Introduction

Degenerative, inflammatory, and posttraumatic arthritis of the ankle are the primary indications for total ankle arthroplasty

Ankle arthrodesis has long been the “gold standard” for the surgical treatment

Total Ankle Arthroplasty. implant survivorship has been reported to range from 70% to 98% at three to six years

The combination of younger age and hindfoot arthrodesis or osteoarthritis may lead to a relative increase in failure rates after TAA

Intraoperative complication include malaligment, fracture and tendon Postoperative complications include syndesmotic nonunion, wound problems, infections and component instability and lysis

After TAA few difficulties mainly due to poor Talar and Tibial bone stock. It is difficult to stabilize the fusion and usually there is shortening after removal of the implant. Also there is a need for massive bone graft-allograft or autograft.

In cases when there is significant bone loss there is a need for stable reconstruction and stabilization of the hindfoot. Bone grafting with structural bone graft may collapse and it has to be stabilized with screws or nail.

Background

Hip fractures affect annually over 350,000 people in the USA and over 1.6 million worldwide. About 50% of these numbers are intertrochanteric fractures,

The surgeon should be able to minimize the morbidity associated with the fracture by: recognizing the fracture pattern, choosing the appropriate fixation device, performing accurate reductions with ideal implant placement and being conscious of implant costs. In this study we assessed the ability of the orthopaedic surgeons to recognize fractures pattern, and choosing the ideal implant for the recognized fracture.

Purpose: Describe our experience with our new approach for treating displaced subcapital femoral fractures in our active patients.

Materials and Methods: From August 2005 till January 2008, 79 active patients were treated for displaced Sub-capital Femoral fracture by close reduction and internal fixation with Short Trochanteric Antegrade Nail (T.A.N.) (Smith& Nephew).

Mean age 74.5 (range 38–93),

Partial weight bearing began 0–4 weeks post operation and Full Weight Bearing 4–8 weeks post operation.

Patients were evaluated at 1,2,6,12& 24 months after the operation.

Results: All patients returned to walk on their feet.

The patients were scored by modified lower extremity questionnaire with mean results 4.1 (scale of 1–5, 1-poor, 5-excellent).

There were no cases of implant failure. No cases of infections.

Two patients had a cut-out of the implant and two other patients had a nonunion of the fracture. Those 4 patients (5.06%) were converted to a THR.

There were no cases of avascular necrosis.

Conclusions: Our complications rate for displaced sub-capital fractures treated by C.R.I.F. were lower than that reported for the alternative treatment modality. Our findings show that these fractures can be treated with a high rate of success by closed reduction and internal fixation with an intramedullary biaxial fixation in all age groups. With this simple and minimally invasive operation and the nail’s biaxial angular stability, we can achieve stable fixation.

This procedure offers several advantages over hemiarthroplasty, by lowering the risk of immediate complications such as prolonged anesthesia, bleeding, infection, periprosthetic fractures and dislocations. Furthermore, the use of the short TAN preserves the femoral head and the normal anatomy in active patients in order to avoid the late complications of hemiarthroplasty.

Purpose: To report our experience in diagnosis and treatment of Osteoid Osteoma in the foot and ankle.

Material and Methods: Six patients, 4 males and 2 females, mean age 24 (range 17–40), were diagnosed, suffering of osteoid osteoma of the foot and ankle in our outpatients clinic. All the patients had typical spontaneous pain and night pain improved by NSAIDs. In all patients, the diagnosis was delayed for one – two years. Treatment by Computed Tomography guided percutaneous radiofrequency ablation was performed in 4 patients, one patient underwent CT guided curettage and one underwent open excision and local bone graft of the lesion. In patients treated by RF, the lesions were heated three times to 90° for 2 minutes. All the procedures were done under ankle block and local anesthesia. Patients were evaluated in our outpatients foot and ankle clinic 1–2 years following the procedure.

Results: The Osteoid Osteoma was found in the talus of two patients and one in the cuboid, one in the base of third metatarsus, one in the calcaneus and one in the ankle. In all patients most of the pain was resolved within 3 days of the procedure. In 3 patients after a year there was still mild pain at tremendous physical efforts attributed to minimal damage to adjacent joint. Three patients completely recovered including pain free physical efforts. CT at follow-up in 2 patients revealed no pathology of the involved bones.

Conclusions: OO is an uncommon affection in the foot and ankle. The diagnosis is difficult and usually there is delayed. CT guided percutaneous radiofrequency of the foot is a safe and effective. The procedure can be performed under ankle block and local anesthesia.

The Purpose: To compare clinical results of proximal humerus fractures following internal fixation with proximal humeral locked plate versus conservative treatment.

Materials and Methods: 25 patients sustained 3-part fractures of the proximal humerus. 8 were internally fixed and 17 were treated conservatively in two different centers.

Mean age: 65.4±12.7 Gender: 22 females, 3 males. Age and gender were similar in both groups. Follow up was longer in the conservative group (23.8 m ±7.5) compared to the operated one (11.1 m ±8.3).

All the patients were evaluated clinically using Constant’s score.

Statistical analysis was performed using Fisher’s exact test (examination rates differences), Mann-Whitney test (examination means difference) and Spearman’s test (evaluation of the correlation coefficient between two continuous variables).

Results: Constant’s score in the operated group was 57.1±19.3 and 58±21.5 in the conservative group. Union was noticed in all the operated patients, and there was one case of nonunion in the conservative group. There were no cases of AVN in any group.

Statistical Analysis: No significant difference between the two groups was found for total Constant’s score. ROM was similar in both groups except for the rotations, which tended to be better in the operated group: IR 7.6±2.6 versus 5.4±3.3 (p=0.103) respectively, ER 7.7±3.1 versus 6±2.6 (p=0.169) respectively.

Conclusions: Clinical results are similar for operative and conservative treatments in 3 part fractures of the proximal humerus. There are better results for rotations in the operated group. Strength in abduction is superior in the conservative group.

The difference could be influenced by the shorter follow–up period in the operated group.