Aims: To compare the functional and radiological outcome between MIS pinning and ORIF by lateral extensile plating of DIACFs and its rate of complications. Material and Methods: We performed a RCT study involving 40 patients of closed displaced intra-articular calcaneal fractures of Sanders type 2,3 &4. Lateral extensile approach and plating was used in the ORIF group while Sinus tarsi approach and pinning was used in MIS group. Outcome: Radiographic measurements of Bohler’s angle and Gissane angle. Functional outcome was assessed by AOFAS score during follow up at 2 years. Results: Radiologically Bohler’s angle were better restored in lateral extensile plating group with average of 26.560 and 22.810 in MIS pinning group, but it was statistically insignificant (p value=0.06), similarly Gissane angle was better restored in lateral extensile plating group with average of 113.810 and 113.170 in MIS pinning group, but it was statistically insignificant (p value=0.41). MIS pinning group had better functional outcome with mean AOFAS score of 84.15 than lateral extensile plating group with AOFAS score of 83.15, even though the difference was statistically insignificant (p = 0.48). Those patients with restored Bohler’s angle and Gissane angle had better functional outcome than those not restored, however the difference was statistically insignificant. The rate of infection in lateral extensile plating group was 21% while that of MIS group is 5%. Conclusion: There is no significant difference in radiological and functional outcomes of both groups. However MIS pinning had a lesser waiting period, hospital stay, surgical time & wound complications.

Background – Calcaneum fractures are high energy, complex injuries, providing anatomical and technical treatment challenges. There is a ongoing debate as to their best management, with high complication rate and potentially very poor outcomes if not treated correctly. The aim of our study was to analyse the outcomes of these injuries from a large trauma centre series.

Method - We retrospectively collected data on all trauma patients presenting to a single high volume major trauma centre with a calcaneum fracture between 2017 – 2021. .All patients were over the age of 18 with a minimum of 6 months follow up post injury. Retrospective review of case notes and imaging was conducted to collate demographic data and to classify fracture morphology. Whether patients were managed non-operatively or operatively was noted and where used, the type of operative fixation, outcomes and complications were recorded.
Results – 160 cases were identified over a 4year period. 80% of injuries were body fractures with the most common pattern being Sanders3. Average angle of Bohler 30.8%, Gissane 121. 29% of people had contralateral injury, 21% had pelvic fracture, 29% vertebral fracture, 14% tibial fracture. 20% proceeded with operative intervention, with wound complication rate of 20%

Conclusion – To our knowledge this is one of largest cohorts of calcaneum fractures available in the literature. We present the experiences of a major trauma centres treatment of this complex fracture, and it’s associated other injuries.

Deltoid ligament injury may accompany a lateral malleolar fracture caused by a rotational injury. Ankle instability can be assessed through gravity stress radiograph performed before surgery, and this helps in deciding whether to have surgery for the lateral malleolar fracture. This study aims to suggest indications for deltoid ligament repair procedure by analyzing the radiologic parameters of preoperative ankle radiographs. This retrospective study was performed on patients who underwent surgical treatment for a weber B type lateral malleolar fracture at our hospital from 2015 to 2020. Manual valgus and external rotation stress test was performed under C-arm after internal fixation of lateral malleolus fracture and if medial clear space widening was confirmed, deltoid repair was performed. Patients with a follow-up of less than 1 year were excluded. A total of 51 patients were included. As radiographic parameters, medial clear space (MCS), medial-superior clear space ratio (M-S ratio), medial clear angle (MCA), fibular lateral shift distance (FSD) and difference between MCS and FSD (MCS-FSD difference) were analyzed in the preoperative ankle radiographs, gravity stress views, immediate and 1-year postoperative ankle radiographs. As a result, deltoid ligament repair ratio was 29.4%(15/51). Both MCS & MCA are significantly higher in repair group (p < 0.01). No significant difference in MCS-FLSD difference between the two groups (p = 0.732). An increase in MCS and MCA can be expected in the presence of a deltoid ligament injury. Cut-off value was analyzed as 6.03mm for MCS and 11.5 degrees for MCA.

Introduction: Hallux valgus (HV) is a complex multifactorial deformity of the first ray of the forefoot. The peroneus longus (PL) muscle is one of the key dynamic stabilisers of the first ray, acting through its insertion.
Aim: To assess the association between the type of PL insertion and the prevalence of HV.
Methodology: Twenty-five cadaveric foot specimens were dissected to expose the insertion of the PL. The head of the first metatarsal was exposed to determine the presence of morphological changes in keeping with HV. The type of PL insertion, anatomical HV status and number of tarsometatarsal facets were documented.

Results: Twenty-five foot specimens were reviewed from seventeen unique donors. Seven (28%) had morphological changes in keeping with HV deformity. There were 4 double insertions, which none had HV. Whereas 33.33% of the single insertions had evidence of HV. Regarding width of insertion to the peroneus longus tubercle, 15.38% (2/13) narrow insertions had HV, whereas 41.67% (5/12) had broad insertions. There were 2 unifacet tarsometatarsal joints, 19 bifacet and 4 trifacet in the cohort. HV was more common in the bifacet tarsometatarsal joints (31.58%).

Conclusion: Patients with HV were more likely to have single PL insertions which were broad. The pull of a narrow PL insertion may increase the stress concentration of the PL muscle action, therefore having a greater effect to the lateral and downward movement of the first ray, thus preventing HV. Further research is required to understand if the morphology change is a cause or effect relationship.

This study aimed to evaluate the outcomes of using the Ilizarov fixator for the treatment of neglected (late presenting) pilon fractures and to assess if this method would be successful to avoid arthrodesis.
Patients and Methods: This retrospective case series was conducted on 18 patients with an average age of 42.17 years having an untreated late presenting pilon fracture more than one month after injury. Twelve patients were male and six were female. The average period from trauma to treatment was 11.17 (Range: 7-15) weeks. All fractures were AO type C. Open fracture was present in four patients. These cases were treated by a closed reduction technique using the Ilizarov fixator with deformity correction and alignment restoration. The radiographs were assessed for alignment, reduction, and occurrence of secondary osteoarthrosis. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind Foot Scale was used for functional assessment. Results: The average follow-up duration was 38 (range 18-168) months. The mean external fixator period was 29 (range 26-32) weeks. Fracture union was achieved in all cases without deep infection. The ankle range of motion averaged 8.7° and 25.7° for dorsiflexion and plantar-flexion respectively in 15 cases. Arthrodesis was done in three cases. The mean AOFAS Ankle-hindfoot score was 82.7. One patient had a mild anterior translation. Osteoarthritis occurred in six ankles. Conclusions: The closed reduction technique using the Ilizarov fixator was successful in achieving satisfactory radiographic and functional outcomes in this series of late-presenting neglected pilon fractures. Moreover, arthrodesis was avoided in most patients.

Background: Recent studies have proposed the use of primary fusion of the involved tarsometatarsal joints as a mean of definite treatment in management of Lisfranc injuries. ORIF is also an available option. Controversy exists whether ORIF or Primary Fusion results in better surgical outcome.
Methods: A Systematic Review and Meta-Analysis was conducted on ten different studies with pre specified eligibility criteria according to Cochrane's handbook of systematic review guidelines to compare safety and efficacy of Primary Fusion versus ORIF in treating patients with Lisfranc Injuries.
Results: This systematic review and meta-analysis included total number of 782 cases; 540 cases in ORIF group and 242 cases in primary fusion groups. both groups had Comparable VAS for pain, AOFAS scores, ORIF group showed better recovery and early return for full activity, no difference in Radiological union nor in the rate of complications between both groups. ORIF group showed higher rate of hardware removal with higher re-operation rate.
Conclusion: ORIF offered a better therapeutic effect than primary arthrodesis for the treatment of Lisfranc injuries with significant risk of re-operation.

Purpose: several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). no agreement among different authors about either the ideal fixation method or which technique is minimally invasive. Methods: a randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the orthopedics department of sohag university hospital, between April 2020 and February 2022. Functional assessment was done by AOFAS score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus). Results: Mean operative time was signifcantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was signifcantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks. Conclusion: both techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.

Background: We aimed to report the early results of performing acute ankle arthrodesis using a modified retrograde femoral IMN concomitant with plating for managing diabetic patient's acute ankle fractures.
Methods: We prospectively included patients who presented acutely with ankle fractures, where (HbA1C) on admission was > 7%, and the Adelaide Fracture in the Diabetic Ankle algorithm score was 5 or above. All patients were treated by ankle arthrodesis using a modified retrograde femoral IMN combined with lateral plating. Functional assessment was reported according to a (AOFAS), and complications were documented. Results: Six patients had an average age of 55.7 years (37-65). The average HbA1C on admission was 7.9 (7.3 to 9), and the average AFDA score was 7.3 (6 to 8). The average operative time was 79.2 minutes (70 to 90).
All patients, except for one, achieved union at the arthrodesis site after an average of 10.3 weeks (8 to 14). After an average last follow up of nine months (6 to 12), the average modified AOFAS was 73.2 (82 to 62); four patients had an excellent score and one good. Complications developed in two, one deep infection treated by metal removal and Ilizarov, and the other patient developed a stress fracture at the tibial end of the nail, treated by fixation by aplate. Conclusion: Using a modified femoral IMN combined with lateral plating is a promising technique to achieve ankle arthrodesis in diabetic patients with acute ankle fractures with acceptable outcomes; however, further studies with larger numbers are needed.

Aim:
To assess the treatment outcome in patients with fifth metatarsal fractures allowed early weight-bearing in comparison with those treated with an initial non-weight-bearing period.

Methodology:
100 patients with base of fifth metatarsal fractures were reviewed between April 2022 to January 2023 and all of them were allowed to weight-bear. These 100 patients were divided into 2 groups respectively; early and late weight-bearing. After 6 weeks, these same 100 patients were reviewed again to evaluate the need for operative measures based on clinical union, bone resorption, American Orthopaedics Foot and Ankle Society score ( AOFAS ), and visual analog scores ( VAS ).


Evaluation
Plain radiographs are the initial imaging of choice used to evaluate these injuries. AP, lateral, and oblique views of the foot are taken to make the diagnosis. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scan is used to assess delayed healing, symptomatic non-union, or a high clinical suspicion of a stress fracture.

Results
All patients showed clinical union at an average of 6 weeks. However, those in the early weight-bearing group showed earlier clinical union and lesser bone resorption compared to those who are late weight-bearing.

Conclusion:
Early weight-bearing in fifth metatarsal fractures results in improved confidence in patients regarding their rehabilitation and motivate them to get involved early in physiotherapy. There is also improved circulation seen in these patients resulting in shorter healing time and the risk of deep venous thrombosis (DVT) is also minimized in this group of patients.

Background:This study aimed at comparing outcomes of primary tarso-metatarsal joints fusion
versus open reduction and internal fixation in treatment of such condition and determining the possible factors that may alter the outcomes.Methods: This study comprised 30 patients; 16 in fusion group and 14 in ORIF group. One column was operated on in 2patients, two columns in 21, and three columns in 7. The mean follow-up period was 36 months.Results: There was no statistically significant difference between both groups regarding patients or injury characteristics. The mean AOFAS and FFI-Rs scores were 88.9 and 22.7 in the fusion group, compared to 61.7 and 34.5 in the ORIF group (P = .03,.04 respectively). At final follow-up all patients in the primary arthrodesis group were maintaining an anatomical reduction versus 71.5% in the ORIF group. Sixteen patients
(53%) reported prominent hardware troubles that required removal. Five patients in ORIF group developed
osteoarthritis, and four of them underwent secondary fusion. There was significantly higher incidence of
posttraumatic osteoarthritis in patients with non-anatomical reduction and complete injuries. Better mean AOFAS and FFI-Rs scores occurred with non-smokers and with anatomical reduction.
Conclusion: Based on this limited case series, purely ligamentous Lisfranc injuries were found to have better outcomes when managed with a primary fusion as compared to ORIF. Achieving and maintaining anatomical reduction was the most important factor that is significantly
attributed to improved outcomes. Possible arthritic changes and additional surgeries apart from implant removal could be avoided by primary fusion.