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OBJECTIVE: To investigate the effect of second toe-to-hand transfer on the plantar pressure distribution of the donor foot. METHODS: Twelve normal fresh-frozen cadaveric foot specimens were subjected to an axial load of 600 N. An F-Scan plantar pressure analysis system was used to measure the forefoot plantar pressure. The testing was performed under the conditions of intact second toe, second toe removal with the second metatarsal head reserved, and second toe removal in combination with the distal one-third of the second metatarsal, respectively. RESULTS: The peak pressure of the second metatarsal head was greater than other four forefoot plantar regions. There was no statistically significant change in the forefoot plantar pressure distribution after the second toe was removed (p > 0.05). When the second toe and the distal one-third of the second metatarsal were removed, the forefoot plantar pressure distribution changed significantly (p < 0.05). CONCLUSIONS: An intact second metatarsal is essential for the normal distribution of plantar pressure. Removal of the second toe with the second metatarsal head reserved had little influence on the plantar pressure distribution of the donor foot. Removal of the second toe and distal one-third of the second metatarsal resulted in abnormal plantar pressure distribution. Level of Evidence II, Experimental Study.

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ABSTRACT Objective: To investigate the effect of second toe-to-hand transfer on the plantar pressure distribution of the donor foot. Methods: Twelve normal fresh-frozen cadaveric foot specimens were subjected to an axial load of 600 N. An F-Scan plantar pressure analysis system was used to measure the forefoot plantar pressure. The testing was performed under the conditions of intact second toe, second toe removal with the second metatarsal head reserved, and second toe removal in combination with the distal one-third of the second metatarsal, respectively. Results: The peak pressure of the second metatarsal head was greater than other four forefoot plantar regions. There was no statistically significant change in the forefoot plantar pressure distribution after the second toe was removed (p > 0.05). When the second toe and the distal one-third of the second metatarsal were removed, the forefoot plantar pressure distribution changed significantly (p < 0.05). Conclusions: An intact second metatarsal is essential for the normal distribution of plantar pressure. Removal of the second toe with the second metatarsal head reserved had little influence on the plantar pressure distribution of the donor foot. Removal of the second toe and distal one-third of the second metatarsal resulted in abnormal plantar pressure distribution. Level of Evidence II, Experimental Study.

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OBJECTIVE: The objective of this prospective study was to test whether the treatment of Lisfranc injuries with open reduction and dorsal plate fixation would have the same or better functional outcomes as treatment with standard trans-articular screw fixation. METHODS: Sixty patients with primarily isolated Lisfranc joint injury were treated by open reduction and dorsal plate fixation or standard screw fixation. The patients were followed on average for 31 months. Evaluation was performed with patients' chief complaint, clinical examination, radiography, and AOFAS Midfoot Scale. RESULTS: Thirty two patients were treated with open reduction and dorsal plate fixation, and twenty eight patients were treated with open reduction and screw fixation. After two years follow-up, the mean AOFAS Midfoot score was 83.1 points in the dorsal plate fixation group and 78.5 points in the screw fixation group (p<0.01). Of the dorsal plate fixation group, radiographic analysis revealed anatomic reduction in twenty-nine patients (90.6%, 29/32) and nonanatomic reduction in three patients. Of the screw fixation group, radiographic analysis revealed anatomic reduction in twenty-three patients and nonanatomic reduction in five patients (82.1%, 23/28). CONCLUSIONS: Open reduction and dorsal plate fixation for a dislocated Lisfranc injury do have better short and median term outcome and a lower reoperation rate than standard screw ORIF. In our experience, we recommend using dorsal plate in ORIF on dislocated Lisfranc injuries. Level of Evidence II, Prospective Comparative Study.

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O objetivo deste estudo prospectivo foi testar se o tratamentode lesões de Lisfranc com redução aberta e fixação da placadorsal teria os mesmos resultados funcionais, ou melhores, do quetratamento padrão com fixação com parafuso transarticular. Métodos:Sessenta pacientes com lesão articular de Lisfranc foram tratadospor redução aberta e fixação da placa dorsal ou pelo método padrãopor fixação de parafusos. Os pacientes foram acompanhados por,em média, 31 meses. A avaliação foi realizada com base na queixaprincipal dos pacientes, exame clínico, radiografia, e escala AOFAS.Resultados: Trinta e dois pacientes foram tratados com redução abertae fixação da placa dorsal, e vinte e oito pacientes foram tratadoscom redução aberta e fixação com parafuso. Depois de dois anos deacompanhamento, a média do escore AOFAS foi de 83,1 pontos nogrupo de fixação da placa dorsal e 78,5 pontos no grupo de fixaçãocom parafusos (p <0,01). Do grupo de fixação com placa dorsal, aanálise radiográfica revelou redução anatômica em vinte e nove pacientes(90,6%, 29/32) e redução não anatômica em três pacientes.Do grupo de fixação com parafuso, a análise radiográfica revelou reduçãoanatômica em vinte e três pacientes e redução não anatômicaem cinco pacientes (82,1%, 23/28). Conclusões: A redução abertae fixação com placa dorsal para lesão de Lisfranc deslocada têmmelhor resultado a curto e médio prazo e uma taxa de reoperaçãoinferior do que a técnica padrão de redução aberta e fixação interna(RAFI) com parafuso. Em nossa experiência, recomendamos o usode placa dorsal em RAFI nas lesões de Lisfranc deslocadas. Nívelde Evidência II, Estudo Prospectivo Comparativo...

The objective of this prospective study was to testwhether the treatment of Lisfranc injuries with open reductionand dorsal plate fixation would have the same or better functionaloutcomes as treatment with standard trans-articular screwfixation. Methods: Sixty patients with primarily isolated Lisfrancjoint injury were treated by open reduction and dorsal platefixation or standard screw fixation. The patients were followedon average for 31 months. Evaluation was performed with patients’chief complaint, clinical examination, radiography, andAOFAS Midfoot Scale. Results: Thirty two patients were treatedwith open reduction and dorsal plate fixation, and twenty eightpatients were treated with open reduction and screw fixation.After two years follow-up, the mean AOFAS Midfoot score was83.1 points in the dorsal plate fixation group and 78.5 points inthe screw fixation group (p<0.01). Of the dorsal plate fixationgroup, radiographic analysis revealed anatomic reduction intwenty-nine patients (90.6%, 29/32) and nonanatomic reductionin three patients. Of the screw fixation group, radiographicanalysis revealed anatomic reduction in twenty-three patientsand nonanatomic reduction in five patients (82.1%, 23/28).Conclusions: Open reduction and dorsal plate fixation for adislocated Lisfranc injury do have better short and median termoutcome and a lower reoperation rate than standard screw ORIF.In our experience, we recommend using dorsal plate in ORIF ondislocated Lisfranc injuries. Level of Evidence II, ProspectiveComparative Study...

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OBJECTIVE: Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. METHOD: In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). RESULTS: Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. CONCLUSION: Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study.

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Objective: Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. Method: In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). Results: Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. Conclusion: Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study. .

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Objetivo: apresentar nossas experiências no tratamento de más uniões ou não consolidações talares. Método: entre janeiro de 2000 e setembro de 2009, 26 pacientes com má união ou nãounião depois de fraturas do tálus foram submetidos a tratamento cirúrgico de acordo com os diferentes tipos de deformidade talar. Os desfechos do tratamento foram avaliados pela escala tornozelo-retropé da AOFAS, assim como por radiografias simples. Resultados: 20 pacientes ficaram disponíveis para acompanhamento por 30 (24 a 60) meses. Não houve problema de cicatrização ou infecção das feridas e foram obtidas uniões sólidas em todos os pacientes. As uniões radiológicas foram atingidas em tempo médio de 14 (faixa de 12 a 18) semanas. O tempo médio para concluir o apoio de carga foi 16 (faixa de 14 a 20) semanas. O escore AOFAS médio aumentou significantemente de 36,2 (27 a 43) para 85,8 (74 a 98). Conclusão: as intervenções cirúrgicas das fraturas mal-unidas ou não consolidadas dos tálus podem produzir resultados satisfatórios e o procedimento apropriado deve ser adotado, de acordo com diferentes tipos de deformidades pós-traumáticas. Nível de Evidência: IV, Estudo Retrospectivo.

Objective: To present our experiences of treating talar malunions and nonunions. Method: between January 2000 and September 2009, 26 patients with malunions or nonunions after talar fractures underwent surgical treatment according to different types of talar deformities. The treatment outcomes were evaluated using AOFAS ankle-hindfoot scale as well as plain radiographs. Results: 20 patients were available for follow-up for 30 (range, 24 to 60) months. No wound healing problems or infections occurred and solid unions were achieved in all patients. Radiological unions were achieved at a mean time of 14 (range, 12 to 18) weeks. The mean time to complete weight-bearing was 16 (range, 14 to 20) weeks. The mean AOFAS score increased significantly from 36.2 (range, 27 to 43) to 85.8 (range, 74 to 98). Conclusion: surgical interventions for malunions and nonunions after talar fractures can bring about satisfactory outcomes, and the appropriate procedure should be adopted according to different types of posttraumatic deformities. Level of Evidence: IV, Retrospective Study.

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OBJECTIVE: To present our experiences of treating talar malunions and nonunions. METHOD: Between January 2000 and September 2009, 26 patients with malunions or nonunions after talar fractures underwent surgical treatment according to different types of talar deformities. The treatment outcomes were evaluated using AOFAS ankle-hindfoot scale as well as plain radiographs. RESULTS: 20 patients were available for follow-up for 30 (range, 24 to 60) months. No wound healing problems or infections occurred and solid unions were achieved in all patients. Radiological unions were achieved at a mean time of 14 (range, 12 to 18) weeks. The mean time to complete weight-bearing was 16 (range, 14 to 20) weeks. The mean AOFAS score increased significantly from 36.2 (range, 27 to 43) to 85.8 (range, 74 to 98). CONCLUSION: Surgical interventions for malunions and nonunions after talar fractures can bring about satisfactory outcomes, and the appropriate procedure should be adopted according to different types of posttraumatic deformities. LEVEL OF EVIDENCE: IV, Retrospective Study.

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OBJETIVO: Estudar o desfecho de fraturas subtrocantéricas de quadril tratadas com placa de bloqueio lateral da parte proximal do fêmur. MÉTODO: Revisamos retrospectivamente os resultados clínicos de 48 casos de fraturas subtrocantéricas tratadas com placas de bloqueio lateral da parte proximal do fêmur de janeiro de 2008 a maio de 2010. Registrou-se o progresso da consolidação da fratura, assim como a ocorrência de complicações. A função da articulação do quadril foi avaliada pelo índice social de Harris e o escore de mobilidade de Parker-Palmer, um ano após a cirurgia. RESULTADO: Quarenta e cinco pacientes foram acompanhados até a união da fratura ou a revisão da cirurgia. Entre os 45 pacientes, 43 atingiram a união da fratura sem outra intervenção. Trinta e oito fraturas consolidaram sem perda da posição no acompanhamento de um ano. Não houve casos de perfuração da cabeça do fêmur pelo parafuso. O escore médio do índice social de Harris foi 86,5 ± 9,8 (73 ~95). A média do escore de mobilidade de Parker e Palmer foi 7,4 ± 2,1 (3~ 9). CONCLUSÃO: A placa de bloqueio lateral da parte proximal do fêmur é o tipo de fixação interna estável e efetiva para tratar as fraturas subtrocantéricas de quadril e tem a vantagem de fixação estável, em especial em fratura da parede lateral do fêmur. Nível de evidência IV, Série de Casos.

OBJECTIVE: To study the outcome of subtrochanteric hip fractures treated by using a proximal lateral femur locking plate. METHOD: We retrospectively reviewed the clinical results of 48 cases of femoral subtrochanteric fractures treated with proximal lateral femur locking plates from Jan 2008 to May 2010. The progress of fracture healing, as well as the occurrence of complications, was recorded. The function of the hip joint was evaluated by Harris social index and the Parker and Palmer mobility score at 1 year after the operation. RESULT: 45 patients were followed up until fracture union or a revision surgery. Among the 45 patients, 43 patients obtained fracture union without further intervention. 38 fractures healed with no loss of position at the 1-year follow-up. There were no cases of hip screw cutting through the femoral head. The mean score of Harris social index was 86.5±9.8 (73~95). The mean Parker and Palmer mobility score was 7.4±2.1 (3~9). CONCLUSION: The proximal lateral femur locking plate is the kind of stable and effective internal fixation of treating subtrochanteric hip fractures which has the advantage of stable fixation especially for the lateral femoral wall fracture. Level of Evidence IV, Case Series.

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OBJECTIVE: To study the outcome of subtrochanteric hip fractures treated with proximal lateral femur locking plate. METHOD: We retrospectively reviewed the clinical results of 48 cases of femoral subtrochanteric fractures treated with proximal lateral femur locking plates from January 2008 to May 2010. The progress of fracture healing, as well as the occurrence of complications, was recorded. The function of the hip joint was evaluated by the Harris social index and the Parker and Palmer mobility score one year after the operation. RESULT: 45 patients were followed up until fracture union or a revision surgery. Among the 45 patients, 43 patients obtained fracture union without further intervention. Thirty-eight fractures healed with no loss of position at 1-year follow-up. There were no cases of hip screw cutting through the femoral head. The mean score of the Harris social index was 86.5±9.8 (73~95). The mean Parker and Palmer mobility score was 7.4±2.1 (3~9). CONCLUSION: The proximal lateral femur locking plate is the kind of stable and effective internal fixation for treating subtrochanteric hip fractures which has the advantage of stable fixation especially for the lateral femoral wall fracture. Level of Evidence IV, Case Series.