Journal of the American Podiatric Medical Association

Historically custom implants have been made from metal, bulk allograft, and PEEK, among others. PEKK has seen increased utilization in medicine, specifically in custom implants due to its higher tensile strength and also its molecular composition that aids in promoting cellular activity, such as bone healing. In this case report, we present a 72-year-old female who initially presented with a collapse of her talus after failed attempted ankle arthrodesis. A custom PEKK talus implant was designed, implanted and secured via tibiotalocalcaneal arthrodesis using an intramedullary nail. The patient had significant improvement in AOFAS (17 to 92), FFI (90 to 8), and VAS (9 to 0) from preoperative evaluation to the final 1.5-year postoperative follow-up. This is one of the only case reports that documents the utilization of a custom PEKK implant for lower extremity reconstruction. Although more studies are needed, this case report shows promising results with PEKK implants, especially in limb salvage procedures. Level of Clinical Evidence: 5, Case Report.

Background: Trimalleolar ankle fractures (TMFs) compromise ankle biomechanics; optimal operative strategy is debated. We compared single-stage open reduction and internal fixation (ORIF) with staged external fixation (EF) plus ORIF for outcomes and hospital billed charges. Methods: Retrospective cohort of adults treated 2018–2022 at a tertiary center. EF + ORIF (n = 40) vs. ORIF (n = 49). Outcomes: length of stay (LOS), hospital billed charges (stage-1, stage-2, total), readmission, additional surgical procedures, complications, and visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), Short Form-36 (SF-36) to 2 years. Results: After multivariable adjustment, ORIF was associated with a lower first-stage hospital billed charge (charge ratio, 0.55; 95% CI, 0.37–0.81; p = 0.003), a lower total hospital billed charge (charge ratio, 0.33; 95% CI, 0.24–0.47; p < 0.001), and earlier partial and full weight-bearing. Adjusted AOFAS scores were higher in the ORIF group at 3 months, 6 months, and 1 year, but not at 2 years. Holm-adjusted postoperative VAS contrasts were not significant, and the SF-36 group-by-time interaction was not significant. Conclusions: In this clinically selected cohort, single-stage ORIF was associated with lower hospital billed charges, earlier partial and full weight-bearing, and higher adjusted AOFAS scores at selected early follow-up points. Because Tscherne grade 2 and 3 injuries occurred only in the staged-treatment group, these findings do not establish comparative effectiveness for those injury grades or long-term functional superiority. Temporary external fixation remains an appropriate bridging strategy when soft-tissue conditions preclude immediate ORIF. Levels of Evidence: Level III, retrospective cohort.

Introduction: Posterior heel pressure ulcerations are a common problem seen both in the clinic and in the hospital setting. This type of ulceration can cause necrosis of soft tissue and bone to the posterior heel, which can have devastating consequences. We believe that this technique provides an effective adjunctive treatment for posterior heel pressure ulcerations. Methods: In this paper, we present a casting technique to provide intrinsic off-loading to the heel while maintaining optimal soft tissue and bone positioning. Discussion: The primary author and senior author have had success employing this technique in patients that suffer from posterior heel pressure ulcerations. Applying maximal plantarflexion allows for relaxation of the soft tissues to the posterior heel and reduces tension on wound edges. This technique also allows for the correction of combined soft tissue and bony pathology, increasing stability and reducing the progression of deformity. This technique may in turn offer an approach to reduce the risk of osteomyelitis of the calcaneus, reducing the risk of higher-level amputation and ultimately reducing morbidity and mortality rates in our wound care patients.