Ankle arthroplasty with custom-made talar component is used to avoid talar subsidence, one of the most common causes of ankle prosthesis failure. We have used Agility ankle system with custom-made talar component to treat young patients with postraumatic arthritis, revision arthroplasty and takedown ankle arthrodesis. Ankle substitution was indicated in young patients who refused arthrodesis and understood that revision or additional surgery would be inevitable in the future. Twelve cases were revised with a minimum of nine months of follow-up, females, 2; males, 10; average age, 42 years. Primary replacements were performed in 9 patients, takedown fusion in 2 and revision arthroplasty in 1. Other additional procedures as subtalar fusion (8 cases), calcaneal osteotomies (6), medial column reconstruction (2), anterior compartment tendon lengthening (2 cases) and TAL or gastrocnemius lengthening (12 cases) and reoperation were also revised. Early complications included a fracture of the malleoli in 1 ankle and a dehiscence of the principal wound in 1 case. The mean postoperative ankle ROM was 32° (range 10°–40°) in comparison with preoperatively (0° –15°). The postoperative functional results were evaluated with the SMFA (Short Musculoskeletal Function Assessment) score system and a visual analog pain scale (VAS Questionnaire). The average preoperative SMFA and VAS scores for all patients was, 40,6 and 8,1 respectively. Postoperatively, these scores averaged 18,9 and 2,0 respectively. Those patients with conversion to ankle arthroplasty presented more stiffness after surgery and had required more rehabilitation time. Despite short-term follow-up, talar stems may provide an excellent alternative for the difficult problem of talar subsidence in young patients in total ankle arthroplasty, with good results and restoration of ankle function.

Introduction: There are protocols on the management of polytrauma in obstetric patients. However, there is little information about osteo-articular injuries sustained in these patients. The object of this study is to review the management of these patients and to suggest a guideline.

Material and method: Inclusion criteria: Pregnant patients treated during the last 6 years, treated as inpatients in our center during pregnancy due to osteo-articular injuries.

Variables studied: Gestational age, mechanism of injury, fracture type, management, termination of pregnancy and sequelae.

Results: We treated 13 patients with 21 fractures in our center, with an incidenc of 2,13 fractures/10.000 births. The mechanism of injury was low degree trauma in 6 cases (60% 3rd trimester) and high-degree in 7 (83% 1st and 2nd trimester). There was a predominance of lower extremity fractures, especially tibia and fibula (7 cases) and pelvis (3 cases).

Gestational age was 1st trimester (3 cases), 2nd trimester (5 cases), 3rd trimester (5 cases). 10 women were treated surgically, 8 before finishing gestation. Gestation ended as and induced abortion (3 cases, 1 due to fetal death and 2 due to teratogenic risk), and birth (10 cases, all alive, 50% eutocic). Only 3 babies needed type II or type III neonatal reanimation.

CONCLUSIONS: Pregnant women can get injured by low-energy trauma, especially during the third trimester. Pregnancy does not necessarily compromise surgical management of fractures. We review diagnostic and therapeutic management strategies for these patients.