 1.14, 95% CI: 1.03-1.26, P = 0.010). There was a nonlinear relationship between D-dimer and DVT risk, After adjusting for confounding factors (age, sex, CCI, diabetes and preoperative waiting time),exploratory analysis identified an inflection point at 3.92 mg/L. Below this threshold, each 1 mg/L increase in D-dimer was associated with a significantly higher odds of DVT (OR = 1.60, 95% CI: 1.24-2.06, P < 0.001). D-dimer is independently associated with preoperative DVT in ankle fracture patients, and the relationship appears to be non-linear.
The purpose was to identify the 100 most-cited scientific publications in ankle cartilage and provide an analysis of their main characteristics. The Web of Science (Clarivate) database was searched in April 2025 to obtain data and metrics on ankle cartilage research. The search list was sorted by the number of citations, and articles were included or excluded based on their relevance to ankle cartilage research. The information extracted for each article included the publication year, citation count, author's name, country of origin, journal name, article type, citation density and the level of evidence. The 100 studies generated a total of 17,208 citations, with an average of 172 citations per article. The most-cited article was cited 489 times. The 100 studies included in this analysis were published between 1979 and 2018. In total, these articles represented 13 different countries of origin. The United States represented 38 of the 100 articles. The Netherlands, Italy and Germany followed with nine articles, and South Korea with seven articles. The most prevalent study designs were case series, and the most prevalent level of evidence was Level IV (69 studies). The present research concludes that the 100 most-cited publications in cartilage lesions of the ankle research were cited a total of 17,208 times. Case series and cohort studies were among the most frequently used study designs with an overall relatively low-level of evidence. The present work may function as a reference standard to help direct orthopaedic providers to the 100 most-cited studies in cartilage lesions of the ankle. N/A.
Chronic lateral ankle instability (CLAI) often requires anatomic ligament reconstruction after failed conservative treatment. Precise bone tunnel placement remains challenging during traditional open surgery. To evaluate the clinical value of three-dimensional (3D) printed personalized guide plates for improving surgical precision and reducing intraoperative radiation exposure during lateral ankle ligament reconstruction. Retrospective comparative cohort study. Forty-eight patients with CLAI were consecutively enrolled and allocated by surgery date to a template group (n = 24) or a conventional group (n = 24). Primary outcomes included operation time, intraoperative fluoroscopy frequency, and radiation exposure time. Secondary outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and Karlsson score. The VAS, which measures patient-reported pain intensity on a 10-cm line, was completed independently without surgeon interference. Clinical stability was assessed using the Anterior Drawer and Talar Tilt tests. All patients completed 12-20 months of follow-up (mean, 14.5 ± 5.5 months). Compared with the conventional group, the template group had a shorter operation time (35.42 ± 5.23 vs. 44.79 ± 6.85 min, p < 0.001) and fewer fluoroscopic exposures (1.58 ± 0.65 vs. 3.33 ± 0.48, p < 0.001). No significant between-group differences were observed in AOFAS, VAS, or Karlsson scores at the final follow-up (all p > 0.05). Both groups had negative Anterior Drawer and Talar Tilt tests postoperatively, indicating successful stabilization. Compared with conventional surgery, 3D-printed guide-assisted surgery significantly reduced operation time, intraoperative positioning time, and radiation exposure. It is a promising and efficient approach for non-arthroscopic ankle ligament reconstruction. 3.
BackgroundNon-tobacco nicotine dependence (NTND) products, such as vaping, nicotine patches/pouches, gum, and lozenges, have become increasingly prevalent. While the negative effects of cigarette smoking on bone healing are well established, the impact of NTND on surgical outcomes remain unclear, particularly in foot and ankle surgery. This study aimed to evaluate the effect of NTND on short- and long-term postoperative complications following midfoot arthrodesis, a procedure commonly performed for arthritis, trauma, and congenital deformities.MethodsThis retrospective cohort study was conducted utilizing the TriNetX database. Patients undergoing midfoot arthrodesis were identified and stratified into NTND (ICD-10: F17, excluding tobacco-specific codes) and nonsmoker cohorts. 1:1 propensity score matching was performed based on demographic and comorbid variables. Postoperative complications were assessed at both 90 days and 2 years utilizing risk ratios (RRs) and 95% confidence intervals (CIs).ResultsAfter matching, 1235 patients were included in each cohort. At 90 days, NTND patients had significantly higher rates of opioid prescriptions (RR 1.18, 95% CI: 1.11-1.26), emergency department visits (RR 1.52, 95% CI: 1.20-1.93), hospitalizations (RR 1.59, 95% CI: 1.28-1.99), postoperative infections (RR 1.95, 95% CI: 1.13-3.37), and wound complications (RR 1.72, 95% CI: 1.14-2.58) (all P < .05). At 2 years, NTND was associated with increased rates of pseudoarthrosis (RR 1.27, 95% CI: 1.06-1.51) and mechanical implant failure (RR 1.39, 95% CI: 1.11-1.75) (both P < .05).ConclusionNon-tobacco nicotine dependence is associated with significantly increased risk of both early and late postoperative complications following midfoot arthrodesis. These findings suggest that vaping may adversely affect bone healing and implant integrity. Surgeons should incorporate NTND screenings and cessation counseling into preoperative planning to optimize patient outcomes.Level of Evidence:III-Retrospective Comparative Study.
Both the stability of the subtalar joint and the support of the medial column serve as crucial stabilising structures in progressive collapsing foot deformity (PCFD). Effective restoration of these stabilising components-often involving gastrocnemius or Achilles tendon recession-is essential for the treatment of PCFD. Therefore, this study aims to evaluate the clinical outcomes of extracorporeal shock wave therapy (ESWT) combined with subtalar arthroereisis and medial column stabilisation for PCFD. Sixty-eight patients (68 feet) with PCFD treated at our hospital between February 2023 and April 2024 were retrospectively analysed. The patients were divided into two groups based on treatment regimen: the intervention group (IG, n = 36), which received ESWT combined with subtalar arthroereisis (HyProCure) and medial column stabilisation [hereinafter referred to as 'dual stabilisation procedures (DSP)'], and the control group (CG, n = 32), which underwent DSP alone. The groups underwent preoperative and postoperative assessments of clinical function and imaging parameters. Clinical function assessments included the Visual Analogue Scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and Tegner activity scale score. Conversely, imaging assessments encompassed weight-bearing anteroposterior talo-first metatarsal angle (T1-MT), talonavicular coverage angle (TNCA), lateral calcaneal pitch angle (pitch angle), lateral talo-first metatarsal angle (Meary's angle), calcaneal valgus angle (CVA), and elastic modulus of the Achilles tendon or gastrocnemius muscle. Complications, including flatfoot recurrence, internal fixation implant rejection, and wound infection, were also documented. Postoperative follow-up lasted at least 12 months, with a mean duration of (13.66 ± 1.65) months. At the last follow-up, analyses revealed that both groups exhibited significant improvements in weight-bearing X-ray parameters (T1-MT, TNCA, pitch angle, Meary's angle and CVA) compared with their preoperative values (P < 0.05). The intervention group demonstrated superior outcomes for CVA and elastic modulus of the Achilles tendon and gastrocnemius muscle compared to the control group (P < 0.05). Postoperatively, in both groups, the AOFAS and Tegner activity scores were higher than the preoperative values within the same group, whereas the VAS scores were lower relative to the preoperative measurements. Notably, the intervention group showed higher AOFAS and Tegner activity scores than the control group at 2 and 6 months postoperatively and at the last follow-up (P < 0.05) and a lower VAS score at 2 months postoperatively (P < 0.05). During follow-up, 59 patients (86.76%) from both groups met the criteria for returning to athletic activity. The intervention group achieved a shorter time to return to athletic activity [(6.26 ± 1.26) months; 33 cases, 91.67%] compared with the control group [(8.24 ± 2.06) months; 26 cases, 81.25%], with a significant difference (P < 0.05). Postoperatively, one patient in the intervention group developed recurrence of flatfoot deformity after removal of the subtalar joint stabiliser, and one patient in the control group had poor healing of an infected medial foot wound. No other severe adverse complications were observed in either group. ESWT combined with DSP effectively ameliorates PCFD, restores ankle-foot function and lower limb alignment and facilitates earlier return to athletic activity postoperatively.
Peripheral nerve blocks are commonly used for intraoperative and postoperative analgesia in foot and ankle surgery due to superior pain control and opioid-sparing effects. Although considered safe, neurologic complications can occur and present diagnostic and management challenges for the anesthesiologist. This case-based educational review describes a 72-year-old patient who developed persistent postoperative sciatic-distribution motor and sensory deficits after ankle open reduction and internal fixation performed with adductor canal and popliteal sciatic nerve blocks. The clinical scenario highlights the difficulty of determining causation when neurologic deficits arise in the setting of regional anesthesia, surgery, tourniquet use, and patient-specific risk factors. Through this clinical scenario, key perioperative considerations are reviewed, including risk factors for nerve injury, recognition of abnormal block recovery, diagnostic evaluation, and evidence-based management strategies. This structured case discussion is designed for anesthesiology trainees and perioperative clinicians to support safe regional anesthesia practice and early identification of neurologic complications.
BackgroundOsteochondral lesions of the tibial plafond (OLTPs) are considerably less common than osteochondral lesions of the talus (OLT), and the terminology, prognostic factors, and treatment strategies for these lesions remain poorly characterized.MethodsExperts participated in a structured Delphi-based consensus process during the International Consensus Meeting on Cartilage Repair of the Ankle (ICCRA) meeting held in 2019. Blinded surveys, structured questionnaires, literature review, and in-person discussions were used to develop and refine statements. Consensus strength was defined as consensus (51-74%), strong consensus (75-99%), or unanimous (100%).ResultsA total of 11 consensus statements were developed addressing terminology, prognostic factors, and management of OLTP, all of which achieved strong consensus. Unanimous agreement was reached on the terminology "osteochondral lesion of the tibial plafond." Key prognostic factors included lesion characteristics, cystic changes, kissing lesions, and hindfoot alignment. Nonoperative treatment may be considered in asymptomatic or nondisplaced lesions, whereas surgical treatment may be indicated for symptomatic or progressive lesions. Bone marrow stimulation was recommended for small, non-cystic lesions; osteochondral transplantation was supported for larger or cystic lesions. Associated pathology such as kissing lesions and malalignment should be addressed concurrently, and salvage procedures may be considered in advanced cases.ConclusionThese international consensus statements establish practical guidance for the assessment and management of OLTP by integrating current evidence with expert opinion. By outlining key prognostic considerations and treatment pathways, these recommendations aim to reduce variability in clinical practice and provide a foundation for future investigation in this challenging pathology.Level of Evidence:V, expert consensus.