” I don’t want to achieve immortality through my work. I want to achieve it by not dying”

Woody Allen b.1935, American filmmaker, actor and comedian

The Bone & Joint Journal 360 provides a treasure trove of academic content in its back catalogue, all of which is hugely synergistic with our own techniques.This month, it is a pleasure to revisit some of high points in foot and ankle content from both publications.

Ankle fractures are a very varied group of injuries that often are one of the early tasks of surgical training and yet can still challenge the most experienced trauma surgeon.  In their review “Ankle Fractures – Facts & Fiction” Tim White and T H Carter from the Edinburgh Royal Infirmary home in on some of the most critical aspects of these injuries.  Their clear and comprehensive review of the relative lack of evidence behind newer forms of syndesmosis fixation and aggressive operative management of posterior malleolar fractures will definitely stimulate debate but provides important perspective for everybody treating these injuries. Their critique of the literature of thromboprophylaxis in ankle fractures and the benefits of percutaneous nail fixation of the fibula are also highlights of this excellent article.

Ankle replacement on the other hand, is an operative technique that far fewer will be familiar with but is now part of the “standard” orthopaedic armamentarium. As such it is relevant for anyone involved in orthopaedic practice to have a grounding in its history, principles and current outcomes. Though first published in 2015, the article “Ankle Replacement: Where Are We Now?” by Fred Robinson and CJ Lever from Addenbrookes Hospital, Cambridge, UK is no less definitive now than when first published in all these areas.The key concept of fixed bearing ankle replacement versus the more common mobile bearing replacements are explained and the key features of the original replacements that gave surgeons well designed implants and jigging with reproducible results, the star, agility and Buechel Pappas ankle replacements. The third generation replacements that have followed are discussed as is the perpetual “replacement versus fusion”question for the ankle.

For those unfamiliar with ankle replacement the authors give a useful perspective on UK foot and ankle practice with 540 replacements entered into the joint registry in 2012 against 77,000 knees and 85,000 total hip replacements.  In arthroplasty, patient outcome often correlates well with a surgeon’s case numbers and with such a low number of replacements performed this is an important point explored by the authors in this very balanced article.

On OrthOracle we have a dozen detailed ankle and pilon fracture surgical techniques covering all of the common, and some less common, strategies.  Each of them provides complementary  operative perspective to the bone and joint journal review. Mark Davies’ technique on fixation of the fibula using the Acumed fibular rod system, as a less common but well proven  works technique particularly well with the Bone and joint Journal review.

In terms of ankle replacement, we currently demonstrate seven different replacements in detail. These include the BOX, Salto and STAR but the Wright INFINITY by Kartik Hariharan is profiled here, though most replacements follow the same fundamental steps.

For a wealth of academic papers on foot and ankle, many of which are open access, visit the new Bone & Joint Journal platform and for many more instructional techniques demonstrating real cases, visit us at OrthOracle.