Aims

Anatomical atlases document classical safe corridors for the placement of transosseous fine wires through the calcaneum during circular frame external fixation. During this process, the posterior tibial neurovascular bundle (PTNVB) is placed at risk, though this has not been previously quantified. We describe a cadaveric study to investigate a safe technique for posterolateral to anteromedial fine wire insertion through the body of the calcaneum.

Introduction:. TTC fusion for the salvage of failed TARs with significant bone loss using a hindfoot nail and femoral head allograft has been reported in a number of small series. We present our experience of this procedure. Method:. Review of the theatre records from 2006 to July 2011 identified twenty four cases using this technique. The case notes and imaging were retrospectively reviewed. Results:. Overall eighteen of the twenty four cases had achieved union (mean time 18.8 months). Of this number two had under gone a revision hindfoot nailing and another case needed revision with a circular frame. A further three cases required dynamisation to unite. There were five non unions and one loss to follow up (at two months). Complications included one deep infection (non union) and one case with chronic regional pain syndrome. Metalwork complications included five nail fractures and five cases that required prominent screw removal. Conclusions:. This is the largest series reported using this technique for the salvage of failed TARs with significant bone loss. Other smaller series using this technique have reported union rates around fifty per cent. The time to union is long and half of these cases required further procedures during this course. This is important to reflect when consenting the patient for this type of surgery

Aim. Young patients with ankle arthritis that remains symptomatic in spite of conservative treatment and following arthroscopic debridement are usually offered either ankle fusion or ankle replacement. Both these options are far from ideal in this age group. The aim of this study was to evaluate functional outcomes following ankle distraction to determine whether it is a reliable alternative for the treatment of ankle arthritis in young adults. Material and methods. Data was collected prospectively for 15 patients (9 males and 6 females, mean age 31.9 years) with “stage 2” ankle arthritis who failed conservative treatment and continued to be symptomatic following arthroscopic ankle debridement. Distraction of 8 mm was done using a dynamic constrained ankle circular frame and all patients were allowed full weight bearing all through the distraction process. The subjective functional evaluation was based on the American Orthopaedic Foot and Ankle Score (AOFAS), the Foot Disability Index (FADI) and the Visual Analogue Score (VAS). In 10 patients the Manchester Oxford Foot questionnaire (MOXFQ) and the Short Form (SF) 12 patient satisfaction questionnaire were also filled preoperatively and at final follow up. Results. At a minimum follow-up of 24 months (mean 34.4) none of the patients required fusion or replacement. There was a significant improvement in all the functional outcome scores. There was also a significant improvement in the ankle joint space on weight bearing x-rays. Conclusion. Based on these results the use of ankle distraction can be considered a useful option for the treatment of symptomatic “stage 2” ankle arthritis in young adults. Longer-term follow-up and comparison with alternative techniques will be required to evaluate the true effectiveness of this treatment option

Numerous techniques are used for the fusion of failed TAR. We wish to report our results of the revision of failed TAR to fusion. Between July 2005 and February 2011 the senior author had performed 20 arthrodeses in 19 patients (13 male and 6 female) who had failed total ankle arthroplasty (TAR). Their mean age was 63.5 years. All of them had the AES total ankle replacement. (Biomet UK). The mean period from the original TAR to fusion was 51 months (6 to72). The indication for revision of TAR to fusion was septic loosening in 4 patients and osteolysis and or aseptic loosening in 16 cases. Three types of fusion techniques were used. The mean follow-up was 15 months. All 3 tibiotalar arthrodeses with screws alone fused successfully. Of the 13 patients where the fusion was augmented with an Ilizarov frame, 4 were done for septic loosening. There were 2 non unions of which one was stable without pain and the other required a further revision fusion with a frame and subsequently fused. Of the 9 patients who had a fusion with a frame for osteolysis and or aseptic loosening, there was one non union which was revised to a tibiotalocalacaneal fusion with a hind foot nail. The nail fractured at the level of the posterior oblique screw hole. The patient subsequently developed a relatively pain free non-union of the tibiotalar joint and not required further surgical intervention. The remaining 8 ankles fused at a mean of 5 months. The average time of frame removal was 17 weeks. There was four pin-site infection all of which settled with oral antibiotics. 5 patients had tibiotalocalacaneal fusion with a hind foot nail. The indication for the hind foot nail was significant osteolysis and loss of talar bone stock. The average shortening as a result of the fusion for the failed TAR was 1.5cms. Our results were comparable to the previous reports of arthrodesis for failed total ankle replacement. We recommend the use of tibiotalocalcaneal fusion with a hind foot nail in the presence of severe osteolysis or accompanying subtalar arthritis. In the presence of good bone stock an ankle fusion supplemented with a circular frame gives a good predictable outcome

Aims

To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle.

Aims

In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method.

The last decade has seen a considerable increase in the use of in total ankle arthroplasty (TAA) to treat patients with end-stage arthritis of the ankle. However, the longevity of the implants is still far from that of total knee and hip arthroplasties.

The aim of this review is to outline a diagnostic and treatment algorithm for the painful TAA to be used when considering revision surgery.

Cite this article: Bone Joint J 2017;99-B:5–11.

Salvage of a failed total ankle replacement is technically challenging and although a revision procedure may be desirable, a large amount of bone loss or infection may preclude this. Arthrodesis can be difficult to achieve and is usually associated with considerable shortening of the limb.

We describe a technique for restoring talar height using an allograft from the femoral head compressed by an intramedullary nail. Three patients with aseptic loosening were treated successfully by this method with excellent symptomatic relief at a mean follow-up of 32 months (13 to 50).