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Category: Ankle Introduction/Purpose: Chronic open wound(COW) over lateral malleolus(LM) is hard to manage for high recurrence rate. Characteristic bone to skin structure of LM is vulnerable to pressure or shear force causing bursitis or ulcer leading to bone exposure in some cases. In resting state, ankle is slightly plantar flexed and varus position, so the skin over LM receives tension. This unfavorable condition for vascularity and pressure endurance could be worse when patients have sensory loss, vascular impairment or paraplegia. We hypothesized short leg cast (SLC) or short leg splint (SLS) keeping ankle in neutral position relieves skin tension and reverse this unfavorable condition leading to wound healing. Methods: Between July, 2014 and November, 2018, fifteen patients with COW over LM were included. Infection was accompanied by twelve. Seven patients were diagnosed diabetic foot. Seven patients could not move their affected limb actively due to paraplegia or weakness. Firstly, Vascular evaluation and management was done for ischemic patients. For all patients, repeated debridement for necrotic and infected tissue was done at intervals of two or three days until the viable wound was present. Negative pressure wound therapy(NPWT) was added in non-viable wound cases. SLC or SLS followed these procedures till wound healing. Removable SLS was kept for the patients who could not control lower limb such as paraplegia or weakness after wound healing. Results: Wound healing was achieved in 14 cases(93.3%). It took average 51.4±40.2 days for wound healing. One patient did not succeed in wound healing resulting in below knee amputation because of infection aggravation. There was no recurrence in all wound healed patients. Conclusion: Repetitive COW over LM could be healed using SLC or SLS and the healed wound kept its state with removable SLS. It is considered that conservative treatment for Repetitive COW over LM with SLC or SLS is another favorable treatment option.

Category: Midfoot/Forefoot, Sports, Trauma Introduction/Purpose: The treatment of 5th metatarsal stress fractures of the can be challenging and at times can result in significant disability. Intramedullary screw fixation has become a popular surgical method for management. However, many recent reports have described failures after screw fixation in athletes. The aim of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and complications of elite athletes with proximal fifth metatarsal fracture treated with plantar plating. Methods: Thirty-eight patients with fifth metatarsal stress fractures treated using the plantar plating technique in four hospitals from 2013 to 2018 were evaluated retrospectively. All of the patients were elite athletes. Demographic data, radiographic evaluation, and the time until union and return to unrestricted sporting competition were collected and analyzed. Results: A total of 38 patients underwent the plantar plating for 5th metatarsal stress fracture with a mean follow-up of 23 months (range, 12-49 months). The mean time to radiologic union as determined by CT was 9.3 weeks (range, 8-16 weeks). However, during follow-up, there were 4 refractures but no union problems. One patient experienced temporary sensory disturbance that resolved within 3 months. There was one patient with temporary wound complication, two cases with hardware prominence. All but one patients were able to return to their previous levels of sporting activity at 21 ± 4 (range, 18 to 40) weeks. Conclusion: With minimum 1-year follow-up, the described plantar plating technique is a good alternative method for the surgical treatment of fifth metatarsal stress fractures with less complications.

Category: Ankle, Trauma Introduction/Purpose: Isolated Lateral malleolus fracture, like any other fractures can be treated by operative or conservative treatment. Stability of ankle joint is the most important factor in deciding the type of treatment. Unstable ankle joints present superior clinical outcomes with surgical management. There are many methods to assess the stability of ankle joint such as plain x- ray films, stress radiographies and physical examination. Many studies have suggested the usage of ultrasound for diagnosis of ankle ligament injury. But, there are no reports about its use for stability assessment of isolated lateral malleolar ankle fracture. Therefore, the purpose of this study is to evaluate the value of ultrasound for stability assessment of isolated lateral malleolar fractures, compared to simple x-ray, stress radiography and arthroscopy. Methods: We have conducted a prospective study which included 13 consecutive patients who underwent arthroscopic exam and subsequent open reduction and internal fixation for isolated lateral malleolar ankle fracture. Before operation simple x-ray, external rotation stress radiographs were done. Stress ultrasound was performed to assess the anterior inferior tibiofibular ligament (AITFL) and medial deltoid ligament prior to operation. The arthroscopic findings were used as the reference standard. A standardized physical examination (tenderness and ecchymosis, external rotation stress test), simple radiography, stress radiography and ultrasound images were compared to assess the stability. Results: Deltoid ligament injury and or syndesmosis injury were verified arthroscopically in 12 cases with a clinical diagnosis (92.3%). There were 9 cases who showed unstable ankle fracture on the simple radiography. (69.2%). There were all cases who showed unstable ankle fracture on the external rotation stress radiography. (100%) In addition, for 12/13, there were acute tear of the deltoid ligament or AITFL injury on the ultrasound (92.3%). Conclusion: The results suggest that ultrasound could be used for the assessment of the instability of isolated lateral malleolar fracture.