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Background: Determining the stability of ankle fractures, particularly Weber B fibula fractures, can be challenging. Ability to weight-bear after injury may be predictive of stability. We sought to determine whether patients' ability to weight-bear immediately after injury was an effective indicator for ankle stability following fracture., Methods: A prospective review was conducted of patients sustaining ankle fractures. Patients' ability to weight-bear after injury was elicited and correlated with ankle radiographs, which were deemed stable or unstable based on commonly used indices to assess stability., Results: For the entire cohort (n = 121), patients who were able to weight-bear immediately after injury were over 8 times more likely to have a stable fracture than those who could not (odds ratio [OR] = 8.6, P < .001). Positive predictive value (PPV) for being able to fully weight-bear as it related to stability was 73%. Inability to weight-bear was 85% specific among patients with an unstable fracture. When analyzing patients with radiographic isolated fibula fractures (n = 67), PPV = 82%, negative predictive value [NPV] = 53%, specificity = 79%, whereas the OR was 5.0 (P = .003) for those who could weight-bear having a stable fracture. When subanalyzing patients who presented with isolated fibula fractures and anatomic mortises (n = 43), PPV = 74%, NPV = 52%, specificity = 62%, whereas the OR was 3.6 (P = .07) for those who could weight-bear having a stable fracture., Conclusion: Patients' ability to weight-bear immediately after injury was a specific and prognostic indicator for stability across a range of ankle fracture subtypes. Patients with an isolated fibula fracture and anatomic mortise were 3.6 times more likely to have a stable fracture if they were able to fully weight-bear at the time of injury. Although a patient's history does not preclude the need for appropriate imaging studies and clinical judgment, it may aid in the assessment of ankle stability following fracture., Level of Evidence: Level II, clinical diagnostic., (© The Author(s) 2016.)

Unlabelled: Tibiotalocalcaneal (TTC) arthrodesis using an intramedullary hindfoot nail is a common procedure for deformity correction and the treatment of combined tibiotalar and subtalar end-stage arthritis. Nonunion at one or both fusion sites is a difficult complication that can result in reoperation, significant morbidity, and below-knee amputation. There is currently a need for sustained compression across fusion sites using a TTC hindfoot nail with good mechanical stability. The DynaNail TTC Fusion System (MedShape, Inc, Atlanta, GA) uses an internal nitinol compression element to apply sustained compression across the tibiotalar and subtalar joints after surgery. In preliminary clinical cases, we have found that the nail is safe, reliable, and has promising clinical and radiographic results in settings of hindfoot arthritis, complex deformity, Charcot arthropathy, and talar avascular necrosis., Levels of Evidence: Expert opinion, Level V., (© 2015 The Author(s).)

Unlabelled: The distal tibial blind spot represents an area where improperly measured long screws may pose a risk to surrounding anatomic structures and is not well visualized on AP, mortise, and lateral radiographs. Awareness of this area as well as the use of a 45° external rotation oblique view when placing fixation in this area may prevent iatrogenic injury., Levels of Evidence: Level V, Expert Opinion., (© 2014 The Author(s).)

Objective: To determine the outcome of the mangled foot and ankle undergoing limb salvage surgery that required free tissue flaps for wound closure compared with a similar patient foot and ankle injury group that underwent early below knee amputation (BKA)., Design: : Prospective longitudinal study., Setting: : Eight level 1 trauma centers., Patients/participants: LEAP (Lower Extremity Assessment Project) study. One hundred seventy-four open severely injured hindfoot or ankle injuries (116 had salvage; 58 had a BKA)., Intervention: Patients either required immediate amputation or salvage was attempted., Main Outcome Measurements: The Sickness Impact Profile (SIP) was the principal measure of outcome (higher SIP scores equal greater disability). Secondary outcomes included walking speed, number of rehospitalizations for injury-related complications, time to full weight-bearing, the visual analog pain scale, and return to work at 2 years., Results: When compared to patients treated with standard BKA, salvage patients who required free flaps and/or ankle arthrodesis had significantly worse 2-year outcomes. They had overall SIP scores that were 2.5 points higher and psychosocial SIP scores that were 8.4 points higher at 24 months (P = 0.014 and P = 0.013, respectively). Physical SIP scores were 3.7 points higher in the free flap and/or arthrodesis group but only approached statistical significance (P = 0.10). After adjusting for the need for free flap and/or arthrodesis, the salvage pathway had clinically, but not statistically, significantly better overall and psychosocial SIP scores than the standard BKA patients (P = 0.34 and P = 0.20, respectively)., Conclusions: : Patients with severe foot and ankle injuries who require free tissue transfer or ankle fusion have SIP outcomes that are significantly worse than BKA with typical skin flap design closure., Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: Tibialis anterior tendon rupture is an uncommon injury that can cause significant functional deficit. Recent series have supported surgical reconstruction in younger, more active patients. We investigated our clinical outcomes of patients having undergone surgical management of tibialis anterior tendon ruptures., Materials and Methods: Fifteen tibialis anterior tendon ruptures in 14 patients were retrospectively reviewed after surgical management. Five had primary repair, while 10 had tendon transfers. Average age at time of surgery was 70.6 years with an average followup of 27.2 months. Patients were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and SF-36 clinical outcome scores. Strength measurements utilizing a dynamometer and range of motion (ROM) were documented on the operative and non-operative ankles. Patient satisfaction surveys were performed., Results: Average postoperative AOFAS hindfoot score was 88.8 and SF-36 score was 76.4. There was a statistically significant difference in average dorsiflexion strength of 21.8 lbs/in(2) on the operative side and 28.8 lbs/in(2) on the non-operative limb, and in dorsiflexion ROM of patients that received a gastrocnemius recession. There was no statistically significant difference between primary tendon repair versus tendon transfer groups nor plantarflexion strength or ROM among any group. Patient surveys revealed that seven patients were completely satisfied, six had minor reservations, and one had major reservations. There were no complications., Conclusion: This study supports the surgical repair or reconstruction of the tibialis anterior tendon ruptures to restore functional strength and ROM.