锁定加压钢板治疗锁骨远端Neer IIB 型骨折

 目的 探讨采用锁骨远端前外侧锁定加压钢板(locking compression plate, LCP)治疗锁骨远端Neer IIB 型骨折的疗效。方法 回顾性分析2009 年1 月至2010 年10 月采用锁骨远端前外侧LCP治疗11 例Neer IIB 型锁骨远端骨折的资料, 男9 例, 女2 例;年龄23~43 岁, 平均37.2 岁;左侧5例, 右侧6例;损伤至手术时间为24~72 h, 平均48 h。骨折复位后将LCP 置于锁骨远端上方, 首先采用锁定螺钉固定锁骨远端, 可根据骨折的长度选择3~6枚2.5 mm 的锁定螺钉, 然后用3.5 mm锁定螺钉固定骨折近端, 无需修复喙锁韧带。采用美国肩肘外科医师学会(American Shoulder and Elbow Surgeons, ASES)评分评价术后肩关节功能。结果 11 例患者均获得随访, 随访时间为9~12 个月, 平均10.3 个月。X 线片示锁骨骨折均愈合, 其中10 例在术后6 个月内骨折愈合, 1 例在术后9 个月骨折愈合。11 例患者ASES 评分为84~91 分, 平均89.1 分, 与健侧肩关节的功能评分相近。末次随访时, 无一例发生钢板断裂、钢板周围骨折和肩袖损伤等并发症。结论 采用锁骨远端前外侧LCP治疗Neer IIB 型锁骨远端骨 折可以稳定锁骨远端, 避免骨折不愈合和经肩关节固定锁骨远端的并发症。     

CT引导下微创导向器在经皮骶髂关节螺钉固定中的初步应用

 目的 探讨CT引导下微创导向器辅助经皮骶髂关节螺钉固定的准确性。方法 2011年 1月至 5月, 采用 CT引导下微创导向器辅助经皮骶髂关节螺钉固定治疗骶髂关节骨折脱位患者 8例, 男 5例, 女 3例;年龄 26~56岁, 平均 32岁;均为垂直不稳定骨盆骨折。术前对 6例骶髂关节移位超过 2 cm的患者行股骨髁上骨牵引, 牵引重量为体重的 1/8~1/7。在 CT操作台的计算机屏幕上进行定位、测量最佳进针轨道后, 在患侧臀部标记定位。根据 CT扫描确定的进针角度调节导向器角度, 沿导向器前 端套筒打入克氏针, 并顺克氏针拧入 7.3 mm的空心螺钉。结果 8例患者均一次操作成功。手术时间 10~20 min, 平均 14 min。术后即刻行 CT扫描, 确认所有螺钉均位于术前预计的位置并完全位于骨内无 穿出, 骶髂关节形态恢复满意并得到确切固定。所有患者术中均未诉患侧下肢麻木或放射样疼痛, 术后患肢无一例发生血管、神经并发症。结论 导向器可避免 CT引导下骶髂关节螺钉固定时术者仅凭感觉判断进针角度而造成的偏差, 提高了CT引导下骶髂关节螺钉置入的准确性、安全性和简便性。     

经口咽入路寰椎前路钢板固定治疗不稳定性寰椎骨折

 目的探讨经口咽入路寰椎前路钢板内固定治疗不稳定性寰椎骨折的临床疗效。 方法2004年3月至2010年5月,采用经口咽入路寰椎前路钢板内固定治疗不稳定性寰椎骨折患者20例,男12例,女8例;年龄23~68岁,平均(47.7±13.9)岁。4例为寰椎前1/2 Jefferson骨折;8例为半环 Jefferson骨折;8例为前3/4 Jefferson骨折。患者均有不同程度的颈枕区疼痛,活动受限。疼痛视觉模拟评分(visual analog scale,VAS)为4~8分,平均(6.0±1.3)分。20例患者均选择行经口咽入路寰椎前路钢板内固定,随访通过临床和影像学检查评价其疗效。结果所有患者均获得随访,随访时间12~81个月,平均(48.5±20.0)个月。术中未出现螺钉松动、断裂,钢板移位,脊髓损伤,椎动脉损伤。20例患者共放置钢板20块,置入寰椎侧块螺钉40枚。术后CT显示有2枚螺钉过于靠近椎动脉沟,但是未出现临床症状。术后VAS评分为0~3分,平均(1.3±1.0)分。静态和动态的影像学资料显示,术后6个月所有患者均达到骨性愈合,寰枢关节旋转功能良好。随访期间无一例出现内植物相关的并发症。结论寰椎前路钢板内固定能获得坚固的骨性愈合和较低的并发症发生率,是治疗不稳定性寰椎骨折的一种有效方法。     

真骨盆缘完整的髋臼高位前柱骨折的治疗

 目的 探讨真骨盆缘完整的髋臼高位前柱骨折的治疗方法。方法 2006年 1月至 2010 年 1月, 治疗 12例真骨盆缘完整的髋臼高位前柱骨折, 男 8例, 女 4例;年龄 29~46岁, 平均 35.6岁;挤 压伤 7例, 压砸伤 3例, 高处坠落伤 2例。术前常规摄骨盆正位、闭孔斜位、髂骨斜位 X线片及 CT扫描。 根据是否合并后壁骨折及髂骨骨折块的完整性分为单纯型 5例, 合并后壁型 6例, 粉碎型 1例。 5例单纯型及 2例合并较小的无移位后壁型骨折者采用髂股入路行髂嵴支持钢板加髂骨前缘拉力螺钉固定; 4例合并明显移位的后壁型骨折者采用前后联合入路行拉力螺钉、支持钢板固定;1例粉碎型骨折采用 扩展髂股入路行钢板螺钉固定。结果 12例患者均获得随访, 随访时间 14~37个月, 平均 26.7个月。术后按 Matta影像学评定标准, 优 8例, 良 3例, 差 1;优良率为 92%。无一例发生骨折不愈合及内固定断 裂。末次随访按 Matta改良的 Merled爷Aubigne和 Postel功能评分系统评分为 11~18分, 平均 16.8分;优 7例, 良 4例, 差 1例;优良率为 92%。 1例发生异位骨化和轻度的创伤性关节炎。结论 选择合理的手 术入路、解剖复位、坚强固定是治疗真骨盆缘完整的髋臼高位前柱骨折的关键。     

经踝后内侧入路空心螺钉治疗距骨后突骨折

<正>2013年2月~2015年8月,我科采用经踝关节后内侧入路空心螺钉内固定治疗9例距骨后突骨折患者,效果满意,报道如下。1 材料与方法1.1 病例资料本组9例,男8例,女1例,年龄22~55岁。单纯距骨后突骨折6例,合并距骨体、颈骨折2例,合并距下关节脱位1例。完全距骨后突骨折7例,外侧结节骨折1例,内侧结节骨折1例。伤后至手术时间4~12 d。1.2治疗方法硬膜外麻醉下手术。经踝后内侧纵向切口约10 cm,显露距     

空芯加压螺钉内固定治疗儿童距骨颈骨折

目的探讨切开复位空芯加压螺钉内固定治疗儿童距骨颈骨折的临床疗效。方法 2008年9月至2012年6月,采用切开复位空芯加压螺钉内固定治疗儿童距骨颈骨折9例,男8例,女1例;年龄8~15岁,平均12.5岁。骨折按Hawkins分型,Ⅰ型2例,Ⅱ型7例。结果 9例获得8~18个月随访,平均12.5个月,全部骨折均愈合,愈合时间8~22周,无距骨坏死病例。按Kenwright四级分类法功能标准评价,优6例,良3例。结论空芯加压螺钉内固定治疗儿童距骨颈骨折疗效确切,临床易操作,是一种实用的内固定方法。     

短节段椎弓根螺钉固定结合椎体增强术治疗胸腰椎爆裂性骨折

 目的 探讨短节段椎弓根螺钉固定结合椎体增强术治疗胸腰椎爆裂性骨折的疗效。方法 2006年 11月至 2009年 9月采用短节段椎弓根螺钉固定结合自固化硫酸钙骨水泥椎体增强术治疗且有完整随访资料的胸腰椎爆裂性骨折患者 37例,男 21例,女 16例; 年龄 39耀60岁,平均 47.3岁。术后评估伤椎前缘高度比、矢状面 Cobb角、神经功能恢复、内固定失败率、疼痛视觉模拟评分及 Oswestry功能障碍指数。结果随访 14~37个月,平均 19个月。无内固定失败。 16例术前神经功能部分损害者 12例完全恢复,无神经功能损害加重。自固化硫酸钙平均于术后 3个月开始吸收,椎体骨折术后 5个月内愈合。伤椎前缘高度比由术前 55.40%±9.79%恢复至术后 85.46%±6.56%,最终维持在 82.35%±7.48%; 矢状面 Cobb角由术前 22.45°±7.74°恢复至术后 6.86°±5.27°,最终维持在 9.66°±5.88°。末次随访时疼痛视觉模拟评分平均 1.2,Oswestry功能障碍指数平均 20.4。结论,短节段椎弓根螺钉固定结合自固化硫酸钙骨水泥椎体增强术治疗胸腰椎爆裂性骨折安全、简便,能有效防止椎体高度丢失及进行性后凸畸形。     

应用微型钢板和螺钉内固定治疗距骨骨折22例

目的：探讨微型钢板和螺钉内固定治疗距骨体和距骨颈骨折的效果。方法：经前内外侧联合入路,采用传统拉力螺钉辅助距骨外侧微型钢板内固定,必要时行距骨颈内侧植骨治疗距骨颈骨折15例,采用螺钉治疗距骨体骨折7例,术后采用Hawkins评分和放射学检查,分析其临床疗效和并发症。结果：22例中术后发生创伤性关节炎11例,距骨体坏死4例;Hawkins评分,优7例,良9例,可4例,差2例。结论：传统拉力螺钉辅助距骨外侧微型钢板内固定治疗距骨颈骨折,可减少距骨颈骨折内翻畸形发生,可以减少骨折后期复位丢失,并发症少,值得临床推广应用。     

儿童陈旧性孟氏骨折的手术治疗 创伤骨科

  目的 探讨尺骨截骨后成角延长钢板内固定或单臂外固定两种方法治疗儿童陈旧性孟 氏骨折的疗效及相关影响因素。 方法回顾性分析2005 年7 月至2011 年6 月收治的儿童陈旧性孟氏 骨折患儿19 例, 男11例, 女8例。Bado 玉型13 例, III型6 例。按照尺骨截骨后固定方法分为钢板内固 定组(12 例, 治疗时平均年龄为5.3 岁, 受伤时间平均为6.8 个月;Bado 玉型9 例, III型3 例)和单臂外 固定组(7 例, 治疗时平均年龄为11.8 岁, 受伤时间平均为16.6 个月;Bado 玉型4 例, III型3 例)。对两 组患儿的年龄、受伤时间、术后并发症、肘关节与前臂旋转功能、骨折愈合时间等指标进行比较。 结果 19例患儿均获随访, 平均10 个月(6~36 个月)。术后钢板内固定组1 例发生桡骨头再脱位, 单臂外固定 组1 例发生筋膜室综合征。钢板内固定组、单臂外固定组两组患儿除1 例外, 术后屈肘功能平均120° (110°~130°), 前臂旋前功能均有15°(10°~20°)的受限。尺骨截骨成角延长后的愈合时间:钢板内固定组 平均8 周(6~15 周), 单臂外固定组平均22 周(10~44 周)。按Nakamura 等影像学评估标准:钢板内固定 组优11 例(图1), 差1 例;单臂外固定组7 例均为优。 结论 尺骨截骨成角延长是治疗儿童陈旧性孟氏 骨折矫正尺骨骨折后畸形的关键, 截骨后的两种固定方法不同、 目的 相同。术前评估最重要:年龄小、受 伤时间短患儿选择钢板内固定, 而对年龄大、受伤时间长者选择单臂外固定。     

前路经皮三钉固定治疗老年寰枢椎联合骨折

 目的 探讨经皮内固定技术治疗老年(特别是合并颅脑损伤)患者急性寰枢椎联合骨折的方法及其疗效。方法 2006年 3月至 2011年 2月, 共 7例老年急性寰枢椎联合骨折患者。男 6例, 女 1例;年龄 64~84岁, 平均 72.4岁。寰椎骨折: Jefferson骨折 2例, 前弓骨折 2例, 前后弓两处骨折 2例, 前后弓骨折+侧块骨折 1例。枢椎齿状突骨折: Anderson域型骨折 6例, 浅芋型骨折 1例。颅脑损伤 5例, 均合并不同程度意识朦胧、谵妄或昏迷。对所有患者均在”C冶型臂X线机监视下行经皮前路枢椎齿状突和两侧寰枢关节螺钉内固定术治疗, 并分析其治疗效果。结果 手术时间 36~78 min, 平均 56 min。同时行植骨术的患者出血 20~50 ml, 未行植骨术者无明显出血。 7例患者均获得满意治疗效果, 螺钉位置正确。无神经根、脊髓、椎动脉和食管损伤等并发症发生。全组病例平均随访 10.7个月, 无脱钉、弯钉及断钉发生, 枢椎齿状突骨折均骨性愈合, 无寰枢关节不稳。结论 对于老年特别是合并颅脑损伤患者的急性寰枢椎联合骨折, 经皮前路三钉固定技术是一种简单、安全和有效的方法, 有利于对患者临床护理和早期功能训练, 减少并发症的发生。     

Screw fixation of the syndesmosis alters joint contact characteristics in an axially loaded cadaveric model

BackgroundThe purpose of this study was to quantify the effects of rigid syndesmotic fixation on functional talar position and cartilage contact mechanics.MethodsTwelve below-knee cadaveric specimens with an intact distal syndesmosis were mechanically loaded in four flexion positions (20° plantar flexion, 10° plantar flexion, neutral, 10° dorsiflexion) with zero, one, or two 3.5-mm syndesmotic screws. Rigid clusters of reflective markers were used to track bony movement and ankle-specific pressure sensors were used to measure talar dome and medial/lateral gutter contact mechanics.ResultsScrew fixation caused negligible anterior and inferior shifts of the talus within the mortise. Relative to no fixation, mean peak contact pressure decreased by 6%–32% on the talar dome and increased 2.4- to 6.6-fold in the medial and lateral gutters, respectively, depending on ankle position and number of screws.ConclusionsTwo-way ANOVA indicated syndesmotic screw fixation significantly increased contact pressure in the medial/lateral gutters and decreased talar dome contact pressure while minimally altering talar position.     

Fractures of the talar neck. A mechanical study of fixation.

Anatomical reduction and rigid internal fixation of fractures of the talar neck allow early mobilization of the ankle and subtalar joints. Forty fresh tali from cadavera were fractured across the talar neck and were internally fixed with one of four methods. The specimens were again loaded to failure, and mean yield loads, yield deformations, stiffness, and energy absorbed were compared. The two configurations of screws that were inserted posterior to anterior provided yield loads superior to those of screws inserted anterior to posterior. All combinations of screws were stronger than Kirschner wires. Comparisons of yield deformations, stiffness, and energy absorbed corroborated these results. The calculated theoretical maximum shear force across the talar neck during active motion was 1129 newtons. This exceeded the strength that was provided by Kirschner wires and anteriorly inserted screws but not that provided by screws that were placed posteriorly.     

Comminuted talar neck fractures: a mechanical comparison of fixation techniques

OBJECTIVE: To compare the mechanical performance of 3 fixation techniques for comminuted talar neck fractures. DESIGN: In vitro biomechanical study. SETTING: Bioengineering research laboratory. PARTICIPANTS: Thirty previously frozen human cadaveric tali were osteotomized across the talar neck. A wedge of bone 2 cm long and extending 50% of the medial to lateral and superior to inferior dimension of the talus was removed to create an unstable, comminuted fracture. INTERVENTION: The specimens were randomized to one of 3 fixation groups. The first group was fixed with 3 anterior-to-posterior screws. The second group was fixed with 2 cannulated screws inserted from posterior to anterior. The third group was fixed with 1 screw from anterior to posterior and a medially applied blade plate. Specimens were embedded in acrylic cement and mounted on an Instron mechanical testing machine. Loading was applied in the dorsal-medial direction to failure. MAIN OUTCOME MEASURES: For each specimen, the load-displacement curve, yield point, and 3 mm displacement point were recorded in response to controlled dorsal-medial loading to failure. Stiffness was calculated as the linear portion of the slope of the load (kN) versus displacement (mm) curve. Statistical analysis of the data was conducted using analysis of variance. RESULTS: The mean yield point of each of the fixation techniques tested exceeded 1.4 kN. No statistically significant difference was found between the fixation methods, even when variations in age and sex were considered. CONCLUSIONS: The mean yield point of the fixation techniques tested exceeds the theoretical stress across the talar neck during active motion. Anterior plate fixation provided equivalent stability to posterior screw fixation.     

Talus fractures: evaluation and treatment

Fractures of the talus are uncommon. The relative infrequency of these injuries in part accounts for the lack of useful and objective data to guide treatment. The integrity of the talus is critical to normal function of the ankle, subtalar, and transverse tarsal joints. Injuries to the head, neck, or body of the talus can interfere with normal coupled motion of these joints and result in permanent pain, loss of motion, and deformity. Outcomes vary widely and are related to the degree of initial fracture displacement. Nondisplaced fractures have a favorable outcome in most cases. Failure to recognize fracture displacement (even when minimal) can lead to undertreatment and poor outcomes. The accuracy of closed reduction of displaced talar neck fractures can be very difficult to assess. Operative treatment should, therefore, be considered for all displaced fractures. Osteonecrosis and malunion are common complications, and prompt and accurate reduction minimizes their incidence and severity. The use of titanium screws for fixation permits magnetic resonance imaging, which may allow earlier assessment of osteonecrosis; however, further investigation is necessary to determine the clinical utility of this information. Unrecognized medial talar neck comminution can lead to varus malunion and a supination deformity with decreased range of motion of the subtalar joint. Combined anteromedial and anterolateral exposure of talar neck fractures can help ensure anatomic reduction. Posttraumatic hindfoot arthrosis has been reported to occur in more than 90% of patients with displaced talus fractures. Salvage can be difficult and often necessitates extended arthrodesis procedures.     

Comparison of plate and screw fixation and screw fixation alone in a comminuted talar neck fracture model

BACKGROUND: Talar neck fracture fixation has been studied in noncomminuted fracture models, but no large clinical series of comminuted fracture patterns have been published and no biomechanical studies have compared plate fixation with screw fixation in comminuted talar neck fractures. METHODS: Nine matched pairs of fresh frozen talar specimens were stripped of soft tissue and mounted in a cylindrical jig. The talar neck was fractured using a dorsally directed shear force at a rate of 200 mm/min, and dorsal comminution was simulated by removing a 2-mm section of bone from the distal fracture fragment. One specimen from each pair was fixed with either two solid 4.0-mm partially threaded cancellous screws posterior-to-anterior just lateral to the posterior process of the talus or with a four-hole 2.0-mm minifragment plate contoured to the lateral surface of the talar neck and secured with 2.7-mm screws. A 2.7-mm fully threaded cortical screw was placed medially using a lag technique. The specimens were then loaded to failure with a dorsally directed force at a rate of 200 mm/min. Failure was defined as the load producing 2 mm of displacement. A Student's t-test analysis was used with significance set at p < or = 0.05. RESULTS: Posterior-to-anterior screw fixation had a statistically significant higher load to failure than plate fixation (p < 0.05). Mean load to failure for the screw group was 120.7 +/- 68.5 N and 89.7 +/- 46.6 N for the plating group. CONCLUSIONS: Plate fixation may offer substantial advantages in the ability to control the anatomic alignment of comminuted talar neck fractures, but it does not provide any biomechanical advantage compared with axial screw fixation. Further, the fixation strength of both methods was an order of magnitude lower than those found in previous studies of noncomminuted fractures.     

An analysis of talar surface area occupied by screw fixation in ankle fusions

BACKGROUND: Ankle arthrodesis remains the benchmark of treatment for end-stage arthrosis of the ankle joint. Despite that, the incidence of nonunion can be as high as 15%. Various strategies have been used to reduce the incidence of nonunion, including multiple compression screws and larger diameter screws to improve mechanical stability and compression. The space occupied by an increasing amount of hardware across a finite surface area available for fusion has prompted concern that this strategy may be counterproductive and may reduce the biological potential of the construct. The purpose of this study was to look at 40 anatomic sawbone specimens of the ankle to determine the amount of talar surface contact area used by the screw fixation during arthrodesis. METHODS: Four groups were created to examine different techniques for arthrodesis. Simulated ankle arthrodeses were done using two- or three-screw fixation with 6.5-mm and 7.3-mm screws. Hardware was subsequently removed and the surface area used by the passing screws was measured. Total surface areas were calculated for each of the 40 specimens. RESULTS: The maximal surface area of the talus occupied by screws occurred when using three 7.3-mm screws. This configuration used 16% of the possible talar surface area available for arthrodesis. CONCLUSION: The use of additional screw fixation when performing an ankle arthrodesis does not sacrifice a major amount of the tibiotalar contact area and will most likely not affect the biologic environment needed to obtain fusion.     

Unusual ankle fracture: A case report and literature review

Fractures of the talus are uncommon, and talar body fractures in the sagittal plane are still rarer. The aim of its treatment is urgent anatomic reduction to restore congruency of the ankle and to reduce the risk of avascular necrosis by preserving any remaining blood supply. We report the case of a body talar fracture in sagittal plane associated with fracture of the medial malleolus in a young adult; the mechanism of the fracture was plantar hyperflexion, internal rotation and axial compression. We perform an open reduction and stabilization with two screws for the talus and screw the medial malleolus. At 14 months following the injury patient had good range of movement with little pain. The mechanism is discussed along with a literature review.     

Cadaveric Analysis of Exposure of the Talar Articular Surface Through the Posteromedial Approach

The purpose of this cadaveric study is to assess the talar articular surface visible through a modified posterior medial approach to the ankle joint for talar osteochondral defects. Ten fresh frozen cadaveric specimens were included. The talar surface area was outlined utilizing a marker. The talus was removed to measure the medial to lateral length and posterior to anterior length using a flexible ruler. A skin incision was made posterior to the medial malleolus. The incision was deepened through the flexor retinaculum. Dissection was carried between the posterior tibial and flexor digitorum longus tendons through the posterior tibial tendon sheath in order to access the posteromedial ankle joint. The posterior tibiofibular ligament should remain intact. A Hintermann distractor was then inserted to distract the ankle joint. The average articular cartilage visible from medial to lateral was 1.90 (68.6%) centimeters, while from posterior to anterior was 2.00 (43.6%) centimeters. Medial malleolar osteotomy is often required to visualize posteromedial talar osteochondral defects that are difficult to visualize with standard anterior ankle arthroscopy. Our study suggests that the modified posteromedial approach between the posterior tibial and flexor digitorum longus tendons and utilizing a Hintermann distractor allows for visualization of common posterior and central-medial lesions. When considering the anatomic 9-zone grid scheme proposed by Raikin et al, zone 4, 7, and 8 lesions can be assessed with this approach. A clinical study should be undertaken to evaluate the morbidity of this approach.     

Hawkins-Typ-III-Fraktur

These injuries are extremely rare and severe. The literature describes only individual cases of such injuries. We report a case of a displaced fracture of the talar neck with a complete posterior dislocation and rotation of the body of the talus (Hawkins type III) associated with medial malleolus fracture, treated with the method of urgent open reduction and internal fixation of the talar neck and medial malleolus as well as with the method of distraction external fixation.A 26-year-old male was injured after a fall from a height of over 8 m and was admitted as an emergency to the University Orthopedic and Traumatology Clinic in Nis. Surgery was performed within 4 h postinjury. He was mobilized with crutches with non-weight bearing. The external fixator was removed 10 weeks postsurgery, when physical therapy was initiated. The follow-up was 3 years. There were neither early nor late postoperative complications. Three years postinjury, movements in the ankle joint were satisfactory (plantar flexion 35 degrees , dorsal flexion up to 10 degrees , moderately limited movements in the subtalar joint). There were no signs of avascular necrosis; the patient walked normally and went back to physical work 2 years postinjury.Urgent open reduction and internal fixation of the Hawkins type III fracture with dislocation of the talus and distraction external fixation can play an important role in the prevention of avascular necrosis of the talus and other complications which follow this injury.     

Ankle arthrodesis using internal screw fixation

Ankle arthrodesis treated by external fixation frequently results in complications from pin tract infections, loss of position, nonunion, and malunion. A method of ankle arthrodesis using 6.5-mm cancellous screws as the primary fixation hardware was developed. The most important screw is placed from the posterior malleolus into the neck and head of the talus, and medial and lateral malleolar screws are added to secure fixation. Near-normal anatomy is maintained with this technique because little or no bone, only cartilage, is removed. Earlier cases were all done through an anterior approach. Later, special techniques were developed for placing screws and strain-relieving bone grafting was added to promote union. Twenty-three cases that were treated by the earlier technique are reviewed. The overall fusion rate was 74%. Three conditions (avascular talus, pyarthrosis, and spasticity) were identified that placed patients at high risk for failure of fusion. Of the patients who were not in a high-risk group, only one had a delayed union. When the high-risk patients were not included in the statistics, the fusion rate was 93%. The evolved technique shows great promise for accurate and trouble-free ankle arthrodesis.