Search

Background: Zone II and III fifth metatarsal (5-MT) fractures among athletes are typically managed with percutaneous fixation following anatomic reduction. However, screw head discomfort and refracture after bone union can occur because of the loads placed on the foot during play. Several hardware systems that use a smaller screw head compared to traditional hardware systems have been developed to minimize the rate of postoperative hardware complications. This study compares clinical and radiographic outcomes of 5-MT fractures in elite athletes treated with a solid headless screw vs a solid headed screw. We hypothesized that the headless screw would be associated with faster union rates, faster clearance times, and lower incidence of symptomatic hardware compared to the headed screw. Methods: Athletes competing at a collegiate level or higher treated for a zone II or III 5-MT fracture between 2016 and 2022 by 2 surgeons fellowship-trained in foot and ankle orthopaedics were screened. Operative notes were reviewed to determine the hardware system used. Subjects were divided based on the hardware system used during operation: headed screw and headless screw. Time to radiographic union, time to full clearance, and return to competition were determined. Postoperative complications, including nonunions, need for revision, need for hardware removal, and refractures were also noted. Results: Forty eligible patients (44 feet) were identified. The solid headed screw group included 20 patients (21 fractures), and the solid headless screw group included 20 patients (23 fractures). Average time to union for the headed screw group was 11.78 (range, 5.86-19.00) weeks; average time to union for the headless screw group was 11.65 (range, 6.00-22.57) weeks ( P = .93). Nineteen out of twenty (95%) patients were able to return to competition in both groups. Average time to return to competition for the headed screw group was 26.9 (range, 10.00-47.86) weeks, while average time for the headless screw group was 21.2 (range, 6.86-55.00) weeks ( P = .55). The overall complication rate for the headed screw was 23.8%, which was not statistically different from the overall complication rate for the headless screw of 13.0% ( P = .35). Conclusion: In this relatively small sample of elite athletes undergoing operative fixation of a 5-MT fracture, fixation using either a headless or headed screw system had similar good outcomes in regard to times to union, return to competition, and complication rate regardless of solid screw head type used. Level of Evidence: Level III, retrospective cohort study.

Background: Ankle fractures involving the posterior malleolus (PM) tend to result in inferior clinical outcomes compared to other ankle fractures. However, it is unclear which specific risk factors and fracture characteristics are associated with negative outcomes in these fractures. The aim of this study was to identify risk factors for poor postoperative patient-reported outcomes in patients with fractures involving the PM. Methods: This retrospective cohort study included patients who sustained ankle fractures involving the PM between March 2016 and July 2020 and had preoperative computed tomography (CT) scans. In total, 122 patients were included for analysis. One patient (0.8%) had an isolated PM fracture, 19 (15.6%) had bimalleolar ankle fractures involving the PM, and 102 (83.6%) had trimalleolar fractures. Fracture characteristics including the Lauge-Hansen (LH) and Haraguchi classifications and posterior malleolar fragment size were collected from preoperative CT scans. Patient Reported Outcome Measurement Information System (PROMIS) scores were collected preoperatively and at a minimum of 1 year postoperatively. The association between various demographic and fracture characteristics with postoperative PROMIS scores was assessed. Results: Involvement of more malleoli was associated with worse PROMIS Physical Function ( P = .04), Global Physical Health ( P = .04), and Global Mental Health ( P

Category: Ankle; Arthroscopy; Trauma Introduction/Purpose: The MOCART scoring system is commonly used in both the knee and ankle literature to quantitatively assess cartilage repairs on MRI. For both the knee and ankle, MOCART scores have demonstrated little ability to correlate with clinical outcomes such as survey scores. The system also suffers from issues with repeatability and reproducibility of individual scores. This study seeks to analyze the correlation between MOCART scores and PRMOIS scores obtained from the same time period from patients undergoing surgical management of an osteochondral lesion of the talus. It also seeks to determine MOCART's intra-rater reliability by analyzing multiple independent scoring attempts by the same radiologist. We hypothesized that MOCART scores would correlate with PROMIS outcomes and be repeatable for a given rater. Methods: Patients treated for an osteochondral lesion of the talus by a single surgeon in our department were screened for the existence of preoperative and postoperative MRI and survey scores completed within five months of one another. Each MRI was scored using the MOCART system by one radiologist fellowship-trained in musculoskeletal radiology on two separate occasions, with at least one week between scoring attempts. Each MOCART category and the overall score was compared to each PROMIS category. We also compared the presence of cysts and edema, as noted by the raters, to each PROMIS category. Results: MOCART scores were found to be repeatable between scoring attempts for individual categories and especially for the overall score. Preoperative MOCART scores correlated positively to preoperative PROMIS scores for the Physical Function (r= 0.0173), Pain Interference (r=0.1093), and Depression (r=0.0812) domains. Postoperative MOCART scores correlated positively with postoperative PROMIS scores for the Physical Function (r=0.1639) and Global Physical Health (r= 0.2152) domains. Postoperative MOCART scores did not correlate positively to change in PROMIS scores nor did change in MOCART scores correlate positively to change in PROMIS scores as we had expected. One significant correlation existed between postoperative MOCART score and pre to postoperative change in PROMIS Global Mental Health, but the correlation was negative (r= -0.527; p= 0.044). The presence of cyst and edema likewise did not demonstrate any consistent pattern. Conclusion: While the MOCART score may be repeatable for a given reader, it faces significant issues with correlation to PROMIS outcomes. This has been noted before for certain surgical techniques and other outcomes measurements. We find that this pattern holds true more broadly when looking at a range of methods for the treatment of osteochondral lesions. While quantitative evaluation of MRI is important for better understanding cartilage repair techniques, problems with the MOCART system should be acknowledged and solutions considered.