Martin Wiewiorski

Radiographic evaluation of frontal talar edge configuration for osteochondral plug transplantation.

For successful reconstruction of osteochondral lesions of the talus, the anatomic configuration of the talar edge must be respected. This study evaluated the radiographic configuration of the talar edge in the anterior‐posterior (AP) view by analyzing medial and lateral talar edge angles and radii in 81 patients with a true AP view and without ankle pathology. The mean lateral talar edge angle was 91.8°, and the mean medial talar edge angle was 110.0°. The medial frontal talar edge radius was 4.8 mm and the lateral 3.5 mm, respectively. No correlation between angle and radius was found. These results revealed a significant difference between the medial and the lateral talar edge configuration. This may be due to the three‐dimensional function of the human ankle joint. No study so far has addressed these differences radiologically. These differences should be addressed in the reconstruction of osteochondral lesions and be included in the preoperative planning. Clin. Anat. 22:261–266, 2009.

Ankle Joint Fusion With an Anatomically Preshaped Anterior Locking Plate

We present a novel fixation plate for primary ankle joint fusion. A single anatomically preshaped angular stable plate was used with an anterior approach. An excellent result with good bone consolidation was present at the 1-year follow-up examination.

The Painful Flatfoot

Increased awareness of the acquired adult flatfoot deformity over the past decade has resulted in intensive study of the basic science and pathophysiology behind this common entity. Posterior tibial tendon insufficiency (PTTI), though accepted as the most common aetiology, is frequently missed. This slowly progressive disease requires prompt diagnosis to allow treatment to be started at an earlier, more easily-managed stage. The hallmarks of PTTI are a valgus hindfoot, flattening of the midfoot (longitudinal arch), abduction and supination of the forefoot [36]. This occurs most commonly in women older than 40 years of age. Since the first description of a tendon rupture by Key et al. in 1953 [15], methods of treatment have evolved and the pathology and function of the tendon have been extensively investigated. This article will review the current concepts with regard to the patho-mechanism, clinical evaluation, and treatment of this progressive, debilitating condition.