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Background. There is no consensus in the literature regarding the necessity of syndesmotic screw removal, but the majority of surgeons prefer screw removal in the operating room. Purpose. The aim of this study is to analyze the safety and cost-effectiveness of syndesmotic screw removal in the clinic. Methods . A retrospective chart review was performed on all acute, traumatic ankle fractures that required syndesmotic stabilization over 5 years at a level 1 trauma center. Radiographs were evaluated for maintenance of syndesmotic reduction. Orthopaedic clinic visits and operating room costs were calculated. Results . Of 269 patients, syndesmotic screws were successfully removed in the clinic in 170 patients and retained in 99 patients. Two superficial infections (1.2%) developed following screw removal. The superficial infection rate was 3.3% (2 of 60) in patients who did not receive antibiotics compared with 0% (0 of 110) in patients who received antibiotics (P = .12). No patient lost syndesmotic reduction after screw removal. Cost savings of $13 829 per patient were achieved by syndesmotic screw removal in the clinic. Conclusion . Our study demonstrates that syndesmotic screw removal in the clinic is safe, does not result in tibiofibular diastasis, is cost-effective, and results in substantial financial savings. Level of Evidence: Level IV.

Background: Peroneal tendon subluxation or dislocation is a relatively uncommon entity with multiple operative treatment methods described. This is a report of an indirect fibular groove deepening technique., Methods: Fifteen consecutive patients had repair of peroneal tendon subluxation or dislocation with an indirect fibular groove deepening technique. The mean duration of symptoms before surgery was 32 (range 1 to 80) weeks. Mean followup was 13 (range 3 to 26) months. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was calculated and compared for patients with and without Worker's Compensation claims and in patients with and without concomitant operative procedures., Results: The average postoperative AOFAS score was 87.1. Patients with Worker's Compensation claims had an average AOFAS score of 80.6 compared to 90.4 in patients without Worker's Compensation claims (p = 0.07). Patients who had an isolated repair of peroneal subluxation had a substantially higher AOFAS hindfoot score (95.3) than patients who had other procedures such as a peroneal tendon repair (81.6; p = 0.004). No patient had residual tendency for subluxation or dislocation postoperatively., Conclusions: An indirect groove deepening technique is an effective way of treating peroneal tendon dislocation with good results. Patients with Worker's Compensation claims or other associated pathology have poorer outcomes.

Background: Insertional calcific Achilles tendinosis is a painful, frequently disabling condition. Numerous operative approaches for this problem have been described. This study evaluated the outcome of a central tendon splitting approach., Methods: Twenty-two patients were evaluated after a central tendon splitting approach for persistent insertional calcific Achilles tendinosis. Followup averaged 34 (11 to 64) months. Suture anchors were routinely used to augment the tendon insertion after debridement. An American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, shoewear comfort, and return to work were evaluated. A paired t-test was used to evaluate the results., Results: Pain significantly improved from 7 points preoperatively to 33 points postoperatively (p < 0.001). Function improved significantly from 36 points to 46 points (p < 0.001). The ankle-hindfoot score improved from 53 points to 89 points (p < 0.001). Age older or younger than 50 years did not affect outcome., Conclusion: A central tendon splitting approach yielded good relief of pain with improved function, shoewear, and ability to work without painful postoperative scars.

Background: Skateboarding, roller skating, and scooter riding are popular recreational and sporting activities for children and adolescents but can be associated with skeletal injury. The purpose of this study is to describe the frequency and characteristics of fractures resulting from these activities., Purpose: Fractures from skateboarding, roller skating, and scooter riding compose a considerable proportion of pediatric musculoskeletal injuries., Study Design: Case series; Level of evidence, 4., Methods: Demographic data and injury characteristics were analyzed for all patients who presented to the pediatric fracture clinic of the level I trauma center from January 2001 to May 2002 after sustaining fractures due to skateboarding, roller skating, and scooter riding., Results: Among a total of 2371 fractures, the authors identified 325 fractures (13.7%) that occurred during one of these activities. There were 187 patients (mean age, 13 years; 95% male) who sustained 191 skateboard-related fractures, 64 patients (mean age, 10.8 years; 54% male) who sustained 65 fractures while roller skating, and 66 patients (mean age, 9.7 years; 64% male) who sustained 69 fractures while riding a scooter. The forearm was fractured most often, composing 48.2% of skate-boarding fractures, 63.1% of roller-skating fractures, and 50.7% of fractures due to scooter riding. Of the forearm fractures, 94% were located in the distal third. In the skateboarding group, 10 of 191 (5.2%) fractures were open injuries of the forearm, compared to 6 of 2046 (0.3%) fractures caused by other mechanisms of injury (significant odds ratio, 18.8)., Conclusions: Skateboarding, roller-skating, and scooter-riding accidents result in a large proportion of pediatric fractures. An open fracture, especially of the forearm, was more likely to be caused by skateboarding than by other mechanisms of injury. Use of wrist and forearm protective equipment should be considered in all children who ride a skateboard.