Total ankle replacement (TAR) is contraindicated in patients with significant talar collapse due to AVN and in these patients total talus body prosthesis has been proposed to restore ankle joint. To date, five studies have reported implantation of a custom-made talar body in patients with severely damaged talus, showing the limit of short-term damage of tibial and calcaneal thalamic joint surfaces. Four of this kind of implants have been performed. The first two realized with “traditional” technology CAD-CAM has been performed in active patients affected by “missing talus” and now presents a survival follow-up of 15 and 17 years. For the third patient affected by massive talus AVN we designed a 3D printed porous titanium custom talar body prosthesis fixed on the calcaneum and coupled with a TAR, first acquiring high-resolution 3D CT images of the contralateral healthy talus that was “mirroring” obtaining the volume of fractured talus in order to provide the optimal fit. Then the 3D printed implant was manufactured. The fourth concern a TAR septic mobilization with high bone loss of the talus. The “two-stage” reconstruction conducted with the implant of total tibio-talo-calcaneal prosthesis “custom made” built with the same technology 3D, entirely in titanium and using the “trabecular metal” technology for the calcaneous interface. Weightbearing has progressively allowed after 6 weeks. No complications were observed. All the implants are still in place with an overall joint mobility ranging from 40° to 60°. This treatment requires high demanding technical skills and experience with TAR and foot and ankle trauma. The 15 years survival of 2 total talar prosthesis coupled to a TAR manufactured by a CAD-CAM procedure encourages consider this 3D printed custom implant as a new alternative solution for massive AVN and traumatic missing talus in active patients.

Introduction: A minimally invasive procedure including percutaneous reduction and external fixation can be performed for Sanders’ type II, III and IV heel fractures in order to obtain a tridimensional reconstruction of the os calcis with a reduced risk of local complications, allowing for early motion.

Methods: 54 consecutive closed articular displaced cal-canear fractures in 52 patients were treated with the Orthofix Heel Mini-Fixator. Patients were followed for an average of 49 months (range, 27 to 94 months) and assessed clinically with the Maryland Foot Score and radiographically with X-rays and CT scans.

Results: Clinical results at follow-up scored excellent or good in 49/54 cases (90.7%), fair in 2 cases (3.7%) and bad in 3 cases (5.6%). Mean preoperative Böehler’s angle was 6.98° ± 12.93 (range, − 5.95–19.86), while after surgery the average value was 21.94° ± 9.36 (range, 12.58–31.30) (p < 0.01). C.T. scans were evaluated according to the S.A.VE. score, showing excellent results in 24 cases (44.4%), good results in 25 cases (46.3%), fair results in 3 cases (5.6%) and bad results in 2 cases (3.7%). Mean preoperative S.A.VE. score was 17.58 ± 4.98 (range, 12.60 – 22.56) while the postoperative score was 25.66 ± 2.44 (range, 23.22 – 28.1) (p< 0.01).

Sudeck’s atrophy was observed in 10 patients (18.6%) that healed within four months. Three pin tract superficial infections (5.6%) were resolved without removal of the device. Three patients (5.6%) showed thalamic displacement following early weight-bearing but did not require further surgery.

Conclusions: Percutaneous reduction and external fixation proved to be a reliable technique in order for obtaining stable reduction of os calcis fractures. The clinical results appear to be comparable to those obtainable with the open reduction and internal fixation, with the added advantages of being minimally invasive procedure, having substantially shorter operating times and reducing risk of complications related to surgical exposure.

Implantation of metatarso-phalangeal prostheses or spacers has been widely indicated for the replacement of the articular surfaces in severe hallux rigidus.

A reabsorbable device in poly(D-L-lactic acid) (PDLLA) which is dome-shaped with a stem for implantation into the first metatarsal, avoiding any resection of the base of the proximal phalanx, is proposed.

The rationale of the reabsorbable spacer is to maintain the distance between the articular surfaces and provide a sliding surface suitable for articulation. It is then reabsorbed and replaced by fibrous tissue, which allows motion and removes pain.

37 reabsorbable spacers have been inserted for severe hallux rigidus in 33 patients aged from 26 and 76 years (average 58). Patients were reviewed with a follow-up ranging between 36 and 96 months (average 59.5).

The results were assessed using the American Orthopaedic Foot and Ankle Society (A.O.F.A.S), hallux-metatatarsophalangeal-interphalangeal scale.

Anteroposterior and lateral weight-bearing X-rays were made preoperatively and at follow-up, evaluating the dimensions of the articular space and the length of the first metatarsal.

The chronology of device reabsorption was studied in 10 patients with M.R.I., assessing complete reabsorption within 4 months of the operation.

Excellent and good results were obtained in 91% of patients. The A.O.F.A.S. score was 43.7+/−20.6 pre-operatively and 82+/10.3 post-operatively.

The reabsorbable spacer confirmed the expectations of its protagonists. This procedure would appear to be an alternative to arthrodesis of the first metatarso-phalangeal joint or traditional permanent implants, and represents an intermediate technique between an implant and resection arthroplasty.

Introduction: Distal osteotomy of the first metatarsal is indicated in the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal using a percutaneous technique.

Methods: From 1996 to 2001 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 82 patients for the treatment of painful mild-to-moderate hallux valgus. Patients were assessed at a mean follow-up of 35.9 months employing a clinical and radiographic protocol. The American Orthopedic Foot and Ankle Society’s hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment.

Results: in 107 of the 118 cases (90.7%), patients were satisfied with the procedure. The mean score obtained in the clinical assessment using the AOFAS scale was 88.2 ± 12.9. The radiographic assessment showed significant changes (P< 0.05) in the values of the hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle and the sesamoid position at the postoperative assessment compared to preoperative values. Recurrence of the valgus deformity was observed in 3 cases (2.5%), non-painful stiffness of the first metatarsophalangeal joint in 7 (5.9%) and a deep infection resolved by antibiotic therapy in 1 (0.8%).

Conclusions: The percutaneous procedure proved to be a reliable technique for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable to those obtainable with the traditional open techniques, with the additional advantages of a minimally invasive procedure, substantially shorter operating times and a reduced risk of complications related to surgical exposure.

Distal osteotomy of the first metatarsal can be performed by a percutaneous minimally invasive procedure when indicated for the surgical treatment of hallux valgus. The intermediate-term results of percutaneous distal uniplanar osteotomy of the first metatarsal were assessed in 118 feet in 82 patients (36 bilaterally) to determine the effectiveness of the percutaneous procedure.

A modified Lamprecht – Kramer – Boesh technique was performed under distal nerve trunk anaesthesia (ankle block) without a tourniquet, using a K-wire for stabilisation of the osteotomy. No surgical approaches and no soft-tissue procedures were required. Post-operatively adhesive tape was applied and immediate weight-bearing allowed.

The patients were followed for an average of 36 months (range 24 to 78 months). Clinical assessment was based on the American Orthopaedic Foot and Ankle Society, hallux-metatarsal-phalangeal-interphalangeal (AOFAS) scale. Anteroposterior and lateral weight-bearing radiographs were performed pre- and post-operatively, and the hallux valgus angle, the first intermetatarsal angle, the distal metatarsal articular angle (DMAA) and the position of the sesamoid were recorded. The average score according to the AOFAS scale was 86.6±12.9. Patients were satisfied with the result of the procedure in 90.7% of cases. The results confirm the effectiveness of the percutaneous procedure to achieve a satisfactory distal osteotomy of the first metatarsal without the need for soft-tissue procedures in the surgical management of symptomatic hallux valgus.

Implantation of metatarso-phalangeal prostheses or spacers has been widely indicated for the replacement of the articular surfaces in severe hallux rigidus. Giannini proposed a reabsorbable device in poly(D-L-lactic acid) (PDLLA) which is dome-shaped with a stem for implantation into the first metatarsal, avoiding any resection of the base of the proximal phalanx.

The rationale for the reabsorbable spacer is to maintain the distance between the articular surfaces for a predictable time and to provide a sliding surface suitable for articulation with the proximal phalanx. It is then reabsorbed by fragmentation and replaced by fibrous tissue, which maintains the articular space, allows motion and relieves pain.

Twenty-three reabsorbable spacers have been inserted for severe hallux rigidus in 20 patients aged from 26 to 76 years (average 58). Patients were reviewed with a follow-up ranging between 24 and 50 months (average 36). The results were assessed using the American Orthopaedic Foot and Ankle Society (A.O.F.A.S), hallux-metata-tarsophalangeal-interphalangeal scale. Anteroposterior and lateral weight-bearing X-rays were made preoperatively and at follow-up, evaluating the dimensions of the articular space and the length of the first metatarsal. The chronology of device reabsorption was studied in 10 patients with M.R.I., assessing complete reabsorption within 4 months of the operation.

Excellent and good results were obtained in 91% of patients. The A.O.F.A.S. score was 43.7±20.6 pre-operatively and 82±10.3 post-operatively. The reabsorbable spacer confirmed the expectations of its supporters. This procedure would appear to be an alternative to arthrodesis of the first metatarso-phalangeal joint or traditional permanent implants and represents an intermediate technique between an implant and resection arthroplasty.