Minimally invasive surgery is increasingly popular due to reduced rate of cutaneous complications. However, anatomical reduction is difficult through this approach.
Retrospective study with 27 patients with calcaneus fracture (30 calcaneus) between 2015 and 2018. The ORIF group (16 calcaneus, 14 patients) was compared with the Calcanail group ( 14 calcaneus, 13 patients). Length, height, Bohler angle and Gissane angle were evaluated before and after surgery. Functional outcome was given by the AOFAS score, SF-36v2, Visual analogue pain scale and ability to return to work.
In Calcanail group, the sample corresponded to a Sanders classification: 50% typeII (n=7), 35.7% typeIII (n=5) and 14.2 typeIV (n=2). In the ORIF group, the distribution was: 43.75% typeII (n=7), 18.75 typeIII (n=3) and 37.5 typeIV (n=6). The average time to surgery was 17 days. In the Calcanail group, the Bohler and Gissane angle passed from 3.7 and 122.7 to 10.2 and 122.5 in the postoperative period, respectively. In the ORIF group, the Bohler and Gissane angle changed from 5.9 and 110.1 in the preoperative to 25.4 and 118.8 in the postoperative, respectively.
When adjusted for Sanders II and III fracture pattern, the average VAS score was 2.6 in the ORIF group and 1.8 in the Calcanail group and the AOFAS Score was 88.5 vs 84.25 (Calcanail vs ORIF), with no statistically differences.

Despite best radiological result in the ORIF group, no statistically differences were found in functional outcomes for the Sanders II and III pattern, for the AOFAS score, VAS, and return to work.

Objective Retrospective analyses of treatment through close reduction and percutaneous internal fixation for low energic Lisfranc injury. Methods From January 2010 to January 2018, 24 Lisfranc injuries with Low energic Lisfranc injuries underwent surgical intervention. Of this group, they were 16 males (66.7%) and 8 females (33.3%) with a mean age of （41.2±6.3） years. The duration from injury to surgery is （3.7±1.6） days. The treatment is close reduction internal fixation. Medial and middle columns were fixed with 3.5mm solid screws. Lateral column was fixed with K-wires. Outcome measures included clinical examination，radiographs, AOFAS midfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications were analyzed as well. Results Eighteen patients were followed up for a minimum of 18 months (18-48 months) with an average of 27.（27.4±4.6）months．At 1.5 years postoperatively, the mean AOFAS Midfoot score was（80.3±5.9）. The mean VAS score was （2.1±0.4）. The Bodily Pain （BP）score of SF-36 was （85.7±7.9）. Two patients had loosen or broken hardware. One patient had osteoarthrosis of midfoot without syndrome. Conclusion. Close reduction and percutaneous internal fixation is efficient and feasible method for low energic Lisfranc injury.

Introduction: Despite advancements in primary correction of hallux valgus, significant rates of re operation remain across common techniques, with complications following primary correction as high as 50%. Our review will systematically explore different methods of surgery currently used in treating reoccurrence specifically (which recent research has been limited) – evaluating open and adapted MIS primary techniques used for revision. Methods: In December 2020, literature search for both open and MIS surgical techniques in HV revision was conducted using PubMed, EMBASE and MEDLINE library databases with following strategy: (hallux valgus OR bunion) AND (revision OR revise OR recurrence OR recurrent) AND (minimally invasive surgery OR minimally invasive OR MIS) OR (revision hallux valgus). Of initial 143 publications, 11 were finally included for data synthesis including 279 patients and 307 feet Findings: Out of 307 feet, 86 (28%) underwent revision with MIS techniques (involving distal metatarsal osteotomies). Those undergoing MIS revisions had an average improvement of 38.3 in their AOFAS score, compared to 32.2 in those using only traditional open techniques. Revision approaches using MIS techniques showed a post-operative reduction in IMA and HVA of 5.6 and 18.4 degrees respectively, compared to 4.9 and 15.5 degrees respectively. There are suggestions newer MIS primary techniques may yield better results if adapted for revision procedures. Conclusion: There are limitations to amount of published data on MIS techniques in revision HV surgery specifically, but suggestion of better qualitative and quantitative outcomes in patients receiving such treatment compared to more open surgical techniques or salvage procedures.

Introduction: There are continuing debates as to whether small PMFs (< 25% of joint surface affected) should be anatomically reduced and fixed.

Aim: This study aimed to evaluate the clinical outcomes after trimalleolar ankle fractures osteosynthesis with a posterior malleolus fracture involving < 25% of the articular surface.
Material and Methods: Retrospective comparative study. Patients with trimalleolar ankle fractures who underwent surgery between 2011 and 2018 were identified. Minimum 2 years follow-up. Fracture specific details (CT-scans) were assessed. Patients were grouped per the posterior malleolus fragment treatment: osteosynthesis (group 1) and non-osteosynthesis (group 2).
Results: 64 patients, 58.6 ±17.8 years (range: 23–75) and follow up time was 43.1 ±22.2 (range 24–96) months. Group 1 showed significantly better clinical outcomes ( p < 0.05), AOOS (93.9 ±5.79 (range: 73–99), AOFAS (91.5 ±6.22(range: 72–100) and VAS (0.8 ±1.22 (range: 0–5)compared to Group 2, AOOS (84.25 ±8.34 (range: 63–100); AOFAS (84.75 ±8.05 (range: 58–100) and VAS (1.7 ±1.38 (range: 0–6). The EQ-5D score was better in group 1 (1.08 ±0.27 (range: 1–2.2) compared to group 2 (1.27 ±0.27 (range: 1–2.4) (p > 0.15).
Conclusion: Posterior malleolus fragments (< 25% of the articular surface) have significantly better clinical outcomes following osteosynthesis.

Introduction
The 5-year revision rates for ankle replacements are currently 6.9%. When an ankle replacement fails it can either undergo revision ankle replacement or conversion to fusion. Currently there is a paucity of literature on the outcomes of these.
The aim of this meta-analysis is to assess the outcomes of conversion to fusion for failed ankle replacements with respect to further revision surgery, fusion, complications and functional outcomes
Methods
A systematic review was conducted using PRISMA guidelines. Papers analysing revision ankle replacements were included. All papers were reviewed by two authors. 23 studies met the inclusion criteria. A meta-analysis of proportions was performed
Results
480 patients were included. The pooled percentage of failed conversion to fusion was 8% (95% CI 4%-13%). For non-revision re-operations 13% (95% CI 5%-23%) of conversion to ankle fusion underwent further surgery. Of those that underwent conversion to fusion 87% (95% CI 80%-93%) united at first attempt.
7 studies with a total of 22 individual outcome scores reported pre and post-operative functional scores. Of these 4 demonstrated a significant improvement, 13 did not demonstrate significant improvement, and significance was not calculated in 5.
Conclusions
Conversion to fusion for failed total ankle replacements has considerable risks of failure and re-operations with high risks of non-union. Further longitudinal studies are required to analyse there outcomes.

Aim: Despite the low incidence of pilon fractures, their high impact nature presents difficulties in surgical management/recovery. Current literature is varied, with no universal treatment algorithm. Method: This retrospective study included 135 patients over a 5-year period. AO/OTA classification: closed fractures (43A:n=12, 43B:n=18, 43C:n=55); open fractures (43A:n=11, 43B:n=12, 43C:n=27). Our treatment algorithm consisted of fine wire fixator (FWF) for severely comminuted closed fractures (type 43C3), or open fractures with severe soft tissue injury (Gustilo-Anderson (GA) type 3). Otherwise, open reduction internal fixation (ORIF) was performed. When required, minimally invasive osteosynthesis (MIO) was performed in combination with FWF to improve joint congruency. All open and closed fractures with severe soft tissue injury required initial temporary ankle-spanning external fixation. Soft tissue cover was required for all open fractures; for GA types 1+2, this was done together with ORIF. Open fractures with severe soft tissue injury (GA type 3) were treated with FWF four to six weeks after soft tissue management. Results: Mean AOFAS score for open and closed fractures were 78.44 and 84.06, respectively. Average time to bone union was 51.46 and 36.48 weeks for open and closed fractures, respectively. Open and closed fracture patients took on average 12.29 and 10.76 weeks to PWB; 24.04 and 20.31 weeks to FWB, respectively. Common complications (closed:open) were deep infection (7%:10%) and non-union (11%:24%). Conclusion: The use of FWF with MIO for severely comminuted closed fractures, and FWF for open fractures with severe soft tissue injury is a valuable method for treating pilon fractures.

Introduction: Recently, endoscopically assisted Achilles tendon repair techniques have improved to overcome the surgical complications. however, the risk of sural nerve injury and the strength of repair are still the most concerning aspects.
Material and Methods: 23 patients with acute Achilles tendon rupture were reviewed in the present study. We stitch the Achilles tendon above the ruptured site using the endoscopic locking loop suture technique, and the knotless anchor suture-bridge technique can be used to make the distal fixation of threads. The function was assessed using the muscle power (MRC0-5), ATRS scores, AOFAS ankle-hindfoot scores, and VAS scores at the final follow-up.
Results: The mean follow-up time was 15.74± 2.43(range 12 to 18) months. At the final follow-up, the average of the muscle power (MRC0-5), ATRS score, AOFAS ankle-hindfoot score, and VAS score is 4.74±0.45, 97.83±2.77, 96.52 ±4.87, and 0.35 ±0.49, respectively. Every patient returned to previous sports activity at 6 months postoperative. No wound infection and sural nerve injuries were encountered. Only one case suffers local irritation at the medial knotless anchor site.
Conclusions: Endoscopic “internal splinting” repair technique for acute Achilles tendon rupture using locking loop stitch with suture-bridge technique leads to an expedited return to activity with a low risk of complications.

Introduction: Active diabetic foot disease is accountable for almost fifty percent of diabetic hospital bed days, a marked financial burden on service provision. Recurrent admission, extended antibiotic courses and complex clinical challenges necessitates an MDT approach. We aim to display how our diabetic foot service has oriented its structure around NICE guidelines to reduce diabetes associated lower-limb amputation rates. Methods: A retrospective cohort analysis, of all patients under the care of the diabetic foot team from 2017 to 2020 was performed. Data included demographics, mode and length-of-stay (LOS), intervention or surgery performed and rates of re-admission. We analysed how the service evolved to meet NICE guidelines (NG19) as well as MDT objectives, key improvements and staff satisfaction. Results: 624 patient admission encounters by 419 patients (296 males, mean age 69.24; 123 females, mean age 68.65) were included. 299 patients (71%) had one point of contact, of which 102 patients underwent invasive interventions in their first presentation. We display a shift towards less invasive intervention, such as debridement and revascularisation (25% to 34%), reduced length of stay (18.1 to 15.3 days) and subsequent surgical intervention. Conclusion: Inpatient management of active diabetic foot disease places a considerable workload on service provision, for a number of specialities. Despite increasing emergency admissions and more inpatient interventions, we have demonstrated efficiency within our MDT in reduced average LOS and rates of major amputation, invariably leading to reduced cost. We highlight our service model as a benchmark for the diabetic foot service of tomorrow.

Background: It has been shown that direct fixation of the posterior malleolus improves functional outcomes. Our aim was to audit the functional outcome of patients with these fractures which were fixed with an isolated posterolateral approach. Methods: A consecutive case series of patients who underwent direct fixation of the posterior malleolus using a posterolateral approach between 20/12/2012 and 23/1/2020 was identified. Fractures were classified according to Mason and Molloy classification based on preoperative CT. Type 2a and 2b fractures were included. Functional outcome was assessed using Olerud-Molander score. Results: 18 patients were included. Mean age at time of surgery was 52 years (range 20 to 75 years). 56% (n=10) were female. Mean follow up was 18.1 months (range 4.2 months to 7.2 years). OMAS score for type 2a fractures (n=9) was 71.1 (95% CI 65.3 to 77.0). OMAS score for type 2b fractures (n=9) was 67.8 (95% CI 54.6 to 81.0). There was no significant difference between groups (p=0.65). Conclusion: Fixation of Mason and Molloy Type 2 fractures using an isolated posterolateral approach results in satisfactory functional results for the majority of patients. Further prospective comparative study is needed to identify which patients benefit most from alternative approaches. Disclosures: None