Centripetal Compression Triple Arthrodesis

Forty-nine compression triple arthrodeses were performed in 45 patients whose average age was 16 years. An external compression device was applied to secure rigid fixation of the tarsal bones. The device consisted of two large rings, six compression screws and six small transfixion rings. Union of the tarsal joints was obtained within 6 weeks in 93.7 per cent of cases, and within 8 weeks in the remaining 6.3 per cent. Non-union was completely avoided and the period until fusion reduced to almost half that expected after conventional operations. The compression also ensured maintenance of the correction of deformity initially obtained.     

Centripetal Compression Triple Arthrodesis

Forty-nine compression triple arthrodeses were performed in 45 patients whose average age was 16 years. An external compression device was applied to secure rigid fixation of the tarsal bones. The device consisted of two large rings, six compression screws and six small transfixion rings. Union of the tarsal joints was obtained within 6 weeks in 93.7 per cent of cases, and within 8 weeks in the remaining 6.3 per cent. Non-union was completely avoided and the period until fusion reduced to almost half that expected after conventional operations. The compression also ensured maintenance of the correction of deformity initially obtained.     

Evaluation of Fixation Techniques for Metatarsocuneiform Arthrodesis

First metatarsocuneiform joint arthrodesis has been used in foot and ankle surgery for the treatment of hallux abductovalgus deformity, among other pedal pathologic entities. The goal of the present retrospective study was to compare the fusion rates and complications of an intraplate compression screw fixation, crossing solid core screw fixation, and a single interfragmentary screw with a simple locking plate. All procedures were performed by a single surgeon, and all patients received an identical postoperative protocol. A medical record review was performed of 147 evenly distributed surgical methods. All patients were non-weightbearing by protocol for 4 weeks. The patient covariates included sex, age, nicotine status, osteoporosis, and diabetes. These variables were balanced among the treatment groups and were noncontributory, with the exception of sex. Male patients had a 6 times greater odds of experiencing nonunion. The overall nonunion rate was 6.7%, with 4% symptomatic and requiring revision. The individual nonunion rates for each method were 2% for intraplate compression screw fixation, 5% for single interfragmentary screw with locking plate fixation, and 9% for crossing solid core screw fixation. None of the differences reached statistical significance. The corresponding hardware removal rates were 12%, 11%, and 0%.     

Bilateral Knee Arthrodesis in a Patient With Common Variable Immunodeficiency

Patients with common variable immunodeficiency can present with debilitating arthritis. We present the case of a 42-year-old man with bilateral knee arthritis who underwent a right total knee arthroplasty that subsequently became infected. Five months after resection arthroplasty, his right leg spontaneously fused in extension, but his left knee was limited to an arc of motion between 90° and 110°. At the patient's request, he underwent a noninstrumented arthrodesis of the left knee. The patient now has bilateral arthrodeses and ambulates with a cane. While arthroplasty may be attempted in such patients, the increased risk of infection may potentially result in arthrodesis, possibly without instrumentation.     

Arthrodesis of the knee without removal of the total joint implants

Surgical Principles Excision of the fibrous soft tissue scar between the femur and tibia medial and lateral. Plate fixation with interposition of blocks of cancellous autogenous bone and addition of cancellous bone chips.     

Retrograde Intramedullary Nailing in Tibiotalocalcaneal Arthrodesis: A Short-Term, Prospective Study

In this prospective study, tibiotalocalcaneal arthrodesis was performed in 29 patients with a retrograde femur nail (Interlocking Compression Nail; Stryker Trauma, Sch?nkirchen, Germany) inserted through a plantar approach. Patients were evaluated by a standardized follow-up examination using the American Foot and Ankle Society ankle-hindfoot scale and the main criteria of the short-form health survey (36 items). Special emphasis was placed on surgical approach, bony consolidation, and postoperative quality of life. Solid fusion was achieved in 90% of the patients after a mean follow-up of 25 months. Twenty-two patients (76%) showed primary bone healing after an average of 5.2 months; a delayed union was observed in 7 patients. In 79% of the patients, pain was reduced effectively and quality of life substantially improved with the intramedullary nail arthrodesis. The average ankle-hindfoot score improved from 46 (range, 41-53) to 71 (range, 49-83) points. Complications occurred in 6 patients (21%), including 2 deep infections, 3 nonunions, and 1 case of postoperative flexion deformity. The authors found retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis to be an effective technique in obtaining solid fusion, an effective relief from pain, and an improvement of quality of life.     

External Compression Arthrodesis of the Shoulder Joint

Compression arthrodesis of the shoulder was carried out in 16 patients. One case of postoperative infection healed by conservative treatment, and all but one had primary fusion. With a median of 12 years follow-up, 12 patients were examined clinically and radiologically; one patient was lost to follow-up and three patients were dead. The result was rated as good by 10 patients and as improved by two patients. External compression arthrodesis was found to be a safe and easy way to achieve solid fusion of the shoulder joint. Arthroplasty and arthrodesis of the shoulder joint are complementary operations, applicable in different clinical situations.