Introduction. Ankle fractures are common injuries presenting to trauma departments and ankle open reduction and internal fixation (ORIF) is one of the first procedures targeted in early orthopaedic training. Failure to address the fracture pattern with the appropriate surgical technique and hardware may lead to early failure resulting in revision procedures or premature degenerative change. Patients undergoing revision ORIF are known to be at much greater risk of complications, and many of these secondary procedures may be preventable. Method. A retrospective analysis of all patients attending our unit for ankle ORIF over a two year period was undertaken. Patients were identified from our Bluespier database and a review of X rays was undertaken. All patients undergoing re-operation within eight weeks of the primary procedure were studied. The cause of primary failure was established and potential contributing patient and surgical factors were recorded. Results. 236 patients undergoing ankle ORIF were identified. 13 patients (5.5%) returned to theatre for a secondary procedure within eight weeks. Within this group, 7 (54%) patients returned for treatment of a neglected or under treated syndesmotic injury, 3 (23%) for complete failure of fixation, 2 (15%) with wound problems and 1 (8%) for medial malleoulus mal-reduction. Of the patient group, 5 (38%) were known type 2 diabetics. Consultants performed 2 (15%) of procedures, supervised registrars 5 (39%) and unsupervised registrars 6 (46%) operations. Conclusion. Errors are being made at all levels of training in applying basic principles such as restoring fibula length and screening the syndesmosis intra-operatively. Appropriate placement and selection of hardware is not always being deployed in osteopenic bone resulting in premature failure of fixation and fracture patterns are not being fully appreciated. Patients are undergoing preventable secondary procedures in the operative treatment of ankle fractures

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.

Introduction. Longstanding complex muliplanar foot deformities represent a significant challenge. The traditional surgical techniques involve excessive dissection and excision of large bony wedges or modifications of the triple fusion to correct the deformity. The majority of the reports in the literature present collective data on different deformity patterns and also mix paediatric and adult patients, even with multiple correction techniques. The aim of this study was to evaluate the clinical, radiological and functional outcomes of the gradual correction of a single common deformity pattern of equino-cavo-varus using a single correction technique of the V-osteotomy and the Ilizarov frame. Material and methods. We present prospectively collected data on 40 feet in 35 adult patients with stiff longstanding equino-cavo-varus deformity. All patients had a V-osteotomy and gradual correction using an Ilizarov frame, with a mean follow-up of 20 months. We collected the American Orthopaedic Foot and Ankle Scocity score (AOFAS), the Foot and Ankle Disability Index (FADI) and a Visual Analogue Pain score (VAS) for all ptients preoperatively and between 1 and 2 years following frame removal. Results. In 33 patients (38 feet) a stable plantigrade foot was achieved with significant improvement in the gait and the foot alignment. The mean equinus, heel varus and metatarsus adductus improved significantly as measured on x-rays. The mean AOFAS score improved from 38.2 to 73.2, the mean FADI improved from 51.1 to 70.6 and the mean VAS improved from 4.5 to 0.5. Pin-site infection was encountered in 7 feet, premature consolidation in 2 feet and undercorrection in 4 feet. In 2 patients the correction had to be stopped. Conclusion. The results of this report on a single deformity pattern of equino-cavo-varus support the use of this technique for the management of these challenging cases, as a safe, versatile and powerful tool with predictable outcome

Data is scant on the critical question of whether patients with endstage ankle arthritis are better served by a fusion or a replacement. The STAR trial, a prospective case control study, comparing safety and efficacy of STAR ankle replacement at 24 months for 158 replacements and 66 fusions:. This FDA trial showed the STAR ankle replacement had better function, equivalent pain relief and a higher rate of complications and secondary procedures as ankles treated with fusion. A separate prospective cohort comparison of 200 ankle replacements vs. 94 ankle fusions performed by the collaborative consortium of Canadian Orthopaedic Foot and Ankle Surgeons (COFAS) suggests similar patient oriented outcomes at 24 months. Patients' self-assessment questionnaires do not show significant differences between the two groups. The main medium/long-term concerns with ankle replacement remain component subsidence (especially talar subsidence) and polyethylene wear. Forces across the ankle are considerable, and the orientation of those forces to the underlying trabecular structure are a concern. Whether 2 or 3 part ankles will provide better bearing wear results remains unknown. With older designs, at 10 years the Swedish registry found approximately 60% survivorship. This registry has also shown better survivorship in patients with rheumatoid disease and with increased surgeon experience. More recent results related to the Hintegra and AES components show better midterm (5 year) revision rates in selected surgeons hands, than seen with older designs. A large meta-analysis of ankle fusion and replacement published data by Haddad et al reported a mean nonunion rate of 10%. The main long-term concerns with ankle fusion are limitations of motion, and the development of premature arthritis in adjacent foot joints. In a study of an average of 9 year outcome of the Agility ankle replacement suggested that the incidence secondary arthritis is halved by replacement as compared to fusion

Aims

Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°.

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Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens.

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We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants.

Aims

The aim of this study was to describe the technique of distraction osteogenesis followed by arthrodesis using internal fixation to manage complex conditions of the ankle, and to present the results of this technique.

The purpose of this study was to evaluate the change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA) for osteoarthritis and to investigate factors affecting the restoration of alignment.

This retrospective study included 119 patients (120 ankles) who underwent three component TAA using the Hintegra prosthesis. A total of 63 ankles had anterior displacement of the talus before surgery (group A), 49 had alignment in the normal range (group B), and eight had posterior displacement of the talus (group C). Ankles in group A were further sub-divided into those in whom normal alignment was restored following TAA (41 ankles) and those with persistent displacement (22 ankles). Radiographic and clinical results were assessed.

Pre-operatively, the alignment in group A was significantly more varus than that in group B, and the posterior slope of the tibial plafond was greater (p < 0.01 in both cases). The posterior slope of the tibial component was strongly associated with restoration of alignment: ankles in which the alignment was restored had significantly less posterior slope (p < 0.001).

An anteriorly translated talus was restored to a normal position after TAA in most patients. We suggest that surgeons performing TAA using the Hintegra prosthesis should aim to insert the tibial component at close to 90° relative to the axis of the tibia, hence reducing posterior soft-tissue tension and allowing restoration of normal tibiotalar alignment following surgery.

Cite this article: Bone Joint J 2015;97-B:1525–32.