BACKGROUND: Isolated tibiotalar dislocation is an extremely rare injury. They are most often caused by high-energy trauma.
METHODS: The authors report the case of an acute pure posteromedial tibiotalar joint dislocation in a 45-year-old patient, which occurred as a result of a road traffic accident. The reduction was performed as an emergency procedure under general anesthesia, followed by a 6-week cast immobilization. Twenty months after the injury, at the last follow-up, a very good functional result was observed, with a stable and painless ankle and satisfactory mobility.
CONCLUSIONS: A pure dislocation of the tibiotalar joint without an associated fracture is a rare injury. The posterior type is the most common dislocation. Treatments include close reduction, short leg cast immobilization, and open dislocation. However, certain factors can lead to unfavorable outcomes, such as delayed therapy, damage to the inferior tibiotalar ligaments, anterior tibial artery rupture, and soft tissue damage.
CONCLUSIONS: It is rare for a tibiotalar joint dislocations to occur as an isolated injury. The necessity of immediate orthopedic intervention in the management of this lesion is demonstrated by our observation.

UNASSIGNED: There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA.
UNASSIGNED: A case-control study was conducted on 149 patients who underwent primary TAA. Twenty patients with postoperative medial malleolar fractures >4 weeks postoperatively (cases) were identified. An additional 129 patients (controls) were randomly selected from the TAA database. Radiographic evaluation included tibial component coronal alignment and postoperative medial malleolar width. Demographics and radiographic variables were compared between cohorts. Logistic regression was used to investigate the association between medial malleolar fracture and postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus.
UNASSIGNED: Mean (SD) medial malleolar width was significantly smaller in the fracture cohort (8.52 mm [1.6]) than in the control group (11.78 mm [1.74]) (P < .001). Mean (SD) tibial component coronal alignment was 92.17 degrees (2.77) in the fracture cohort and 90.21 degrees (1.66) in the control group (P = .002). Regression analysis identified a significant negative association between postoperative medial malleolar width and the probability of fracture (OR = 0.06, 95% CI 0.01, 0.26, P < .001). Varus malalignment of the tibial component was positively associated with the probability of fracture (OR = 1.90, 95% CI 1.27, 2.86, P = .002). Prophylactic screw fixation resulted in more than 90% reduction in the odds of a fracture (OR = 0.04, 95% CI 0.01, 0.45, P = .01). ROC curve analysis determined a medial malleolar width of 10.3 mm as a potential threshold for predicting fracture.
UNASSIGNED: Decreased medial malleolar width and postoperative varus malalignment were associated with an increased risk of postoperative medial malleolar fracture. Therefore, surgeons should consider prophylactic screw fixation in patients with a medial malleolar width <10.3 mm or at risk of postoperative varus deformity.

UNASSIGNED: Desmoplastic fibroblastoma is a rare, slow-growing benign soft tissue tumor. It has a wide anatomical distribution and mainly affects adult males. Fourteen percent of cases occur in the ankle or foot.
UNASSIGNED: In this study, we report a rare location of desmoplastic fibroblastoma on the ankle of a 76-year-old female, discovered as a slowly growing mass.
UNASSIGNED: Desmoplastic fibroblastoma is an anatomical and clinical entity. It appears macroscopically as a pseudocartilaginous structure and histologically as a stellate or spindle-shaped fibroblastic proliferation in a collagenous stroma.
UNASSIGNED: Desmoplastic fibroblastoma has anatomical specificities and should still be clearly distinguished from certain malignant tumors.

Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the ankle joint. Controversy exists regarding whether a combined posterior-anterior approach with total synovectomy is necessary to avert recurrence or malignancy. An 18-year-old Caucasian male presented to the outpatient clinic with clinical and imaging findings indicative of a stage III PSO. The surgical intervention involved a combined posterior-anterior arthroscopic approach with the removal of multiple loose bodies and complete synovectomy, resulting in complete relief of symptoms without recurrence at the 12-month follow-up. Pathological examination confirmed the diagnosis. The management of PSO in the ankle joint using a combined posterior-anterior arthroscopic approach with complete synovectomy demonstrated effectiveness in this case. Regular follow-ups are essential for monitoring long-term outcomes and detecting potential recurrence or malignant transformation.

Synovial chondromatosis is a rare benign condition defined by the presence of cartilaginous lesions in the synovium of joints, tendon sheaths, and bursae. It most typically affects large joints, such as the knee, hip, and shoulder, but it is also reported in smaller joints. Nonetheless, ankle involvement is relatively uncommon. A complete history and clinical, physical, and radiographic examinations are usually used to determine the diagnosis. Hence, we reported a case of a young patient with left ankle primary synovial chondromatosis who presented with a left ankle mass and chronic pain.

UNASSIGNED: The free anterolateral thigh (ALT) flap is commonly used to repair a large loss of soft tissue following a lower-limb injury. An issue to be managed is the choice of adequate recipient vessels when the tibial arteries result damaged. In this scenario, vein grafts can be interposed to connect a healthy recipient vessel to the ALT flap pedicle.
UNASSIGNED: We present a report of a 19-year-old male who suffered a Gustilo fracture type IIIc after a road injury involving the right lower limb. After a failed first attempt of limb salvage with reconstruction of extensor tendons and a free ALT flap, a second procedure was performed using another ALT flap with interposed vein grafts to reach very proximal recipient vessels.
UNASSIGNED: The patient demonstrated excellent recovery and restored ambulation. The effectiveness of the most complex reconstructive options for a high-demanding patient with no comorbidities is demonstrated in this case.
UNASSIGNED: The key to success in even the most complex injury cases is early intervention, meticulous surgical planning, and a multidisciplinary approach.

UNASSIGNED: Synovial lipomatosis is a rare disease that often results in joint discomfort, swelling, and effusion. Only a few reported cases have been documented so far.
METHODS: We reported a 50-year-old woman with synovial lipomatosis of the ankle joint. The patient presented with left ankle pain since the least two years, accompanied by swelling and redness. Physical examination demonstrated swollen ankle with warmth palpation. Magnetic resonance imaging (MRI) demonstrated hyperintensity of the ankle joint on the posterior and anterolateral side, thickening of the synovium, and bone marrow edema around the talar bone, surrounding the sinus tarsi. Histopathological examination demonstrated fatty tissues with nonspecific inflammation, suggesting synovial lipomatosis. We performed synovectomy, and the pain did not recur at 1 year of follow-up.
UNASSIGNED: Synovial lipomatosis is a highly uncommon benign condition. Histopathologically, synovial lipomatosis is characterized by notable adipocyte infiltration into the subsynovial tissue and a villous or frond-like morphology of the synovium. It also features transversely hyperplastic synovial lining cells.
CONCLUSIONS: Synovial lipomatosis of the ankle joint is a rare entity. Further studies are required to investigate this disease and its management.

BACKGROUND: Previous studies have demonstrated a positive correlation between case volume and outcomes in foot and ankle surgery. This study elucidates surgical case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic foot and ankle fellowship training in the United States.
METHODS: The ACGME provided case logs for orthopaedic residents and foot and ankle fellows (2018-2021). Variabilities in reported fellowship case volumes were defined as the fold-difference between 90th and 10th percentiles. Reported case volumes were compared between training cohorts with parametric tests.
RESULTS: Case logs from 65 orthopaedic foot and ankle fellows and 3146 orthopaedic residents were included. Fellows reported 1.3- to 1.5-fold more foot and ankle cases during fellowship training than during residency training (P < .001). On average, orthopaedic foot and ankle fellows reported 405.4 cases and most were arthrodesis (17%), forefoot reconstruction (17%), mid/hindfoot reconstruction (13%), tendon repair/transfer (12%), and trauma ankle hindfoot (11%). Case categories with the highest variabilities were amputation (14.8-fold difference), infection/tumor (11.6-fold difference), arthroscopy (9.2-fold difference), and calcaneus (8.7-fold difference).
CONCLUSIONS: Case volume benchmarks can assist trainees and faculty during orthopaedic foot and ankle training. More research is needed to determine case minimum requirements needed for autonomous practice in foot and ankle surgery.
UNASSIGNED: Level III.

暂无摘要。

Angioleiomyoma is a benign soft tissue tumor originating in the smooth muscle of blood vessels. It most frequently presents as a painful, free-moving subcutaneous nodule in the lower extremities and is most common in middle-aged women. Angioleiomyoma is rare amongst benign foot neoplasms, and a preoperative diagnosis of angioleiomyoma is rare. We present a case of angioleiomyoma involving the ankle of a 28-year-old female. To prevent patient suffering, we emphasize the importance of an early and accurate diagnosis. Furthermore, we highlight the salient features of angioleiomyoma, which help with the early detection and differentiation of similar malignant variants, including leiomyosarcoma.