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Background: End-stage post-traumatic osteoarthritis of the ankle joint may require arthrodesis if conservative treatment fails and a decision against total ankle replacement is made. We aimed to compare the sex-specific differences in outcomes and objectify them using validated specific scores., Methods: Between 2010 and 2021, 221 patients underwent ankle arthrodesis at our institution, including 143 men (MAA) and 78 women (FAA). In addition to demographic data, the aetiology of osteoarthritis, the Foot Function Index (FFI-D), the Olerud-Molander Score (OMAS), and the Short Form-12 questionnaire (SF-12) were collected in this monocentric study. The mean follow-up time was 5.8 years. End-stage osteoarthritis was mostly due to ankle fractures as a result of sprains, falls, and road traffic accidents., Results: Post-operatively, the mean FFI-D for pain was 17.3 (MAA: 14.7; FAA 22.2) and 43.9 for function (MAA: 41.1; FAA 49.5); the mean OMAS was 58.2; and the mean SF-12 physical component score was 42.5. Women achieved significantly worse results in all scores; only the mental component summary of the SF-12 did not differ between the sexes (p > 0.05). Approximately 34% of women stated that the result in terms of gait pattern was worse than expected (MAA 16.1%; p < 0.05). Again, significantly more men stated that the result was better than expected (MAA: 48.3%; FAA: 31.5%, p < 0.05)., Conclusions: The fact that the clinical results were significantly worse in women after ankle arthrodesis should be considered when determining the indication. However, the expectations of men and women also need to be individually adjusted., (© 2024. The Author(s).)

Weil osteotomy is a proven procedure to restore the harmonic distal parabola of the forefoot. In addition to the proximal displacement of the head in the sagittal plane, a displacement in the transverse plane may be necessary, with the refixation of the displaced metatarsal head historically performed by screw fixation. We aimed to determine the radiological differences among 136 feet of 127 patients with 256 Weil osteotomies retrospectively enrolled and divided into groups with (n = 182) and without (n = 74) screw fixation. Demographic data, radiographic union, pre- and postoperative metatarsal angles, and differences in the dorsoplantar view were evaluated. The mean follow-up period was 3.6 months. The mean preoperative metatarsophalangeal angle was 9.24°, and the mean postoperative angle was 12.99°. The restoration of the transversal alignment plane was equally successful in both groups, with a mean extent of angle correction of 10.58°. No nonunions of the osteotomized metatarsals were observed. The radiographic comparisons revealed no significant difference between the groups ( p > 0.05). However, visibility of the joint space of the metatarsophalangeal joint was achieved significantly more often in the group without screw fixation ( p < 0.05). In the absence of bony malunion and the satisfactory restoration of a harmonious parabola of the forefoot, apparently there does not appear to be a necessity for regular screw fixation after Weil osteotomy based on the available data from the present study.

Posttraumatic osteoarthritis may lead to surgical fusion of the ankle joint if non-surgical therapy fails. The indication for a fusion of the joint is based on the pain and disability of the patient, radiographic imaging, and surgeon experience, with no strict guidelines. We aimed to compare outcomes after tibiotalocalcaneal arthrodesis (TTCA) and tibiotalar arthrodesis (TTA) to highlight the functional importance of the subtalar joint. In total, 432 patients with ankle arthrodesis were retrospectively enrolled. Group A ( n = 216) underwent TTCA; group B ( n = 216) underwent TTA. Demographics, Olerud & Molander Ankle Score (OMAS), Foot Function Index (FFI-D), and Short Form-12 Questionnaire (SF-12) were recorded at a mean follow-up of 6.2 years. The mean OMAS was 50.7; the mean FFI-D was 68.9; the mean SF-12 physical component summary was 39.1. These scores differed significantly between the groups ( p < 0.001). The overall revision rate was 18%, primarily for revision of non-union and infection ( p < 0.001). Approximately 16% of group A and 26% of group B were able to return to previous work ( p < 0.001). Based on significantly worse clinical scores of TTCA compared to TTA and the prolonged downtime and permanent incapacity, the indication for a generous subtalar joint arthrodesis with planned ankle arthrodesis should always be critically examined.

Introduction: Closed suction drainage is an established procedure in arthroscopic surgery. It is intended to reduce the retention of wound and irrigation fluids, which form the basis for postoperative swelling, pain, and infection. However, currently, there is no scientific review of the actual benefit of this procedure., Methods: Between 2020 and 2021, 84 patients (53 males, 31 females; mean age: 42 years) were prospectively randomised into this study. The patients underwent arthroscopic surgery of the ankle joint with (group A) or without (group B) insertion of a closed suction drain (42 patients per group). Assessments included upper ankle swelling using the figure-of-eight-20 method, pain preoperatively and 48 h postoperatively, and unexpected events within 6 weeks postoperatively., Results: The measurements performed 48 h postoperatively showed a mean circumferential increase of 1.38 cm (1.48 and 1.28 cm in groups A and B, respectively; p > 0.05) in all patients. The mean pain at rest, assessed using the visual analogue scale (maximum 10 points), was 2.7 and 2.4 in groups A and B, respectively (p > 0.05). Overall, two minor complications occurred: residual swelling in group A and persistent limitation of movement in group B. The average length of hospital stay was 2.4 days (p > 0.05)., Conclusions: Based on the available data, the routine insertion of a closed suction drainage at the upper ankle does not offer any objective benefit and must be considered obsolete. From both a medical and an economic point of view, the decision to conduct this procedure should be justified on an individual basis., Level of Evidence: Level I, prospective randomised trial., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The Weil osteotomy is an established procedure to reduce plantar pressure in chronic metatarsalgia. Historically, the refixation of the displaced metatarsal head is performed by screw fixation. We aimed to demonstrate that screw fixation is not always necessary. Between 2016 and 2021, 155 patients with 278 Weil osteotomies (20 males and 135 females, mean age: 63 years) were retrospectively enrolled. Group A (n = 96) underwent 195 Weil osteotomies with screw fixation; group B (n = 59), 83 without screw fixation. Demographic, Visual Analog Scale Foot and Ankle (VAS-FA), SF-12 questionnaire, and toe mobility data were recorded. The mean follow-up period was 4.5 years. The mean VAS-FA was 75.5; mean SF-12 physical component summary, 42.0; and mean SF-12 mental component summary, 51.0. The overall revision rate was 20% (group A: 25%, group B: 10.2%), primarily for arthrolysis of the metatarsophalangeal joint in group A. Clinical comparisons showed no significant difference between the groups (p > 0.05). The revision rate was significantly higher in group A (p < 0.05), with equal satisfaction in clinical outcomes. Based on the available data, the need for regular screw fixation after a Weil osteotomy cannot be justified.

Background: Acute syndesmosis injury (ASI) is an indication for surgical stabilization if instability is confirmed. In recent years, fixation using the knotless suture-button (SB) device has become increasingly established as an alternative to set screw fixation (SF). This study directly compared the clinical long-term results after prospective randomized inclusion. Materials and Methods: Between 2011 and 2012, 62 patients with ASI were enrolled in a prospective, randomized, and monocentric study. Forty-one patients were available for a 10-year follow-up ((31 males and 10 females), including 21 treated with SB (mean age 44.4 years), and 20 with SF (mean age 47.2 years)). In addition to comparing the demographic data and syndesmosis injury etiology, follow-up assessed the Olerud−Molander Ankle Score (OMAS) and FADI-Score (Foot and Ankle Disability Index Score) with subscales for activities of daily living (ADL) and sports activity. Results: The mean OMAS was 95.98 points (SB: 98.81, SF: 93.00), the mean FADI ADL was 97.58 points (SB: 99.22, SF: 95.86), and the mean FADI Sport was 94.14 points (SB: 97.03, SF: 91.10). None of the measurements differed significantly between the groups (p > 0.05). No clinical suspicion of chronic instability remained in any of the patients, regardless of treatment. Conclusions: The short-term results showed that athletes in particular benefit from SB fixation due to their significantly faster return to sports activities. However, the available long-term results confirm a very good outcome in the clinical scores for both approaches. Chronic syndesmotic insufficiency was not suspected in any of the patients. Level of evidence: I, randomized controlled trial.

Background: Adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction (PTTD) is one of the most common foot deformities among adults., Hypothesis: Our study aimed to confirm that the combined procedures of calcaneal displacement osteotomy and talonavicular arthrodesis are equivalent to double arthrodesis., Methods: Between 2016 and 2020, 41 patients (13 male and 28 females, mean age of 63 years) were retrospectively enrolled in the comparative study. All deformities were classified into Stages II and III of PTTD, according to Johnson and Strom. All patients underwent isolated bony realignment of the deformity: group A ( n = 19) underwent calcaneal displacement osteotomy and talonavicular arthrodesis, and group B ( n = 23) underwent double arthrodesis. Measurements from the Foot Function Index-D (FFI-D) and the SF-12 questionnaire were collected, with a comparison of pre- and post-operative radiographs conducted. The mean follow-up period for patients was 3.4 years., Results: The mean FFI-D was 33.9 (group A: 34.5; group B: 33.5), the mean SF-12 physical component summary was 43.13 (group A: 40.9; group B: 44.9), and the mean SF-12 mental component summary was 43.13 (group A: 40.9; group B: 44.9). The clinical data and corrected angles showed no significant intergroup differences., Conclusion: Based on the available data, our study confirmed that the combined procedures of talonavicular arthrodesis and calcaneal shift, with preservation of the subtalar joint, can be considered equivalent to the established double arthrodesis, with no significant differences in terms of clinical and radiological outcomes.

Introduction: Calcaneal fractures account for 60-75% of all tarsal fractures and represent surgical challenges because of their frequency and complexity. Despite standardized procedures and new implants, literature reports high revision rates and unsatisfactory results. The study aims to describe the role of the surgeon with respect to the clinical outcome., Methods: Between 2014 and 2017, 94 calcaneal fractures (all type AO C1-3) were re-examined in 86 patients (67 male and 19 female; mean age: 51 years). The treatment was always carried out by means of locking compression plate via the extensile lateral approach. A comparison was made between treatment by an experienced (ES) and less experienced surgeon (LES). Annually, the ES performed at least 30 procedures for calcaneus fracture treatment as compared to < 10 operations performed by the LES., Results: The mean AOFAS, VAS FA, and Kiel Score in the ES group were 77.0 (SD 15.9), 69.0 (SD 18.8), and 65.0 (SD 20.6), respectively. The corresponding values in the LES group were 68.1 (SD 21.0), 60.3 (SD 22.4), and 53.0 (SD 21.9) (p < 0.05). The operation time was on average 14 min shorter in the ES group than the LES group (p < 0.05)., Conclusion: The significantly better scores, along with shorter operation time, shorter duration of incapacity to work, and lower complication rate prove the importance of having an experienced surgeon perform complex intra-articular calcaneal fracture repairs. The extensile lateral approach is still considered the standard method., Level of Evidence: Level III, comparative series., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Dislocation of the ankle without fracture is very uncommon. There are only few reports in the international literature. Up to now approximately 80 cases are published. The risk of hyperflexion and -inversion of the ankle seems high on a trampoline. A multiple of the jumper's body-weight projects delayed on the upper ankle joint while dipping in the trampoline-sheet. Reduction should be performed as fast as possible to ensure a good clinical outcome. Imaging via MRI and CT scan allows a detailed evaluation of the injury severity. The decision for further treatment should be based on the findings in the MRI and CT scans. Reconstructing the medial and lateral capsular ligaments can be necessary. With a consequent treatment algorithm a good functional outcome can be achieved. In our case we documented a post-traumatic AOFAS score of 87/100 six months after the injury without an instability of the upper or lower ankle joint. Propioreceptive reflex and pronator training as well as taping seem to be useful before and during trampoline sports., Competing Interests: The authors declare that they have no conflict of interest./Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Extremely heterogeneous revision rates in total ankle arthroplasty (TAA) of the upper ankle joint are reported and result to heterogeneous collectives and to short follow-up times. The aim is to investigate revision rates and the underlying reasons, as well as treatment outcome and quality of life after TAA in post-traumatic cases with sufficient follow-up., Methods: In 2008-2013, 74 patients with post-traumatic arthrosis were treated using TAA with a Tornier Salto prosthesis, and 60 (35 males and 25 females; mean age 56) were followed-up (mean: 59 months; range 24-91 months)., Results: The revision rate after TAA was 42% (n = 25), and it was 8% after 12 months and 18% after 24 months. Twenty percent of the patients had significant symptomatic periprosthetic bone cysts, 5% had impingement, 3% had soft tissue infections, and, in 14%, revision was caused by other factors. The most commonly performed procedures were cyst debridement and autologous spongy bone grafting (20%). Fifteen percent (n = 9) of the prosthetics were explanted or switched to a tibiotalar arthrodesis (TTA). The mean AOFAS (American Orthopaedic Foot and Ankle Society) score was 55.15 (range 12-100) and the mean FAO (Foot and Ankle Outcome) score was 49.6 (range 18-100). The revision subgroup had impaired outcomes (AOFAS 38.84; FAO 35.5) while the non-revision subgroup had improved outcomes (AOFAS 66.8; FAO 60.48). TAA patients undergoing conversion to TTA had worse outcomes (AOFAS 39; FAO 35.29)., Conclusion: Total ankle replacement in post-traumatic end-stage arthrosis patients is associated with high revision rates. High rates of symptomatic periprosthetic bone cysts caused high rates of revision surgery and worse outcomes, which were not improved by secondary TTA.

Background: With the introduction of a diagnosis related groups (DRG)-system in Germany, the medical analysis of the total costs of caring for a given patient is of significance. The medical identification of cost intensive patients becomes of increasing importance for the financial perspective of a department, because the averaged lump sum system might not break even these treatments., Patients and Methods: In the Department of Otorhinolaryngology, University Ulm, a tertiary referral center, the 56 most expensive patients from 3131 inpatients which were treated in 2002 were retrospectively identified and expenses for diagnostic tests, therapy and post-operative complications were analyzed. All patients' related costs, including all costs for personnel, were assigned to a DRG (Version 1.0 G-DRG and G-DRG 2004)., Results: The most expensive treatments included extensive tumor surgeries, surgery of the trachea, emergency procedures and reconstructive surgery. Costs increased with complications, prolonged stay in the intensive care unit and simultaneous internal diseases. The cost at our institution for an pharynocutaneous fistula added 3000 Euro., Conclusion: The assignment of treatment costs to a DRG is complex. Based on our data extensive surgeries for head and neck malignancies showed a homogeneous cost distribution in the DRG group of G-DRG 2004 which was however inadequately reimbursed. Detailed prospective analyses from multiple centers to identify expensive treatments in the field of otorhinolaryngology are necessary to incorporate modifications into the German DRG-system.