Background: The management of infections involving the distal tibia and ankle is a significant challenge in orthopedic surgery due to complex anatomy and the high risk of complications. The study aims to present our clinical experience in managing these infections and focusing on surgical strategies, infection control, and functional outcomes over a minimum 24-month follow-up period. Methods: This is an observational, retrospective case series of 17 patients treated for osteoarticular infections of the distal tibia and/or ankle between January 2020 and May 2023, in a second-level referral trauma center. A staged surgical approach was employed, including radical debridement, temporary stabilization with external fixation, and, in most cases, implantation of a cement spacer loaded with antibiotics. Functional outcomes were assessed using scores such as EQ-5D-5L. Results: The cohort was predominantly male (76.5%), with a high prevalence of elevated BMI and comorbidities. Infection onset was most frequently associated with open fractures (64.7%). Staphylococcus aureus was the most common isolated pathogen (41.2%), and infections caused by Gram-negative or multidrug-resistant bacteria were associated with more reoperations. Overall, complications occurred in 10 patients (58.8%), requiring reintervention in 9 patients (52.9%). Limb salvage was achieved in 16 of 17 patients (94.1%). Conclusions: Our study highlights the critical role of a tailored, multidisciplinary approach in managing these complex infections. Meticulous surgical planning and proactive management of complications are essential for optimizing patient outcomes.

Background: Recent advances in microsurgical techniques have established free flaps as a cornerstone in complex orthopedic reconstructions, particularly in trauma, infection, and tumor resection cases requiring reliable soft tissue coverage for healing and functional recovery. Among them, the anterolateral thigh (ALT) flap is highly recognized for its versatility and consistency; Methods: We conducted a retrospective case series of five patients who underwent orthopedic reconstructive surgery using a free ALT flap in our department. Demographic, surgical, and clinical data were collected, and outcomes were evaluated and compared with the current literature. Results: The ALT flap proved to be a reliable option across a wide range of orthopedic conditions, providing well-vascularized and adaptable tissue for complex reconstructions. Clinical outcomes in our series were consistent with the favorable results reported in the literature. Conclusions: The ALT flap served as one of the most effective and versatile solutions for orthopedic reconstruction. Its adaptability to diverse clinical scenarios, combined with reproducible positive outcomes, supports its role as a preferred option for managing challenging soft tissue in orthopedics, ultimately contributing to improved function and recovery.

Background: Distal tibial fractures (DTFs) are a major cause of post-traumatic osteoarthritis (PTOA). The risk of conversion to total ankle arthroplasty (TAA) or ankle fusion (AF) after DTFs remains unclear, and the current literature provides heterogeneous and often incomplete data. The aim of this systematic review was to evaluate the incidence of TAA and AF following DTF-related PTOA and to explore potential predictors of conversion, including initial treatment strategy. Methods: A systematic review was conducted according to PRISMA guidelines. The PICO framework was applied during the study design and literature search phase to define the research question and eligibility criteria. Studies reporting adult patients with a history of DTFs who later developed PTOA and underwent TAA or AF were included. Descriptive statistics were performed. Study-level proportions of conversion to TAA, AF, or both were analyzed using random-effects meta-analysis with logit transformation. Results: Eight studies comprising 190,383 fractures met the inclusion criteria. Overall, 31,269 patients underwent TAA or AF, corresponding to a conversion rate of 16.4%. The pooled conversion incidence from the random-effects model was 5.6%, with considerable heterogeneity (I² ≈ 100%). When procedures were analyzed separately, the pooled incidence was 0.25% for TAA and 0.76% for AF. Conclusions: The risk of conversion to TAA or AF after DTFs appears to be relatively low, despite the high prevalence of PTOA. The higher conversion rate observed in surgically treated fractures likely reflects the complexity of the initial fracture rather than the failure of surgical management itself. Level IV, systematic review of retrospective studies.

Background: Total ankle replacement (TAR) has emerged as a valuable alternative to ankle arthrodesis for the treatment of end-stage ankle osteoarthritis, offering pain relief while preserving joint motion and improving quality of life. Despite advances in implant design and surgical techniques, complications remain common, and tibial component malalignment has been increasingly recognized as a major contributor to implant failure and revision surgery. Purpose: To provide a comprehensive overview of the current evidence regarding tibial component malalignment in TAR, focusing on its etiology, radiographic assessment, biomechanical implications, clinical consequences, and available treatment strategies. Methods: A narrative review of the literature was conducted using PubMed, Scopus, and Web of Science. English-language studies published up to 2026 investigating tibial component positioning, malalignment, associated complications, and revision strategies in TAR were included and qualitatively analyzed. Results: Tibial component malalignment is a multifactorial condition influenced by preoperative deformities, patient-specific anatomy, surgical technique, instrumentation, and surgeon experience. Malposition in the coronal, sagittal, or axial planes alters ankle biomechanics, resulting in abnormal load distribution, altered kinematics, polyethylene wear, instability, and increased stress at the bone–implant interface. These changes may lead to pain, aseptic loosening, subsidence, osteolysis, and ultimately prosthetic failure. Weight-bearing radiographs remain the standard imaging modality for postoperative assessment, while weight-bearing computed tomography provides complementary three-dimensional evaluation, particularly in complex cases. Management should be individualized according to implant stability, degree of deformity, and symptom severity, ranging from supramalleolar osteotomy and isolated polyethylene insert exchange to partial or complete revision arthroplasty, including the use of custom implants in cases of substantial bone loss. Conclusions: Tibial component malalignment represents a critical determinant of functional outcomes and implant survivorship following TAR. Early recognition through standardized imaging and a thorough understanding of its biomechanical and clinical implications are essential to optimize treatment strategies, minimize revision rates, and improve long-term outcomes after total ankle replacement.

Background: Calcaneal fractures are complex injuries frequently associated with significant soft tissue damage and a high risk of post-operative complications, particularly infection. Despite advances in surgical techniques, infectious complications remain a major cause of morbidity and can severely compromise functional outcomes. The aim of this systematic review was to analyze the incidence, management strategies, and clinical impact of infectious complications following surgical treatment of calcaneal fractures. Methods: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science in accordance with PRISMA guidelines, including studies published up to May 2025. Randomized controlled trials and prospective and retrospective cohort studies involving adult patients surgically treated for calcaneal fractures and reporting post-operative infectious outcomes were included. Data extraction focused on patient demographics, fracture characteristics, surgical techniques, infection rates, microbiological findings, management strategies, complications, and functional outcomes. Methodological quality and risk of bias were assessed using the MINORS score. Due to substantial heterogeneity, results were synthesized descriptively. Results: Forty studies met the inclusion criteria, encompassing 5343 patients and 4638 surgically treated calcaneal fractures. Displaced intra-articular fractures predominated, with Sanders type II and III accounting for 79.8% of classified fractures, while Sanders type IV fractures represented 20.2% and were associated with higher complication rates. The overall post-operative infection rate was 9.4%, including 6.3% superficial surgical site infections and 3.0% deep infections. Open fractures accounted for 7.5% of reported cases and demonstrated markedly higher infection rates than closed injuries. Deep infections frequently required implant removal (62%), prolonged intravenous antibiotic therapy (100%), and additional surgical procedures (71%). Staphylococcus aureus, including methicillin-resistant strains, was the most commonly isolated pathogen. Functional outcomes were consistently worse in patients who developed infections. Conclusions: Infectious complications remain a clinically significant problem following surgical treatment of calcaneal fractures, particularly in severe fracture patterns, open injuries, and patients with relevant comorbidities. Deep infections are associated with substantial morbidity and inferior functional outcomes. Optimization of patient-related risk factors, careful surgical planning, and the selective use of minimally invasive approaches may help reduce infection risk. Further high-quality prospective studies with standardized outcome measures are needed to define optimal management strategies.