The December 2022 Foot & Ankle Roundup³⁶⁰ looks at: Evans calcaneal osteotomy and multiplanar correction in flat foot deformity; Inflammatory biomarkers in tibialis posterior tendon dysfunction; Takedown of ankle fusions and conversion to total ankle arthroplasty; Surgical incision closure with three different materials; Absorbable sutures are not inferior to nonabsorbable sutures for tendo Achilles repair; Zadek’s osteotomy is a reliable technique for treating Haglund’s syndrome; How to best assess patient limitations after acute Achilles tendon injury; Advances in the management of infected nonunion of the foot and ankle.

Aims

This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes.

Aims

The proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs).

We describe a 13-year-old boy with atrophic tibial pseudarthrosis associated with neurofibromatosis who had undergone nine unsuccessful operations. Eventually, union was obtained by the use of bone morphogenetic protein 7 in conjunction with intramedullary stabilisation and autologous bone graft

Tönnis triple pelvic osteotomy is an accepted technique to correct acetabular dysplasia and degenerative labral pathology. A series of 409 consecutive patients who underwent a triple pelvic osteotomy between 1987 and 1999 were followed for a mean of 7.1 years (2 to 15). Five patients (1.2%), all women, developed a double nonunion and required revision, which involved excision of the pseudarthrosis, autologous bone grafting and osteosynthesis with screws or reconstruction plates. Bony healing was achieved in all after a mean of 7.8 months

Stress fractures of the tarsal navicular do not heal predictably with conservative treatment, so we recommend operation if the fracture remains symptomatic, and radiographs show wide separation of a complete fracture, extension of an incomplete fracture, delayed healing, or a medullary cyst. An autologous bone graft is inserted after en-bloc resection of the fracture surfaces. It is important that the fracture is fully exposed to its distal limits before the graft is inserted. We have grafted 19 fractures in 18 patients. Six fractures were complete, 12 incomplete and one had a residual medullary cyst. Of the 15 patients with adequate follow-up, 12 had been able to return to a pre-injury level of activity by five to 12 months

Spines are often stabilised posteriorly by internal fixation and anteriorly by a bone graft. The effect of an autologous bone graft from the iliac crest on implant loads is unknown. We used an internal spinal fixation device with telemetry to measure implant loads for several body positions and activities in nine patients before and after anterior interbody fusion. With the body upright, implant loads were often higher after than before fusion using a bone graft. Distraction of the bridged region led to high implant loads in patients with a fractured vertebra and to marked changes in load in those with degenerative instability. Leaving the lower of the bridged intervertebral discs intact led to only small changes in fixator load after anterior interbody fusion. A bone graft alone does not guarantee a reduction of implant loads

Demineralised homologous bone-matrix implant was used to bridge a large circumferential osteoperiosteal gap in the diaphysis of the ulna of rabbits. Periodic observations of the graft were made clinically, radiologically, histologically and by tetracycline fluorescence up to forty-two weeks. By the twelfth week after operation 81 per cent of the animals revealed bone formation in the implant and complete bridging of the gap. The new bone was laid on the surface and in the substance of the matrix, suggesting that the inductive principle was acting locally. The bone, once formed, remodelled to the texture of a mature tubular bone and did not undergo absorption during a long follow-up period. Demineralise bone-matrix proved to be a highly osteoinductive and readily osteoconductive material. The graft did not evoke any appreciable local foreign-body or immunogenic reaction. The high degree of success in bridging massive bone defects justifies further serious studies and hopes for a useful substitute for massive autologous bone grafts

Aims

The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle.

Aims

The purpose of this study was to: review the efficacy of the induced membrane technique (IMT), also known as the Masquelet technique; and investigate the relationship between patient factors and technique variations on the outcomes of the IMT.

Aims

The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.

Aims

Treatment of chronic osteomyelitis (COM) for young patients remains a challenge. Large bone deficiencies secondary to COM can be treated using induced membrane technique (IMT). However, it is unclear which type of bone graft is optimal. The goal of the study was to determine the clinical effectiveness of bone marrow concentrator modified allograft (BMCA) versus bone marrow aspirate mixed allograft (BMAA) for children with COM of long bones.

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°.

Aims

We compared the clinical outcomes of curved intertrochanteric varus osteotomy (CVO) with bone impaction grafting (BIG) with CVO alone for the treatment of osteonecrosis of the femoral head (ONFH).

One hundred and fifty patients in Hong Kong with a diagnosis of tuberculosis of the thoracic, thoracolumbar or lumbar spine were allocated a random to the "Hong Kong" radical resection of the lesion and the insertion of autologous bone grafts (Rad. series) or to debridement of the spinal focus without bone grafting (Deb. series). All patients received daily chemotherapy with para-aminosalicylic acid (PAS) plus isoniazid for 18 months, with streptomycin for the first three months. After exclusions, the main analyses of this report concern 119 patients (58 Rad., 61 Deb.) followed up for 10 years. During the first five years the allocated regimen was modified because of the spinal lesion in 14 patients, but there were no further modifications between five and 10 years. No patient developed a sinus or clinically evident abscess or a neurological abnormality between five and 10 years. Bony fusion occurred earlier and in a higher proportion of patients in the Rad, series but at five and 10 years there was vary little difference between the series. Over the period of 10 years there was a mean increase in vertebral loss of 0.05 of a vertebral body in the Rad. series and 0.23 in the Deb. series. In both series most of this loss occurred in the first 18 months, with very little subsequent change in the next eight and a half years. Over the 10 years there was a mean reduction in the angle of kyphosis in the Rad. series of 1.4 degrees for patients with thoracic and thoracolumbar lesions and 0.5 degrees for those with lumbar lesions. By contrast, in the Deb. series there were mean increases in the angle of 9.8 degrees and 7.6 degrees respectively. In both series most of the changes had occurred early, and persisted subsequently. At 10 years 57 of 58 Rad. and all 61 Deb. patients had a favourable status, 50 (86 per cent) and 54 (89 per cent) respectively on the allocated regimen without modification