Introduction:

The role of total ankle replacements remains unproven within orthopaedic literature. We present a prospective series of patients who underwent a SALTO TAR (Tornier) between October 2006 and January 2014.

Introduction:

Open reduction and internal fixation of displaced intra-articular calcaneal fractures is susceptible to a high incidence of wound complications. Displaced fractures create abnormal contact characteristics at the subtalar joint, resulting in poor functional outcome and arthritis. We present the functional outcomes of 32 fractures (Sanders 2 and 3) at an average follow up of two years.

Introduction

We present a consecutive series of 19 patients with 22 intra-articular calcaneal fractures treated by percutaneous arthroscopic fixation (percutaneous arthroscopic calcaneal osteosynthesis “PACO”). Traditional open reduction and fixation regularly has significant wound complications. PACO has the advantage of direct visualization of the joint surface reduction with the benefit of minimal soft tissue trauma and wound complications.

Background: Complex tibiotalar (TT) and tibiotalocalcaneal (TTC) fusions are performed for significant ankle and hindfoot arthritis and/or deformity. Literature suggests several methods of fixation including crossed screws, plates, nail and external fixation. These are technically difficult operations with reported complication rates as high as 30–80%. We present a retrospective cohort study of angle blade plate and PHILOS plate fixation for these patients in our hospital.

Methods: This study describes 21 consecutive patients with 22 TT or TTC fusions between December 2005 and May 2009. The surgery was performed for severe deformity or arthritis as a result of: osteoarthritis(2), post-traumatic arthritis(4), rheumatoid arthritis (7), Charcot arthropathy (5), avascular necrosis(1), and post traumatic avascular necrosis (3). The senior author performed all of the operations. In the first ten cases (two TT and eight TTC) an angle blade plate was used, A PHILOS plate was used in the subsequent ten cases (three TT and seven TTC). One patient had bilateral TTC fusions with a blade plate on one side and a PHILOS plate on the other. There were eight male and 13 female patients. All the procedures were performed through a lateral transfibular approach. The patients were followed up regularly with clinical and radiological evaluation until union or otherwise.

Results: Fusion was achieved in 19 out of 21 patients (90.5%) and 20 out of 22 arthrodeses (90.9%). All five TT fusions went on to union (100%). Fifteen out of 17 TTC fusions united (88.2%). One TTC fusion using an angle blade plate needed revision surgery for non-union of subtalar joint. In the PHILOS group one patient developed MRSA infection of the surgical site leading to non-union. This necessiated removal of metal and prolonged treatment with intravenous antibiotics. The patient now has a relatively painless fibrous ankylosis.

Conclusion: TT and TTC fusions are complex operations performed for severe arthritis and deformity, often on patients with significant co-morbidities. It is a salvage procedure to relieve pain and/or correct deformity of the foot and ankle. This study suggests that both the angle blade plate and PHILOS plate provide a stable fixed angle construct, which achieves a high rate of bony union with alignment correction.

Background: The incidence of nerve injury following ankle arthroscopy has a documented rate of 1% to 24%1-15. The intermediate branch of the superficial peroneal nerve is at most risk with an antero-lateral portal incision 6, 9–12. The superficial peroneal nerve (SPN) is often marked as part of pre-operative planning,1 despite there being little evidence of the effectiveness of this simple measure in reducing nerve injury in ankle arthroscopies.

Methods: We reviewed 100 consecutive cases who had an anterior ankle arthroscopy between February 2005 and April 2009. All arthroscopies were performed by a single surgeon (PFR) with pre-operative marking of the SPN. All patients were interviewed by telephone to find out if there had been any temporary or long-term neurological problems following the surgery. Any patients with neurological complications were reviewed in clinic. Patients’ notes were reviewed for any documented complications. Their level of satisfaction and improvement of symptoms were also assessed.

Results: We were able to trace 98% of patients. The average follow up was 15.3 months (1 to 39 months). The only neurological deficit in this series was in one case (1%) who developed sensory loss in the distribution of the medial branch of the SPN. 61% of the cases were highly-satisfied/satisfied, 23% were moderately satisfied and 16% were not satisfied with the outcome of their surgery. The reason quoted by the 16% unsatisfied patients was failure to improve their symptoms to their expected level or their need for another operation (41% of the unsatisfied group)

Conclusion: The incidence of nerve injury in our series was 1%. This is a dramatic improvement on the majority of published studies 1–15. We believe that marking the SPN prior to surgery is a simple and essential measure in reducing the neurological complications of ankle arthroscopy.

Isolated arthrodesis of the subtalar joint has the advantage that it preserves some motion at the midfoot. In cadaveric studies, movement at the Talonavicular joint is reduced by up to 74% and at the Calcaneocuboid joint by up to 44%. This allows some midfoot flexibility, which would not occur with a triple arthrodesis.

There are several methods of performing a subtalar arthrodesis, broadly divided into extra or intra articular techniques, using structural or cancellous bone graft and a variety of fixation methods.

Earlier studies on primary arthrodesis have shown rate of non union from 0 – 6%. More recently, larger studies have reported higher rates of non union from 14 – 17%.

We present the results of 95 subtalar fusions performed with a standard technique, using one screw from the calcaneum to the talar dome, with 100% follow up.

Between 1993 and 2003 the senior author performed 105 subtalar arthrodeses. We performed a retrospective chart review. All patients with a primary subtalar fusion were included. All cases had been refractory to conservative therapy.

The senior author reviewed all patients until fusion had occurred or a diagnosis of nonunion was established. Fusion was diagnosed when the patient were pain free while fully weight bearing, with a clinically rigid subtalar joint and radiographs showing trabeculae crossing the arthrodesis. A CT scan was performed in all cases where nonunion was suspected, and the patient complained of persistent pain.

A total of ninety five subtalar arthrodeses were performed in ninety two patients. All were reviewed with clinical and radiological examination, until union had occurred or nonunion diagnosed. The average time to union was 5.0 months, range 3 – 12 months. The outcomes, graded using the method of Angus and Cowell, were 21 Fair, 7 Poor and 67 Good results

Introduction and Aims: Non-union following triple arthrodesis has been significant, up to 23%. Iliac crest bone grafting and internal fixation has reduced this to 0–4%. Harvesting bone graft incurs significant donor site morbidity and may be unnecessary. We present the results of 100 triple arthrodeses performed with local graft, avoiding donor site complications.

Method: Between January 1993 and July 2002 the senior author performed 112 triple arthrodeses. We performed a retrospective chart review, evaluating the incidence of union and the post-operative complications, with a minimum follow-up of six months. For this study, we excluded all (seven) revision fusions, and all (five) fusions using iliac crest or other donor site graft (e.g. calcaneus or tibia). One hundred fusions were performed using a standard technique with internal fixation and without supplementary bone graft. All patients were reviewed until fusion had occurred or non-union declared.

Results: Ninety-six patients had one hundred triple arthrodeses, with an average age of 58 years. Fifty fusions were performed for posterior tibial tendon deficiency, 20 for rheumatoid arthritis, seven for osteoarthritis and 12 for post-traumatic osteoarthritis. The remaining 11 cases included: tarsal coalition, psoriatic arthritis and polio. There were 26 males and 74 females, with 37 fusions performed on the right foot and 73 on the left. The average time to union was 5.4 months (range 3–24) with three patients developing non-unions. Of the three patients diagnosed with a non-union, two had fair outcomes and elected to be treated non-operatively. The third non-union had a poor result, and achieved a successful outcome following revision. Overall, there were 74 good outcomes, 22 fair and four poor results. The complications following surgery included: nine wound infections, one DVT, one malunion and seven cases of prominent screws, requiring removal. The one patient with malunion was successfully revised at two years.

Conclusion: The majority of authors advocate the use of iliac crest bone graft during triple arthrodesis. However, harvesting iliac crest graft has a significant short and long-term morbidity. This study indicates that comparable rates of union are achieved without the need for supplementary bone graft and thereby avoiding donor site morbidity.