Background: Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery. Methods: The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery. Results: The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery ( P < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3. Conclusion: The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM. Level of Evidence: Level II, prospective randomized trial.

Ankle fracture is one of the most common fractures that are mainly treated with open reduction and internal fixation. Wide-awake local anesthesia no tourniquet (WALANT) technique has been widely used for hand and wrist surgeries, this method has been scarcely utilized in ankle surgery. To the best of our knowledge, only one study has evaluated the safety and efficacy of the WALANT technique in distal fibula hardware removal surgeries. This study aimed to investigate the result of using the WALANT technique in distal fibula hardware removal surgery. From April 2020 until March 2021 randomized clinical trial was performed on 60 patients between the ages of 18 and 60 years in our educational orthopedic center. In group A, an anesthesiologist administered spinal anesthesia and in group B the WALANT technique was used for anesthesia. The results of the current study showed that the visual analog scale in group B a day after the surgery was significantly lower, in comparison to group A. The outcome of our study demonstrated lesser blood loss in patients operated under the WALANT. This finding could be related to the vasoconstrictive properties of epinephrine used in the WALANT solution. Our findings suggest that the WALANT technique application in the proper setting and appropriate patient selection could lead to reduced postoperative pain, minimal bleeding, and shorter admission time. Other advantages include the simplicity and safety of the technique, it is being time and cost-effective. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Introduction: The terrible triad of the elbow includes an elbow dislocation or subluxation with coronoid and in combination with radial head fractures. Still, none of them are accompanied by rupture of the triceps tendon. Case Report: The article describes a terrible triad injury in a young patient with an additional triceps rupture. The treatment involved lateral and medial approaches for the repair of various ligaments and fractures, but the elbow remained unstable. A posterior approach was used to repair the triceps rupture. Conclusion: Triceps tendon rupture may be accompanied by dribble triad injuries, highlighting the importance of pre-operative evaluation to select the most appropriate surgical approach. The selection of an optimal surgical approach is crucial for the successful treatment and management of these injuries. Keywords: Elbow, terrible triad, fracture, dislocation, triceps tendon, tear.

Introduction and importance: Stiff person syndrome (SPS) is a rare autoimmune disorder that affects the central nervous system. Patients with this condition may experience sudden muscle spasms, leading to falls and subsequent fractures. Diagnosis is based on clinical presentation, the presence of anti-GAD antibodies, and electromyography (EMG) findings that show continuous motor unit activity. However, there have been few reports of atraumatic fractures in these patients. Case presentation: In this article, we present a case of a patient with stiff person syndrome who sustained an intertrochanteric fracture without any prior history of trauma. Additionally, we review and discuss previous literature on this subject. Clinical discussion: SPS is a rare autoimmune neurological disease with muscle rigidity and spasms predominantly in the trunk and lower limbs. The authors mentioned that SPS diagnosis and managing related fractures could be challenging. They recommended optimizing the patient's status with proper medical treatments before surgical interventions to reduce further complications. Conclusion: In conclusion, it appears that stiff person syndrome can lead to recurrent and even atraumatic fractures, and should be considered as an underlying cause. Additionally, uncontrolled spasms in these patients can result in the failure of previous surgical fixations and complicated surgical management. To prevent surgical complications, it is crucial to initiate and maintain appropriate medical treatment to control spasms as soon as the underlying disease is diagnosed. Highlights: