Hallux valgus (HV) is a common forefoot deformity for which numerous surgical techniques have been proposed, with the Lapidus procedure representing a powerful and durable solution, especially in cases of moderate to severe deformities and first ray hypermobility. Initially described in the early 20th century, the Lapidus procedure involves first tarsometatarsal joint (TMTJ) arthrodesis and has undergone multiple modifications over time to reduce complications such as nonunion, malunion, shortening, and recurrence. The technique offers triplanar correction, addressing axial, sagittal, and coronal deformity components. Despite its proven corrective potential, the procedure remains technically demanding, and no universal consensus exists on the ideal fixation method or postoperative protocol. Recent developments in fixation strategies—including crossed screws, locking plates, intramedullary nails, nitinol staples, external fixation, and arthroscopic approaches—have aimed to improve stability, union rates, and the possibility of earlier weight-bearing. This narrative review provides a comprehensive overview of the Lapidus procedure, focusing on surgical indications, technical variants, fixation methods, clinical outcomes, and complications, with the goal of offering practical guidance for optimizing surgical decision-making in various clinical settings.

Background: The treatment of the third malleolus has evolved in recent years, and surgical treatment can be carried out with traditional percutaneous osteosynthesis using anteroposterior screws or ORIF with a posterolateral plate. Methods: Our study included 54 patients divided into two groups based on the intervention type (screw or plate). Instrumental assessments comprised pre- and post-operative X-rays and pre-operative CT scans to evaluate joint step-off. The mean follow-up duration was 1 year and 9 months. Results: Radiographic control revealed no loss of reduction or mobilization of the synthesis devices, and all patients achieved fracture healing. Articular step-off > 2 mm was observed in 21 patients (38.9%), including 4 in the plate group and 17 in the screw group, with a statistically significant likelihood of step-off presence in the latter. The mean AOFAS score was 90 points, negatively correlated with age, and lower in patients with joint step-off and a 15° reduction in ROM. Conclusions: The management of posterior malleolus fractures has changed with anatomical studies and an understanding of ankle stability through CT scans. ORIF with a posterior plate is advantageous for anatomical reduction of the tibial plafond but is disadvantageous in terms of surgical invasiveness and technical difficulty.

Purpose: Several alignment strategies have been proposed in total knee arthroplasty (TKA), with the two extremes being mechanical alignment (MA) and unrestricted kinematic alignment (KA). While MA standardises coronal knee parameters to achieve a neutral alignment, KA reproduces each patient's native joint lines. The impact of these strategies on the ankle joint remains poorly understood. The aim of this study was to compare the effects of MA and KA on coronal ankle alignment, hypothesising that MA induces greater alterations than KA. Methods: In this retrospective cohort study, 208 consecutive TKA cases, performed with either MA ( n = 104) or unrestricted KA ( n = 104) were included. Preoperative and 1‐year postoperative full‐length standing radiographs were analysed for lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), hip–knee–ankle angle (HKA), Coronal‐Plane‐Alignment‐of‐the‐Knee (CPAK) categories and ankle‐specific parameters: talar inclination (TI), tibial plafond inclination (TPI), and talar tilt (TT). Changes in radiographic parameters (Δ) were calculated as the difference between 1‐year postoperative and preoperative values. Within‐group and between‐group changes were assessed with paired and independent t‐tests, respectively, and correlations between knee and ankle changes were calculated. Statistical significance was set at p < 0.05. Results: MA resulted in significant postoperative changes in TI (–3.21 ± 3.28°; p < 0.001) and TPI (–2.62 ± 3.16°; p < 0.001), whereas KA produced no significant changes (TI: –0.60 ± 3.54°, TPI: –0.18 ± 3.23°; p > 0.05). No significant changes were observed for TT in either group. In the MA group, ΔTPI correlated moderately with ΔHKA, ΔLDFA, and ΔMPTA. Pre/postoperative changes in CPAK category did not show any impact on coronal ankle parameters following TKA ( p > 0.05) Conclusions: Coronal ankle alignment is preserved by unrestricted KA but altered by MA. These findings suggest that KA minimises unintended ankle alterations, maintaining the patient‐specific knee–ankle relationship and potentially reducing the risk of secondary ankle malalignment or degeneration following TKA. Level of Evidence: Level IV, retrospective analysis.

Background: Osteoporosis represents a global problem, which involves high risks of disability and death due to the consequences of fragility fractures. The aim of our study is to verify what type of relationship there is between ankle fractures and osteoporosis. Specifically, we aim to understand how the clinical and anamnestic characteristics of patients, along with the radiographic features of these fractures, may contribute to considering them as osteoporotic fractures. Methods: The study group includes 51 consecutive patients aged 60 years or older operated for ankle fracture from May to October 2022. The fractures were divided into uni-, bi-, or trimalleolar based on the plain X-rays. All patients underwent femoral and vertebral bone mineralometry by DXA associated with the FRAX questionnaire. Results: Ankle fractures in the elderly were associated with reduced BMD (76.5% of the total patients examined, 83.8% considering only women) and low-energy traumas (82%). Furthermore, these fractures present features of increased complexity as bone mass decreases. Conclusions: Ankle fractures in the elderly exhibit characteristics that suggest a relationship with bone fragility. For these reasons, it might be advisable to initiate a comprehensive fracture risk assessment in elderly patients who experience an ankle fracture. These fractures should not be underrated, and antiresorptive therapy must always be taken into consideration when selecting patients at risk.

Background: The optimal management of acute Achilles tendon (AT) ruptures remains debated. Historically, surgical treatment has been preferred over conservative management because of a lower risk of rerupture. In recent decades, minimally invasive (MIS) and percutaneous techniques have been introduced to reduce the complications associated with the traditional open surgery. Comparable clinical outcomes have been demonstrated, with a lower rate of general complications but a higher risk of sural nerve palsy. Endoscopic assistance has been finally proposed to improve intraoperative visualization and potentially decrease this risk, although its actual potential benefit remains uncertain. Methods: A prospective observational study including a total of 94 patients who underwent surgical treatment for acute subcutaneous AT rupture was conducted. 60 of the patients were male and 34 were female, with a mean age at the time of surgery of 42.5 [18–78] years. The patients were then divided into three groups according to the surgical procedure performed: endoscopic-assisted MIS technique (A, n = 30), Ma-Griffith minimally invasive technique (M-G/MISI) (B, n = 34) and traditional open surgery (C, n = 32). Same post-operative protocol. The mean follow-up was 32 months (24–60 months). Patients were evaluated by time taken to return to driving (RTD), to their usual work activities (RTW), and, in active patients, to sports activities (RTS) at a level comparable to that prior to the injury was recorded. Clinical outcomes were evaluated with Achilles tendon Total Rupture Score (ATRS) and Ankle Hindfoot American Orthopaedic Foot and Ankle Society (AH-AOFAS) scores. Results: Significant differences among groups were found for RTD (p = 0.001), RTW (p < 0.001), and ATRS (p < 0.001), while RTS (p = 0.46) and AOFAS (p = 0.41) did not differ significantly. Post hoc analyses showed that the M-G/MISI group achieved faster return to driving and work and higher ATRS compared with the open group (all p < 0.05). No significant differences were detected between M-G/MISI and endoscopic-assisted techniques. Conclusions: All three techniques achieved good functional outcomes and low complication rates. Endoscopic assistance allowed visualization of suture passage and confirmation of gap reduction, but no superiority was observed in clinical outcomes or sural nerve safety. The M-G/MISI approach was associated with faster return to activity and higher ATRS compared with open repair.

Interprosthetic humeral fractures (IHFs) are severe injury patterns associated with surgical issues and contradictory results. The knowledge and literature on this topic are still lacking. A 76 year-old woman was treated for a fracture occurred between the shoulder and elbow stemmed prosthesis. Severe bone loss was associated with the fracture. Treatment: Open reduction, plate fixation, and bone grafting were considered. A xenograft (used as a mechanical strut medially), a synthetic graft associated with bone growth factors, and scaffolds improved the bone healing process. Satisfactory clinical and radiological outcomes were obtained. A scoping review of the literature was also performed by the authors. Only eight papers reported IHFs with a low level of evidence. In total, eight patients were treated; one paper that reported on biomechanical aspects using finite element analysis is discussed. Conservative treatment leads to non-union, and the surgical approach is the gold standard. The osteosynthesis technique associated with bone grafting leads to the best outcomes. The use of a xenograft mechanical strut, associated with synthetic biological bone grafting, led to complete bone union at 9 months follow-up. Larger cohorts, more standardised results, and multicentric studies are mandatory in order to improve and establish a management and treatment algorithm.