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Background: Ankle fracture treatment is predicated on minimal displacement, leading to abnormal joint contact area. The purpose of this investigation is to determine whether computed tomography (CT) detects subtle mortise malalignment undetectable by x-ray in supination-external rotation–II (SER-II) injuries. Methods: A total of 24 patients with SER-II injuries, as demonstrated by negative gravity stress radiography, were included. Medial clear space (MCS) measurements were performed on bilateral ankle x-rays (injured and contralateral, uninjured side) at several time points as well as bilateral non-weight-bearing CT performed once clinical and radiographic healing was demonstrated (mean = 66 days post injury, range = 61-105 days). Statistical analyses examined differences in measurements between both sides. Results: Final x-rays demonstrated no differences between normal and injured ankle MCS (P =.441). However, CT coronal/axial MCS measurements were different (P <.05). CT coronal MCS measured wider by a mean difference of 0.67 mm (P <.001). Conclusion: There is a high incidence of subtle mortise malalignment in SER-II ankle fractures, as demonstrated by CT, which is undetectable when assessed by plain radiographs. Although clinical outcomes are yet unknown, there are important implications of the finding of confirmed, subtle mortise malalignment in SER-II injuries and the limitations of x-ray to detect it. Level of Evidence: Level III [ABSTRACT FROM AUTHOR]

The article presents the discussion on the role of nasal carriage in Staphylococcus aureus related surgical site infection (SSI). Topics include array of surgical subspecialties studying the effects of decolonizing S aureus carriers; and identifying S aureus colonization as one of the modifiable risk factors for prosthetic joint infection alongside smoking, obesity, and malnutrition.

Introduction/Purpose: Fractures of the fifth metatarsal base have been a source of confusion since their original description by Jones in 1902. The term Jones' fracture has been used indiscriminately leading to further confusion. Zone classifications have been described but never evaluated for their reliability. The most recent classification, metaphyseal versus metaphyseal-diaphyseal is unknown to most surgeons. The purpose of this study was to evaluate the inter-rater reliability of American Orthopaedic Foot & Ankle Society (AOFAS) members classifying fractures of the base of the fifth metatarsal. Methods: A survey was emailed to members of the AOFAS including radiographs of 18 fifth metatarsal base fractures. Demographic information was collected in addition to evaluation of the 18 sets of radiographs using three classification systems. Surgeons were asked if the fracture is a Jones' fracture, zone of the fracture and if the fracture was metaphyseal or metaphysealdiaphyseal. A total of 223 surgeons with an average experience of 14 years in practice (range: fellow - 50 years) completed the initial survey for inter-rater reliability. Additionally, each surgeon was asked which zones or zone junctions they consider a Jones' fracture. Reliability was tested using Fleiss' Kappa scores. Results: Inter-rater agreement for use of the term Jones' fracture was moderate (kappa 0.533, 95% confidence interval (CI) [0.530, 0.535]). The zone classification had an inter-rater agreement was moderate (kappa 0.537, 95% CI [0.535, 0.539]). Interrater agreement for metaphyseal versus metaphyseal-diaphyseal was substantial (kappa 0.705, 95% CI [0.702, 0.708]). Results of surgeon definition of a Jones' fracture is seen in Figure 1. Conclusion: This is the largest study of its kind looking at inter-rater reliability of an orthopaedic classification with 223 raters. The terminology regarding the classification of fifth metatarsal base fractures remains confusing and inconsistent. The term Jones' fracture has little meaning in terms of communicating these injuries as there is only moderate agreement when surveying surgeons and it is defined differently by most. The zone classification has similar reliability as the Jones' fracture. The terms metaphyseal and metaphyseal-diaphyseal was the most reliable means to describe these fractures. [ABSTRACT FROM AUTHOR]