Anterior ankle arthrodesis

Ankle arthrodesis is a common procedure that resolves many conditions of the foot and ankle; however, complications following this procedure are often reported and vary depending on the fixation technique. Various techniques have been described in the attempt to achieve ankle arthrodesis and there is much debate as to the efficiency of each one. This study aims to evaluate the efficiency of anterior plating in ankle arthrodesis using customised and Synthes TomoFix plates. We present the outcomes of 28 ankle arthrodeses between 2005 and 2012, specifically examining rate of union, patient-reported outcomes scores, and complications. All 28 patients achieved radiographic union at an average of 36 wk; the majority of patients (92.86%) at or before 16 wk, the exceptions being two patients with Charcot joints who were noted to have bony union at a three year review. Patient-reported outcomes scores significantly increased (P < 0.05). Complications included two delayed unions as previously mentioned, infection, and extended postoperative pain. With multiple points for fixation and coaxial screw entry points, the contoured customised plate offers added compression and provides a rigid fixation for arthrodesis stabilization.     

Non-union of calcaneum – A rare complication of calcaneal fracture – A case report with brief review of literature

Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literature available on calcaneal non-union is also briefly reviewed. Role of subtalar arthrodesis with internal fixation of fracture and bone grafting for successful management of this rare complication is highlighted along with the possibility of under-reporting of this relatively unknown complication.     

Limited intercarpal fusion as a salvage procedure for advanced Kienbock disease

Background

With progressive lunate collapse, salvage procedures in advanced Kienbock disease attempt to provide pain relief and maintain motion. Scaphocapitate arthrodesis may provide a durable option with comparable outcomes to proximal row carpectomy in the well-selected patient.

Methods

We performed a retrospective chart review of all consecutive patients with Lichtman stage IIIA or IIIB Kienbock’s disease who underwent either scaphocapitate or scaphotrapeziotrapezoid-capitate arthrodesis from January 2004 to December 2013.

Results

Twelve patients were included with a mean age of 41.6 years. Ten patients underwent scaphocapitate arthrodesis, while two patients underwent scaphotrapezio-trapezoid-capitate arthrodesis with an average clinical follow-up of 13.1 months. All patients achieved fusion. The average postoperative flexion-extension arc was 53° (range 20–110°). The average ulnar deviation was 9° (range 5–15°), and the average radial deviation was 13° (range 5–25°). Postoperative pain scores were significantly improved, having changed from an average of 6.6 preoperatively to 2.8 on a 10-point scale (W = 18, P < 0.05).

Conclusions

Despite a mean flexion-extension arc that is reduced from that of a normal individual, the postoperative range of motion following a midcarpal arthrodesis was not significantly different than that reported in a recent systematic review of proximal row carpectomy (73.5° compared with 53°, respectively) (P = 0.05). Additionally, given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock’s disease.     

关节镜下距下关节融合术治疗终末期距下关节炎的疗效分析

目的评价关节镜下距下关节融合术治疗终末期距下关节炎的临床疗效。方法 2008年10月至2013年10月本科以关节镜下距下关节融合术治疗终末期距下关节炎共14例14踝,其中男性12例,女性2例,平均年龄35.5岁。包括创伤性关节炎11例,类风湿性关节炎3例。术中采用后侧入路,全镜下切除后距下关节软骨面及部分软骨下骨面。在骨面上微骨折后,透视引导下置入2枚直径7.0 mm的空心螺钉进行固定。术前及术后随访AOFAS评分及VAS评分。结果 14例患者均获得随访,随访时间平均41个月。术后8周X线片显示后距下关节均已获得骨性融合。AOFAS评分从术前53.8分改善至术后89.2分,VAS评分从术前7.8分降低至术后1.5分。结论全关节镜下距下关节融合术治疗终末期距下关节炎融合率高,并发症少,可以获得良好的临床疗效。     

踝关节重度骨关节炎行关节镜下踝关节融合术的临床研究

目的探讨对踝关节重度骨关节炎采用关节镜下踝关节融合术的近期疗效和手术要点。方法 2007年7月至2012年12月,本科采用关节镜直视下的踝关节融合术共治疗25例重度踝关节骨关节炎,这些患者在门诊保守治疗后仍疼痛明显。术前行踝关节正侧位摄片和磁共振检查,术中建立踝关节镜通道,首先彻底清除残留关节面软骨,然后行关节端"微骨折"处理,初步复位踝关节于功能位,克氏针临时固定,"C"臂机透视确认后,旋入空心螺钉。术后石膏托固定6周,然后在保护下部分负重锻炼直至骨性愈合。记录术前和术后1年的疼痛评分,并进行统计学分析。结果所有患者获得随访,均在术后10~16(12±1)周骨性融合,疼痛缓解,步态改善;有1例同期实施小切口辅助下的距下关节融合术。未出现切口愈合不良和感染的早期并发症,随访1~5年,有2例单纯踝关节融合术后患者出现距下关节炎伴轻度疼痛,经保守治疗后症状缓解未进一步手术。根据疼痛评分,术前评分(7.9±1.4)分,术后1年评分(2.1±0.8)分,差异有统计学意义(P=0.005)。结论对保守治疗无效的重度踝关节骨关节炎患者,采用关节镜下的踝关节融合术,具有创伤小、切口美观、融合率高等优势,但同时存在设备要求和学习曲线的前提条件。