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The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288.

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Tarsalmetatarsal (TMT) osteoarthritis is encountered frequently. Pathology at the TMT joints play a role in continued foot fatigue and further compensation of gait laterally to avoid discomfort over the medial and central columns of the midfoot. Sequeula and further pathology to the central TMT joints are multifactorial. Recalcitrant pain, subtle instability, and arthrosis are commonly observed. Patients who fail nonoperative treatment are subjective to reconstructive surgical treatment. We present a straightforward stepwise technique for an in situ arthrodesis of the central TMT joints. We focus on the principles of the dowel arthrodesis with trephine reamers, cancellous bone plugs, and compressive locking plate fixation for a reproducible corrective midfoot fusion.