Aims. This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods. A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results. A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion. This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I. Cite this article: Bone Jt Open 2021;2(10):842–849

The Lisfranc fracture dislocation of the tarsometatarsal joint (TMTJ) is a complex injury with a reported incidence of 9.2 to 14/100,000 person-years. Lisfranc fixation involves dorsal bridge plating, transarticular screws, combination or primary arthrodesis. We aimed to identify predictors of poor patient reported outcome measures at long term follow up after operative intervention. 127 patients underwent Lisfranc fixation at our Level One Trauma Centre between November 2007 and July 2013. At mean follow-up of 10.7 years (8.0-13.9), 85 patients (66.92%) were successfully contacted. Epidemiological data including age, gender and mechanism of injury and fracture characteristics such as number of columns injured, direction of subluxation/dislocation and classification based on those proposed by Hardcastle and Lau were recorded. Descriptive analysis was performed to compare our primary outcomes (AOFAS and FFI scores). Univariate analysis and multivariate regression analysis was done adjusted for age and sex to compare the entirety of our data set. P<0.05 was considered significant. The primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Foot Function Index (FFI). The number of columns involved in the injury best predicts functional outcomes (FFI, P <0.05, AOFAS, P<0.05) with more columns involved resulting in poorer outcomes. Functional outcomes were not significantly associated with any of the fixation groups (FFI, P = 0.21, AOFAS, P = 0.14). Injury type by Myerson classification systems (FFI, P = 0.17, AOFAS, P = 0.58) or open versus closed status (FFI, P = 0.29, AOFAS, P = 0.20) was also not significantly associated with any fixation group. We concluded that 10 years post-surgery, patients generally had a good functional outcome with minimal complications. Prognosis of functional outcomes is based on number of columns involved and injured. Sagittal plane disruption, mechanism and fracture type does not seem to make a difference in outcomes

Aim. Reconstruction of composite soft-tissue defects with extensor apparatus deficiency in patients with periprosthetic joint infection (PJI) of the knee is challenging. We present a single-centre multidisciplinary orthoplastic treatment concept based on a retrospective outcome analysis over 20 years. Method. One-hundred sixty-seven patients had PJI after total knee arthroplasty. Plastic surgical reconstruction of a concomitant perigenicular soft-tissue defect was indicated in 49 patients. Of these, seven presented with extensor apparatus deficiency. Results. One patient underwent primary arthrodesis and six patients underwent autologous reconstruction of the extensor apparatus. The principle to reconstruct missing tissue ‘like with like’ was thereby favoured: Two patients with a wide soft-tissue defect received a free anterolateral thigh flap with fascia lata; one patient with a smaller soft-tissue defect received a free sensate, extended lateral arm flap with triceps tendon; and three patients received a pedicled medial sural artery perforator gastrocnemius flap, of which one with Achilles tendon. Despite good functional results 1 year later, long-term follow-up revealed that two patients had to undergo knee arthrodesis because of recurrent infection and one patient was lost to follow-up. In parts, results have been published under doi: 10.7150/jbji.47018. Conclusions. A treatment concept and its rationale, based on a single-centre experience, is presented. It differentiates between various types of soft-tissue defects and shows reconstructive options following the concept to reconstruct ‘like with like’. Despite good results 1 year postoperatively, PJI of the knee with extensor apparatus deficiency remains a dreaded combination with a poor long-term outcome

Introduction: Darrach’s procedure is indicated for conditions were the distal radio-ulnar joint movement is painful or restricted. The procedure may be indicated at the time of wrist arthrodesis. Darrach’s procedure is not without complications and revision surgery may be indicated. Aims: To determine the success rate following wrist arthrodesis and whether Darrach’s procedure correlates to revision surgery. Methods: A retrospective case note review was performed of a consecutive series of patients who underwent wrist arthrodesis between 1991 and 2002 at our institution; performed by a single surgeon. Results: 73 patients underwent wrist arthrodesis. 39 were female and 34 male. The indications for wrist arthrodesis were rheumatoid disease, osteoarthritis, carpal instability and failed wrist arthroplasty. Successful arthrodesis was achieved in 82% (60/73) of patients, where revision arthrodesis was defined as the end point. 25% (18/73) patients underwent Darrach’s procedure at the time of their primary arthrodesis. 25% (15/60) of the patients whose primary arthrodesis was successful underwent concomitant Darrach’s procedure. 23% (3/13) of patients who underwent revision arthrodesis had undergone concomitant Darrach’s procedure during their primary arthrodesis. 77% (10/13) patients who underwent revision arthrodesis did not undergo Darrach’s procedure at the time of their primary arthrodesis. Of these 10 patients, 3 (30%) of them underwent concomitant Darrach’s procedure during revision arthrodesis. Conclusion: Wrist arthrodesis in our institution is comparable with that of published literature. The incidence of Darrach’s procedure at the time of primary wrist arthrodesis is 25%. There is a small increase to 30% in the number of patients who require Darrach’s procedure at the time of revision arthrodesis, which is not statistically significant

Lisfranc injuries are uncommon and can be challenging to manage. There is considerable variation in opinion regarding the mode of operative treatment of these injuries, with some studies preferring primary arthrodesis over traditional open reduction and internal fixation (ORIF). We aim to assess the clinical and radiological outcomes of the patients treated with ORIF in our unit. This is a retrospective study, in which all 27 consecutive patients treated with ORIF between June 2013 and October 2018 by one surgeon were included with an average follow-up of 2.4 years. All patients underwent ORIF with joint-sparing surgery by a dorsal bridging plate (DBP) for the second and third tarsometatarsal (TMT) joint, and the first TMT joint was fixed with trans-articular screws. Patients had clinical examination and radiological assessment, and completed American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Foot Function Index (FFI) questionnaires. Our early results of 22 patients (5 lost to follow-up) showed that 16 (72%) patients were pain free, walking normally without aids, and wearing normal shoes and 68% were able to run or play sports. The mean AOFAS midfoot score was 78.1 (63–100) and the average FFI was 19.5 (0.6–34). Radiological assessment confirmed that only three patients had progression to posttraumatic arthritis at the TMT joints though only one of these was clinically symptomatic. Good clinical and radiological outcomes can be achieved by ORIF in Lisfranc injuries with joint-sparing surgery using DBP

Introduction and Objectives: Our aim was to study the clinical and work-related results of minimally invasive athrodesis in the treatment of severe calcaneus fractures. Materials and Methods: A total of 50 fractures (42 patients) with intraarticular calcaneus fractures were treated by means of a minimally invasive primary arthrodesis using the VIRA. ®. (Biomet, Valencia, Spain) system with a minimum follow-up of 12 months and a mean follow-up of 21 months. Mean age was 41 years of age. Eight procedures were bilateral and 3 open. According to Sanders classification 74% were type IV. We performed a prospective study with clinical and radiographic assessment (AOFAS scale) 12 months after surgery. Results: The mean AOFAS score was 76.6 points (SD: 13.97): 26% were very good, 62% good and 12% fair to poor. There was no statistical variation of AOFAS in Sanders type of fracture, whether or not the lesion was bilateral and whether or not there was an associated lesion. We found an association (p=0.06) between the AOFAS score and the previous health status of the patient. Böhler’s angle improved slightly, although significantly (p=0.05), and there was seen to be correspondence with the postoperative AOFAS scale. Subtalar arthrodesis was achieved in 48 cases (96%) at 3 months. Discussion and Conclusions: Primary arthrodesis using minimally invasive systems is a valid option for the surgical treatment of severe fractures of the calcaneus. It provides good clinical and radiological outcomes with minimally aggressive surgery and a low complication rate

With increasing numbers of total joint arthroplasties being performed, peri-prosthetic fracture incidence is rising, and operative management remains the gold standard. Short-term survivorship up to 12 months has been well-documented but medium to long-term is almost unknown. We present survivorship review from a district general hospital, undertaking 800 primary hip and knee arthroplasties per year. Patients with peri-prosthetic fractures and background total knee replacements were identified using our computer database between 2006–2011. All patients were operated on our site; methods used include open reduction, internal fixation (ORIF) using Axsos (Stryker Newbury) locking plates (28), intra-medullary nailing (1) or complex revision (6) depending on fracture and patient factors and surgeon's preference. Mortality was assessed at 30 days, 12 months and 5 years. Thirty-four patients were identified with a 7:1 female to male ratio and mean age of 76. 75% of patients had their primary arthrodesis at our hospital. There was only 1 plate failure noted requiring revision plating. Mortality at 30 days, 12 months and 5 years were 3.2, 12.5% and 50% respectively. When compared to the literature our time interval from index surgery to fracture is considerably longer (115 vs 42 months). Further multi-centre reviews are required to further asses this unexpected finding. Overall mortality is better than our hip fracture cohort, suggesting that good results can be achieved in District Hospital. The longer-term results are encouraging and can act as a guide for patients with this injury. We recommend that patients are managed in consultant-led, multi-disciplinary teams

Background: Amputation of the distal fibula for malignant tumors is accepted practice. Few studies have reported limb salvage surgery for malignant tumors of the distal fibula. After distal fibulectomy, the main concerns are local recurrence of the tumor and ankle instability and deformity related to total resection of the lateral malleolus. Our objective was to analyze the oncologic and functional outcome of lateral malleolus en bloc resection for malignant tumors of the distal fibula, with special attention to operative techniques, reconstruction methods, and postoperative complications. Methods: The authors identified ten patients who had malignant tumors of the distal fibula requiring total resection of the lateral malleolus. The patients’ medical records, operative reports, radiographs, and the histologic specimens were reviewed. There were four children (mean age, 7.5 years) and six adults (mean age, 42.16 years). The distal metaphysis was involved in seven patients and the epiphysis in three. There were four osteosarcomas, three chondrosarcomas, two Ewing sarcomas, and one adamantinoma. The most common symptoms at presentation were a palpable mass in nine patients, ankle pain in six, and pathologic fracture in one. The mean duration of symptoms before diagnosis and treatment was nineteen months. All patients had operative treatment; two patients with osteosarcoma had perioperative chemotherapy and one patient with Ewing sarcoma had radiotherapy and chemotherapy and another patient with Ewing sarcoma had chemotherapy only. Two types of “en bloc” resection of the distal fibula were performed. Wide (type II) extra-articular resection was performed in seven patients. Marginal (type I) intra-articular resection of the distal fibula was performed in three patients. After resection, a primary ankle arthrodesis was performed in four adults and postoperative bracing without any reconstruction in four children and two adults. Results: Within a mean follow-up time of 14.4 years (range, three to thirty years), tumor recurred locally in two patients after a marginal type I resection of a chondrosarcoma, and in one after a type II wide extra-articular resection of an osteosarcoma. All ten patients were disease-free at latest follow-up examination. Six patients had reoperation. A below-knee amputation was performed in three patients for chronic osteomyelitis, for local recurrence of chondrosarcoma, and for a late adamantinoma of the tibia. One patient had further soft tissue and bone reconstructive surgery for lateral talus subluxation and cavovarus deformity. Another patient required ankle arthrodesis for recurrent ankle instability and ankle joint degenerative changes. One patient had wide re-resection for local recurrence of an osteosarcoma. All ten patients were ambulatory at latest follow-up evaluation. Four adult patients who underwent primary arthrodesis and one child who had no initial reconstruction and had late ankle arthrodesis had a satisfactory outcome, with an ISOLS functional score of 27.6 (92%). Two adolescents who had postoperative bracing without any soft tissue reconstruction had an ISOLS functional score of 24 (80%) with no ankle pain and satisfactory function; they used an ankle-foot orthosis during sports activities. Three patients who subsequently required below-knee amputation used a below-knee prosthesis for ambulation. Conclusions: Limb salvage surgery for high-grade malignant tumors of the distal fibula can be achieved by wide extra-articular resection. For low-grade malignant tumors or high-grade tumors responding to adjuvant therapy, a more conservative marginal intra-articular resection may be adequate. Primary arthrodesis is indicated in adults after wide extra-articular resection. In children, repair of the lateral soft tissues and reconstruction of the tibiofibular mortise is necessary after tumor resection to avoid late ankle deformity or instability

Background. Subtalar nonunion has a detrimental effect on patients' function, and pose a significant challenge for surgeons particularly in the setting of higher risk factors. Methods. We retrospectively analyzed a consecutive series of 49 subtalar nonunions between October 2001 and July 2013. Patient records and radiographs were reviewed for specific patient demographics and comorbidities, subsequent treatments, revision fusion rate, use of bone graft, complications, and clinical outcome. Results. Forty-nine patients with a mean age of 49 years (range 23–80) were included. Sixteen (32%) were heavy smokers (>1 pack per day) and five (10%) had diabetes. Forty one (84%) of the nonunions were symptomatic and underwent a revision procedure at a mean of 16 months (range 2.8 to 57) from the time of the primary arthrodesis. Four of these patients required a triple arthrodesis at the time of revision. Bone graft was used in all cases, and in 25 cases (61%) additional adjuvant orthobiologics. Thirty-two (78%) of the patients achieved a solid arthrodesis at a mean of 3.4 months (range 1.4 to 7.6). Patients who were diabetic and smokers as a group had a 68% rate of union. Of the nine nonunions following a revision arthrodesis, five were in the setting of a prior ankle arthrodesis, three were complicated by a deep infection, and one had no obvious risk factors. Four of the repeat nonunions elected to not undergo an additional procedure, two had a successful third attempt at arthrodesis, one had an additional nonunion followed by a successful fourth attempt at arthrodesis, one had a successful tibiotalocalcaneal arthrodesis, and one ultimately required a below-knee amputation. Discussion. Management of subtalar nonunions pose a significant challenge with a low rate of arthrodesis at 78% fusion rate, but which can be achieved with rigid fixation and utilization of bone graft and orthobiologics

Introduction. There is a need for a standardised guideline to assist in optimal decision-making in diabetics who have acquired an ankle fracture. Through a critical analysis of the literature, a diagnostic and management algorithm that incorporates a quantitative scoring system is proposed and presented for consideration. Methods. Publications were identified by conducting a comprehensive keyword search of Medline, EMBASE and CINAHL databases. Search terms included “diabetes,” “ankle,” and “fracture”. Articles published in the English language that were pertinent to the topic were included. Manual search of the references in these relevant papers were also completed to further identify publications for potential inclusion. Publications and conferences not published in the English language or not pertinent to the topic in the above databases were excluded. Duplicate results that occurred in different databases were truncated to a single result. Results. A total of 352 results were revealed using the above methods. Of these, 59 articles met our inclusion criteria. 293 articles met our exclusion criteria. A further 9 articles were included after reviewing the included articles and their respective references. From these results, we propose a detailed diagnostic algorithm that may provide a systematic approach to a diabetic patient who presents with acute ankle pain, swelling, warmth, and/or redness. If a fracture is noted on plain radiographs, a proposed management algorithm and scoring system can be used to assist in deciding whether to proceed with primary open reduction, internal fixation (ORIF) or primary arthrodesis/rigid fixation. This scoring system is based on factors acquired through history and examination. Major factors have been allocated a score of 2, which include: previous or coinciding history of Charcot arthropathy, peripheral neuropathy, insulin dependence with poor compliance, and a diabetic history of greater than 20 years. Minor factors have been allocated a score of 1, which include: age > 50, nephropathy, retinopathy, osteoporosis, vasculopathy, and presence of nutrition/diet deficiency. A score of greater than 7 suggests a primary limb-salvage arthrodesis/rigid fixation because of the likely poor outcome in a primary ORIF. A score of less than 7 suggests that an acceptable outcome will likely result with a primary ORIF. Discussion. Through the use of the AFDA algorithm and score, it will hopefully provide a standardised approach to diabetic ankle fractures and; a method of quantifying risks for both the patient and affected ankle joint, thus, allowing the surgeon to have confidence in achieving the best possible outcome. Although this score is based on a critical analysis of the current literature, further validation of both this algorithm and score is recommended. Once validated, the AFDA score in particular, can also potentially be used as a research tool for further follow-up and outcome studies on diabetic ankle fractures

Aims

Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations.

Purpose of the study. We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hindfoot problems the Portsmouth experience with the Ilizarov ring fixator. Methods and results. We report on 10 patients who underwent ankle and hindfoot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR). All patients had undergone multiple previous surgeries which had failed. There were 7 males and 3 females in this group. Average age of the patients was 60 (47 years–77 years) Mean follow up was 32 months (6–56 months) BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening. Patients were assessed clinically, radiologically and using functional outcome scores EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hindfoot nail. All patients were satisfied with their overall improvement in pain and function. Conclusion. We conclude that this is an effective salvage technique for complex ankle and hindfoot problems in patients with impaired healing potential, insufficient bone stock and progressive deformity

We report on the clinical, radiographic and functional outcomes after salvage arthrodesis for complex ankle and hind-foot problems - the Portsmouth experience with the Ilizarov ring fixator. 11 patients underwent ankle and hind-foot (tibio-calcaneal) arthrodeses using an Ilizarov ring fixator between 2006 and 2010. The indications included failed fusion after primary arthrodesis, sepsis complicating internal fixation of fractures, talar avascular necrosis and failed total ankle arthroplasty (TAR). All patients had undergone multiple previous surgeries, which had failed. There were 8 males and 3 females in this group. Average age of the patients was 58 (43 years – 77 years) Mean follow up was 36 months (7 – 60 months). Mean frame time was 24 weeks (15 – 36 weeks). BMP 2 (Inductos) was used in three cases. The procedure was combined with a proximal corticotomy and lengthening in 2 patients who had undergone a talectomy and tibio-calcaneal fusion. There were no major complications apart from minor pin site infections requiring oral antibiotics. There were no deep infections, thromo-embolic issues, CRPS, or functional problems on account of limb shortening. Patients were assessed clinically, radiologically and using functional outcome scores - EQ50 and AOFAS. Solid arthrodesis was achieved in all but one patient who was subsequently revised with a hind-foot nail. All patients were satisfied with their overall improvement in pain and function. We conclude that this is an effective salvage technique for complex ankle and hind-foot problems in patients with impaired healing potential, insufficient bone stock and progressive deformity

Background: Ankle fractures in the elderly with osteoporotic bones are often difficult to manage. The argument of whether we should treat such fractures surgically, conservatively or even plan primary arthrodesis is always there. Also, there is risk of difficult or failed fixation. Patients and Methods: The study was a retrospective evaluation of the management and follow up of 126 patients presented with ankle fracture between 2001 and 2007. All patients were above 60 years at the time of injury and were treated whether conservatively or surgically. Results: About 77% of our patients underwent open reduction and internal fixation (ORIF). The remaining had closed manipulation under anaesthesia (MUA) done. Some patients had multiple co-morbidities including diabetes (around 10%). The results of fixation were satisfactory. Early complications included superficial wound infection (13% of patients-all infections settled after conservative management with antibiotics and dressings), one chest infection. No difference in diabetic patients. Late complications include development of osteoarthritis (2%) and metal work loosening (2%). There were no reported ankle deformities and satisfactory union of fracture was achieved in all patients. Amongst patients who underwent MUA, more than 20% developed post traumatic osteoarthritis of ankle and 18% had chronic ankle pain. Ankle deformity was reported in 2 patients. Conclusion: Our results show that accurate reduction and internal fixation of ankle fracture in the elderly is beneficial and of lower complication rates compared to MUA alone. The osteosynthesis failure rate was very low and patient spent less time in plaster and started physiotherapy earlier

Introduction: The objective of this study was to investigate the clinical, radiographic and subjective outcome after salvage arthrodesis for failed total ankle arthroplasty (TAA), with a focus on salvage in inflammatory joint disease (IJD). Methods: Between 1994 and 2005, salvage arthrodesis for failed mobile-bearing TAA was performed in 18 ankles. Primary diagnosis was IJD 15 and osteoarthritis 3. Tibiotalar fusion was performed in 7 and tibiotalocalcaneal fusion in 11 ankles (in 9 out of these, the subtalar joint was already ankylosed). Serial radiographs were studied retrospectively by an independent observer for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, by the Foot function Index and by VAS scores for pain, function and satisfaction. Results: Blade plates were used in 7 ankles, all united. Nonunion developed in 7 IJD ankles stabilized by either a nail or screws or multiple K-wires. Revision arthrodesis was done for 4 nonunions, 3 were successful. Eleven patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. At follow-up, their mean AOFAS score was 62.4; mean overall FFI was 70.1; VAS for pain was 20.1, for function 64.3, for satisfaction 73.8. Conclusions: Blade plate fixation is successful in salvage ankle arthrodesis. An high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Several publications on primary arthrodesis also show an elevated nonunion rate in IJD. Clinical results were relatively good. The three non-unions in follow-up had subjective results similar to the fused ankles

Purpose: To evaluate the functional outcome of operatively treated Lisfranc injuries. Method: Over a 7-year interval from 1998 to 2005, 184 skeletally mature patients were identified retrospectively with operatively treated Lisfranc injuries. 85 patients had prospectively measured SMFA functional outcomes and satisfaction surveys. The gender was 37 males and 48 females. Mean age was 39 years (range 17–93). Results: The mechanism was fall (31), MVA (24), crush (15), equestrian (5), or twisting (10). Patients were operatively treated with open reduction internal fixation (ORIF, 53) or primary arthrodesis (PA, 32). The SMFA reliability for this patient sample was 0.892. The function and bother outcomes were 19.4 and 15.8, respectively. The function (21.5 vs. 16.0, p=.11) and bother (17.5 vs. 13.0, p=.25) outcomes were not significantly different for ORIF vs. PA, respectively. In the ORIF group, HW removal (40 of 53) performed better than HW retention (13 of 53) with outcome bother but not function measures of (14.7 vs. 26.1, p< 0.05). Conclusion: If performed well, either ORIF or PA technique function well. Patients are more satisfied with the results and appearance of PA over ORIF. HW removal compared to HW retention positively affect bother not function measures. Secondary surgeries negatively affect both bother and function measures. Patients with pain, associated foot or polytrauma injuries function worse

We aimed to investigate the treatment and outcome of patients over 65 years of age with tibial Pilon fracture. Patients were treated by primary open reduction and internal fixation or external fixation (EF) as determined by local soft tissue conditions. Patient course, incidence of radiological osteoarthritis and functional outcome using the SF-36 questionnaire were recorded. All patients were evaluated serially until discharge from final follow-up. The mean follow-up time was 28 months (12-45). Statistical analysis was performed using Analyse-it(tm) software for Excel. In total 25 patients were studied. Two patients died before completion of treatment and were excluded from the final analysis. Therefore, 23 patients (10 male) were included with a mean age of 70.9 years (range 66-89) and a mean ISS of 10.25 (range 9-22). There were 4 grade IIIb open injuries. Three patients suffered superficial tibial wound infection. Two patients underwent early secondary amputation due to deep bone sepsis within 8 weeks of injury. One patient in the ORIF group underwent primary arthrodesis, which was subsequently revised due to non-union. 3 patients underwent secondary bone grafting to enhance healing, performed at 2, 6 and 9 weeks. 2 patients with metal work failure underwent subsequent revision of ORIF and progressed to union; the mean time to union was 33.8 weeks. At final follow-up 7 (28%) patients had radiological features of osteoarthritis but none had symptoms severe enough to warrant ankle arthrodesis. There were significant differences from the USA norm in physical function score, role physical score, and physical component score, (p< 0.01). Conclusion/Significance. In older patients local complications are relatively common and clinical vigilance must be maintained in order to allow appropriate intervention during their post-operative course. Despite the incidence of radiological post-traumatic arthrosis, none of the patients progressed to ankle fusion

The most common indication for knee arthrodesis is pain and instability in an unreconstructable knee following an infected knee arthroplasty. In this study, we compare the use of the Mayday arthrodesis nail (Ortho-dynamics, Christchurch, UK) versus external fixation, Orthofix (Berkshire UK) and Stryker Hoffman II (County Cork, Ireland). All patients in this study underwent arthrodesis between 1995 and 2006 at Conquest Hospital, Hastings. In group A, 11 patients underwent arthrodesis with a Mayday nail. In all cases, the indications were infected total knee replacements (TKR). Three of these patients previously had failed attempts at arthrodesis with external fixation devices. In group B, seven patients underwent arthrodesis using external fixation. In six patients, the indication was infected TKRs. Results were reviewed retrospectively, with union assessed both clinically and radiologically. The mean inpatient stay for the Mayday nail group was 23 days (range 8 – 45 days) compared with 76 days (range 34 – 122) for the external fixation group (p< 0.01, CI 95). Ten patients in group A went on to confirmed primary arthrodesis. One patient underwent revision arthrodesis with a Mayday nail and subsequently united. In group B only two patients achieved union. The rate of union was significantly greater in the Mayday nail group than the external fixation group (91% vs 29%, p< 0.01). Of those patients that achieved union, there was no difference in the time to fusion between groups. Our study supported the existing literature and found that the Mayday nail appeared more effective than monoaxial external fixators for arthrodesis in the management of infected total knee replacements

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: Arthrodesis of the wrist must still be considered as a useful procedure in the treatment of certain deformities of the wrist joint that by performing this operation can improve the function or the aesthetics of the limb. Except those techniques of partial carpal arthrodesis, the surgical procedures of wrist arthrodesis requires a bridging from the radius to the metacarpal in order to stabilize the joint. When this procedure is performed in a growing child this can be a draw back. Material: We have developed a new procedure that producing the arthrodesis distally to the growing cartilage of the radius does not interfere with the growing at wrist level. Furthermore, the use of a wire shroud gives an active fixation reducing postoperative immobilisation and shortening healing time. Since 1986 we have performed this technique in 9 cases of children with mean age of 14 years. The pathology was in 5 cases Cerebral Palsy, in 2 cases Juvenile Rheumatoid Arthritis and in 2 cases Obstetrical Brachial Plexus Palsy. Eight cases were males and 3 cases females. The indication for surgery was flexion deformity of the wrist in 8 cases and extension in 1 case. Four cases had carpal instability (including the 2 Juvenile Rheumatoid Arthritis). Results: The time of fusion was in all cases 2 months with primary arthrodesis and improved extremity. Functional improvement seemed to be most related to pre-operative conditions. Follow up ranged from 4 years to 6 years. Conclusions: The good results obtained with this procedure encourage us to present this new surgical technique to be applied in the still growing child