OSG-Arthrodese über einen posterolateralen Zugang mit der polyaxial-winkelstabilen Talarlock®-Platte

Objective

Safe arthrodesis of the ankle as well as load carrying capacity free of pain.

Indication

Painful arthritis of the ankle joint occurring idiopathic or posttraumatic, resulting from rheumatoid arthritis or neuromuscular diseases. Extensive bony defects in varus or valgus ankle deformities and after failed prosthesis. Complex hindfoot deformities in neurological disease, paralysis and instabilities. Joint destruction after infection.

Contraindications

Active osteitis, extensive skin ulcers in the approach area, periphery artery occlusive disease.

Surgical technique

Posterolateral skin incision. Sparing cartilage resection. Penetrating sclerosis zones. Reorientating anatomic positioning of the talus thereby correcting axis deformities. Talarlock^® plate positioning and tibiotalar arthrodesis.

Postoperative management

Full weight bearing in an arthodesis boot for 6 weeks. After bone grafting partial weight bearing (20 kg) in an arthrodesis boot for 8 weeks. Full weight bearing after 10weeks.

Results

Ten patients were operated on using this procedure. The follow-up time was 1 year. There were no complications requiring further surgical procedures. Ankle fusion and a good clinical outcome could be achieved in all cases.     

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Purpose

Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons.

Methods

In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36.

Results

Twenty-eight patients were followed up for an average of 25 months (range 18–50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12–24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65–91). According to the SF-36, the average score of the physical component summary was 68 (range 59–81), and the average score of the mental component summary was 74 (range 63–85).

Conclusions

Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.     

Functional outcome and mortality in nonagenarians following hip fracture surgery

Introduction

The world’s population is ageing and the elderly population itself is growing older. This population shows a high incidence of hip fractures. We performed a retrospective study, reviewing the functional status, postoperative complications and mortality rate of nonagenarians who underwent surgery for hip fracture.

Methods and subjects

56 nonagenarian patients underwent hip fracture surgery in our institution between January 2000 and December 2010. Two of these patients had presented with hip fracture on separate occasions, giving a total of 58 hips for analysis. Patients with open fracture, subtrochanteric fracture, polytrauma and pathological fracture were excluded. The case notes, electronic records and X-rays for all those included in the study were reviewed. The main outcome measures were functional status, postoperative complications and mortality rate at 1 year.

Results

Patients with extracapsular hip fractures were associated with higher risks of postoperative complications (60.7 %; p = 0.037), mortality (25 %; p = 0.003) and more likely to be non-ambulant at 1 year (53.6 vs 16.7 %; p = 0.003). Females were more likely to suffer postoperative complications than males (p = 0.016). 46.6 % of the patients had immediate postoperative complications and most commonly due to urological complications (29.3 %). The 1-year mortality rate was 12.1 %. A notable proportion of patients (65.5 %) remained ambulant 1 year postoperatively, although almost half of the patients (48.3 %) who could ambulate independently pre-injury required a walking aid after hip fracture surgery.

Conclusion

Nonagenarians have good surgical outcomes after hip fracture surgery with low mortality rate. They should be treated similarly as their younger counterparts in terms of decision for surgery. Potential decline in functional status and rehabilitation options should be shared with the patient and family at an early stage.     

Die Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion mit einem intramedullären retrograden Arthrodesennagel

Background

Limb salvage after operations with deep infections of the ankle is often successful using arthrodesis of the hindfoot. The aim of this study was to evaluate the results of arthrodesis using a retrograde intramedullary nail following post-infectious ankle destruction.

Patients and methods

Between 2007 and 2010 a total of 44 patients were treated with tibiotalocalcaneal (TTC) arthrodesis and 14 patients with tibiocalcaneal (TC) arthrodesis using a retrograde hindfoot nail after quieting of infection. Evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS) and the short-form 12-item (SF-12) scores.

Results

Of the 58 patients 49 (35 male and 14 female) could be followed-up. The average time of follow-up was 18 months and the mean age was 58 years. In 85.7 % bony union could be achieved and 10.2 % suffered from reinfections. The mean results achieved in the different scores were AOFAS 56 and SF-12 39.1 (physical health summary scale) and 46.1 (mental health summary scale). Statistical analysis showed a significantly higher rate of bony fusion for TTC arthrodesis. Bony non-union showed a significant correlation to patients with reinfection and to diabetic patients.

Conclusions

Hindfoot arthrodesis for treatment of septic arthritis after infections is possible by using an intramedullary nail. The results show a high rate of fusion with an acceptable reinfection rate and good patient acceptance.     

The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients

Objective

The purpose of the present study was to evaluate the clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in patients aged 65 years and older.

Patients and methods

The records of consecutive patients who underwent surgery for undisplaced femoral neck fractures between 1999 and 2011 were retrospectively reviewed. The patients underwent the surgery as early as possible, and allowed early full weight-bearing. The interval between initial injury and surgery, time to admission and operation, operation time, decrease in hemoglobin, the postoperative day starting to walk, postoperative walking status, and the incidence of any secondary procedures were evaluated. The average patient age was 77.5 years and the average duration of postoperative follow-up was 46.8 months. The patients were divided to two groups to determine the effect of early operation: the early operation group within 24 h on admission, and the late operation group done 24 h after admission.

Results

Eighty-six percent of surgeries were performed within 48 h of admission. The average operation time was 46 min (range 20–95 min). Transfusions were performed in 6.9 % (4/58) of patients. The mortality rate was 6.9 %, and the rate of complications was 9.3 % (5/54): four cases of avascular necrosis (AVN) and one case of fixation failure. The rate of secondary procedures was 7.4 % (4/54). Seventy-two percent (39/54) of patients recovered their postoperative walking ability to pre-injury levels.

Conclusion

This study demonstrated that early internal fixation of undisplaced femoral neck fractures in elderly patients produced satisfactory clinical outcomes.     

Longitudinal changes in seizure outcomes after resection of cerebral cavernous malformations in patients presenting with seizures: a long-term follow-up of 46 patients

Background

Seizure is the most common presentation in patients with cerebral cavernous malformations (CCMs). Although many articles have documented seizure outcomes after resection of CCM, few have conducted long-term follow-ups; thus, the fluctuating seizure outcomes have been neglected. The purpose of this study is to describe long-term postoperative seizure outcomes in patients with CCM and to compare seizure outcomes between patients with sporadic seizures and those with chronic seizures.

Methods

Forty-six patients with CCM presenting with seizures underwent surgery. The male-to-female ratio was 1:1, and the average age at initial seizure onset was 27.6 years. The mean preoperative seizure duration was 42.7 months. Patients were divided into two groups: a chronic group (N?=?20) and a sporadic group (N?=?26) according to seizure frequency and duration. The mean postoperative follow-up duration was 96.3 months, and the postoperative seizure outcomes were checked annually based upon Engel’s classification.

Results

After the first year of follow-up, 80.8 % of the sporadic group and 75.0 % of the chronic group were evaluated as Engel class I. These rates increased to 100.0 % and 90.0 %, respectively, at the eighth year of follow-up. Overall, 29 (63.0 %) of the 46 patients experienced changes in seizure outcomes over the follow-up period. Despite their delayed improvements, the chronic group showed less favorable outcomes throughout follow-up (p?=?0.025).

Conclusions

Long-term follow-up is indispensable for accurately assessing postoperative seizure outcomes because these outcomes change continuously. We recommend earlier surgery to achieve seizure-free status in patients with CCM. However, even in the chronic group, surgery is recommended, considering the overall delayed improvement.     

Ankle fusion with centralisation of the fibula after distal tibia bone tumour resection

Background

Management of distal tibial tumours with limb salvage surgery poses a challenge for the orthopaedic surgeon. This study was done to evaluate the results of fibular centralisation as a technique to reconstruct defects that occurred after resection at this site.

Materials and methods

Nine patients with a mean age of 23.2 years (range 17–34) with diagnosis of osteosarcoma in four patients, Ewing’s sarcoma in two, giant cell tumour in two and chondrosarcoma in one patient underwent surgical treatment for tumour in the distal tibia. All patients had wide resection of the tumour and ankle arthrodesis with centralisation of the fibula. Patients were assessed clinico-radiologically for bone union, infection and complications. The final functional outcome was estimated according to Musculoskeletal Tumor Society (MSTS) scores.

Results

The mean age at the time of surgery was 23.2 years (17–34). There were five females and four males. The mean follow-up was 37 months (range 28–54 months). One of the patients with osteosarcoma had a recurrence a year after limb salvage surgery, underwent above-knee amputation, and died 18 months later due to metastasis. One patient developed leg length discrepancy. The mean MSTS score was 22.75 (range 17–27).

Conclusion

Fibular centralisation is a durable reconstruction tool for defects of the distal tibial metaphysis with an acceptable functional outcome. It is an inexpensive and simple procedure, with a low rate of late complications, and reproducible results.

Level of evidence

IV Retrospective case series.     

Outcomes of emergency surgery for acute abdomen in dialysis patients: experience of a single community hospital

Purpose

Long-term dialysis often causes physiological and metabolic problems that may affect the outcomes of surgery. The aim of this study was to elucidate whether emergency surgery for acute abdomen yields similar outcomes in dialysis patients versus non-dialysis patients.

Methods

The subjects were 126 patients who underwent emergency surgery for acute abdomen between January, 2007 and November, 2011 in our hospital. They were divided into a dialysis group (HD group; n = 9) and a non-dialysis group (non-HD group; n = 117) and their postoperative morbidity and mortality were compared.

Results

Postoperative morbidity and mortality were significantly worse in the HD group. All 9 of these patients succumbed to postoperative complications versus only 5 of the 117 patients in the non-HD group.

Conclusion

The outcomes of emergency surgery for acute abdomen were significantly worse for dialysis patients than for non-dialysis patients. Prompt diagnosis, initiation of the most suitable surgical procedure, and meticulous postoperative cares are imperative to improving the surgical outcomes of dialysis patients.     

Reconstruction of bone defect with allograft and retrograde intramedullary nail for distal tibia osteosarcoma

Background

To investigate the effectiveness of tibiotalocalcaneal arthrodesis with a retrograde nail and allograft in limb salvage surgery for patients with distal tibia osteosarcoma.

Flaps for closure of soft tissue defects in infected revision knee arthroplasty

Purpose

Total knee arthroplasty revision has wound healing deficits of up to 20 %. Defects in the knee region of multimorbid patients are hard to treat as complete explantation and revision arthroplasty is often too burdensome for them. In this study, we present our results with flaps for the treatment of defects after knee replacement, arthrodesis or osteosynthesis.

Methods

Twenty-five patients (26 knees) with defects in the knee region were treated with flaps. Mean follow-up was 37 months (13–61) and the patients had a mean age of 72 years (49–85). A total of 39 flaps were performed (27 muscle flaps, seven fascio-cutaneous flaps and five free flaps).

Results

Patients with more than three comorbidities showed higher risk of complications after surgery. Fifteen patients showed no infection at last follow up. Five patients received an arthrodesis of the knee, two showed persistent infection of the implant with fistula, and three were amputated above the knee.

Conclusions

Amputation could be avoided in 22 cases (85 %). The gastrocnemius muscle flap showed good results in the treatment of defects after arthroplasty or arthrodesis of the knee in multimorbid patients. This procedure can be used if further revision surgery is not indicated.     

Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study—preliminary report

Purpose

Surgical treatment of an acute Achilles tendon rupture can effectively reduce the risk of re-rupture, but it increases the probability of surgical complications. We postulated that a minimally invasive surgical treatment might reduce the number of complications related to open surgery and improve the functional results.

Method

We enrolled 47 patients with acute Achilles tendon ruptures in a prospective, randomised trial to compare clinical results and complications between a minimally invasive procedure with the Achillon® device and traditional open surgery with Krackow-type sutures. The average patient age was 46 years. The follow up time was 24 months.

Results

No Achilles tendon re-rupture or nerve injury occurred in treated patients. There were two cases of wound infections in the open surgery group, and one superficial wound infection occurred in the minimally invasive group. The groups were not significantly different in the amount of pain, range of ankle movements, the single heel-rise test, calf circumference, or time to return to work and sports.

Conclusion

After a two year follow-up period, we found no significant differences in clinical outcomes between groups treated with traditional open surgery or minimally invasive surgery.     

Impact of incision length on the short-term outcomes of laparoscopic colorectal surgery

Background

The recent introduction of hand-assist devices in laparoscopic colorectal surgery has renewed interest in the influence of incision length. This study aimed to define the impact of extraction incision length on the postoperative outcomes of laparoscopic left-sided colon and rectal resections.

Methods

Consecutive patients undergoing laparoscopic left-sided colorectal resection from 1991 to 2007 were retrieved from a prospectively collected database. The association between incision length and patient characteristics, diagnosis, and perioperative outcomes were analyzed using logistic regression, Spearman correlation, Wilcoxon test, and chi-square test.

Results

A total of 494 laparoscopic colorectal resections (left, sigmoid, anterior, and low anterior resections) were retrieved. Patients with conversions to open surgery (n = 59) and missing data (n = 53) were excluded. As a result, 382 cases were included in the study. A slight majority of the patients had malignant disease (n = 202, 53%). The median incision length was 5 cm (interquartile range, 4–6 cm). Increasing weight was positively correlated with incision length (p = 0.0001). Male patients had modestly larger mean incisions than female patients (5.5 vs. 5.0 cm; p = 0.0075). Age, previous surgery, diagnosis, days to resumption of normal diet, and days to discharge from hospital showed no significant relationship with incision length. No association was observed between the incision length and intraoperative or postoperative complications.

Conclusions

Patients undergoing laparoscopic colorectal surgery appear to achieve the same perioperative outcomes irrespective of their extraction incision lengths. To maintain the short-term benefits of laparoscopy, surgeons should consider pursuing a minimally invasive technique, even when a larger extraction incision will ultimately be required.     

Surgery for pulmonary malignancies in patients with a previous history of head and neck squamous cell carcinoma

Purpose

To examine the perioperative and long-term outcomes of surgery for malignancies of the lungs in patients with a history of head and neck squamous cell carcinoma (HNSCC) and to evaluate the risk factors associated with postoperative complications.

Methods

The data of 39 patients with a history of HNSCC who underwent pulmonary resection were reviewed. The perioperative and long-term outcomes were analyzed.

Results

Eight patients (21 %) had difficult airways, and nine patients (23 %) developed postoperative complications. A low body mass index (<18.5), a history of malignancy besides HNSCC and chronic obstructive pulmonary disease were each found to be significantly associated with the development of postoperative complications. The 5-year survival rate of all patients was 80 %.

Conclusions

The airway management of patients with a history of HNSCC should be carefully undertaken. Preoperative assessment of their nutritional status and careful prevention of air leakage during surgery are important. Because favorable outcomes can be achieved, aggressive surgical management should be considered for the treatment of pulmonary malignancies in patients with a history of HNSCC.     

Arthrodesis of the thumb carpometacarpal joint using a quadrangular plate: surgical technique and long-term results of 70 patients

Purpose

To assess the long-term results of trapeziometacarpal arthrodesis using a quadrangular plate, regarding clinical, radiological and functional outcomes, as well as development of complications.

Material and method

From 2005 to 2015, 70 patients were treated at our institution for primary osteoarthrosis of thumb carpometacarpal joint performing a trapeziometacarpal arthrodesis. A total of 85 arthrodesis were carried out using a titanium quadrangular plate (Proflyle plate, Stryker^®, Kalamazoo MI, USA), without grafting in any case. Pre- and postoperative functional data were assessed at the outpatient clinics using DASH, MWS and VAS. All patients were asked for their ability to perform basic daily activities before and after surgery. All patients were also asked about satisfaction and their return to their jobs after surgery. Pre- and postoperative radiological data were also assessed.

Results

There were 59 females and 11 males with an average age of 55 years (range 44–60). In 66 cases arthrodesis was carried out in the dominant hand, in 45 cases the right thumb was involved, and in 40 the left thumb was involved; in 15 cases arthrodesis was carried out bilaterally. Preoperative average DASH score was 64 (range 50–85), postoperative average score was 25 (range 5–61). Regarding MWS, 51 patients obtained excellent results, 15 patients obtained good results and 4 patients referred poor results. The preoperative average score of VAS was 6 (range 5–10), which decrease to an average of 2 (range 0–3) after surgery; all those differences were statistically significant. All patients reported a mild loss of motion; however, all of them reported improvement to carry out daily activities. There were four cases of nonunion because of failure of fixation and two cases with dysesthetic scar. There was no development of osteoarthritis in adjacent joints. The average follow-up was 60 months.

Conclusions

The use of quadrangular plates for arthrodesis of the trapeziometacarpal joint is a safety and reproducible technique with a low rate of complications. Arthrodesis decreases pain and improves function in patients with primary osteoarthritis of the thumb carpometacarpal joint; in spite of a mild loss of motion, patients are satisfied with this procedure.

     

Nutritional risk is still a clinical predictor of postoperative outcomes in laparoscopic abdominal surgery

Background

The relationship between nutritional risk and postoperative recovery of patients with major laparoscopic abdominal surgery is still unclear. The present study was designed to assess the value of the nutritional risk screening in predicting the postoperative outcomes in this cohort of patients.

Methods

Data from a consecutive series of 75 patients undergoing various elective major laparoscopic abdominal operations was prospectively collected. Nutritional risk was defined by the Nutritional Risk Screening 2002 (NRS 2002) score and correlated to the incidence of postoperative complications and hospital stay. Multivariate regression identified factors associated with 30-day complications [odds ratio (95 % confidence interval)].

Results

The overall incidence of nutritional risk was 34.7 %. There was a significantly higher infectious complication rate of 38.5 % in patients at nutritional risk, compared to 12.2 % in patients at no risk (p = 0.008). No significant difference of postoperative hospital stay and overall complications was found in patients at nutritional risk or not. Nutritional risk was identified as an independent predictor of postoperative infectious complications (odds ratio 4.87 [1.33–17.84]; p = 0.017).

Conclusions

The present study reinforces the value of the NRS 2002 to identify patients at higher risk of infectious complications after major laparoscopic abdominal surgery. In the era of minimally invasive surgery, the problem of nutritional risk still deserves our attention and concern.     

Inhaled tiotropium to prevent postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery

Purpose

A new diagnosis of chronic obstructive pulmonary disease is often made during the evaluation of patients requiring lung cancer surgery. The objective of the present study was to evaluate the clinical effects of inhaled tiotropium on the postoperative cardiopulmonary complications in patients with untreated chronic obstructive pulmonary disease requiring lung cancer surgery.

Methods

A retrospective study involving 104 consecutive patients with moderate to severe chronic obstructive pulmonary disease who underwent a lobectomy for lung cancer at two specialized thoracic centers between April 2008 and October 2011 was performed. The results were compared between patients who did and did not receive inhaled tiotropium during the perioperative period. The primary endpoint was the incidence of postoperative cardiopulmonary complications. The postoperative white blood cell counts and C-reactive protein levels as biomarkers of inflammation were also examined.

Results

The incidence of postoperative cardiopulmonary complications was significantly lower in the tiotropium group than in the control group (18 vs. 48 %, P = 0.001). Patients in the tiotropium group also showed significantly lower white blood cell counts and C-reactive protein levels postoperatively.

Conclusions

Inhaled tiotropium treatment during the perioperative period had a prophylactic effect on postoperative cardiopulmonary complications in patients with newly diagnosed chronic obstructive pulmonary disease requiring lung cancer surgery.     

Efficacy of laparoscopic resection in elderly patients with colorectal cancer

Purpose

The perioperative outcomes of laparoscopic colorectal surgery in elderly patients were compared with those of open surgery in elderly patients and those of laparoscopic surgery in nonelderly patients to evaluate the feasibility and efficacy of laparoscopic surgery in elderly patients with colorectal cancer.

Methods

The data of the patients who underwent surgical resection for colorectal cancer between January 2007 and September 2012 were retrospectively collected. The clinical backgrounds and outcomes of elderly patients (≥70 years of age) who underwent laparoscopic surgery (EL group) were compared with those of elderly patients who underwent open surgery (EO group) and those of nonelderly patients (<70 years of age) who underwent laparoscopic surgery (NL group).

Results

Compared with the EO group, the EL group showed significantly less blood loss (15 versus 100 ml), fewer postoperative complications (10.7 versus 36.7 %), earlier resumption of an oral diet (4 versus 5 days) and shorter postoperative hospital stays (16 versus 28 days). A case-matched analysis showed similar results. All perioperative outcomes were equivalent between the EL and NL groups.

Conclusions

Laparoscopic colorectal surgery in elderly patients with cancer was not only superior to open surgery in elderly patients, but also equivalent to laparoscopic surgery in nonelderly patients in terms of the postoperative outcomes.     

Long-term subjective outcomes of computer-assisted total knee arthroplasty

Purpose

This study aimed to clarify the results of computer-assisted total knee arthroplasty (TKA) after ten years using patient-derived scores.

Methods

Thirty posterior-stabilised total knee prostheses implanted using a computed tomography-free navigation system were compared with 30 matched total knee prostheses of the same type implanted using a conventional, manual technique. At an average of ten years after surgery, we investigated patient-reported outcomes using the Knee Society’s new scoring system. The results of 27 patients (14 patients in the navigation group and 13 patients in the manual group) were assessed in this study.

Results

There was no significant difference between the navigation and manual groups for any section of the questionnaire, which consisted of symptoms, patient satisfaction, patient expectation, walking/standing, standard activities, advanced activities, and discretionary activities.

Conclusion

After long-term follow-up, we found no subjective advantages of using a navigation system for patients who undergo TKA though the absolute number of patients was very small. Additional extensive studies are required to validate our result.     

Extremitätenerhalt durch tibiokalkaneare Arthrodese nach Pirogoff

Background

Irreversible destruction of the forefoot and midfoot generally leads to amputation. So-called limited surgical procedures such as transmetatarsal or Chopart/Syme amputations often result in poor clinical outcomes. Prostheses for these stumps are difficult to fit, a fact that reduces mobility for these patients, so reamputations are not rare. The very old method of tibiocalcaneal arthrodesis introduced by Pirogoff in 1854 can be an interesting surgical alternative in these cases, and the use of an Ilizarov external ring fixator may solve the stabilisation problem.

Material and methods

From 1 January 1990 to 1 January 2007, six patients underwent surgery for tibiocalcaneal Pirogoff arthrodesis with an external Ilizarov ring fixator.

Results

All patients could be evaluated postoperatively, with a medium follow-up time of 45.8 months. Outcome was measured with a modified ankle disarticulation score. In four cases, the outcome was good or excellent. Two cases (33%) with initially successful arthrodeses required transtibial reamputations because of secondary infection. All other cases healed very well. There was no delayed union or nonunion of the arthrodeses in our series.

Conclusions

Tibiocalcaneal Pirogoff arthrodesis can be a surgical alternative in forefoot and midfoot destructions to achieve a well-covered, comfortable stump with a minimum of leg-length shortening that is easy to fit with a prosthesis and even allows some limited barefoot mobility. Bony fixation and healing of the arthrodesis are the challenges, but these difficulties can be avoided by using an external ring fixator system. Despite a failure rate of up to one-third, this method can be an effective solution due to the good functional outcome.