Radiographic Outcomes of Isolated Subtalar Joint Arthrodesis With Varying Fixation Technique

Subtalar joint (STJ) arthrodesis is a well-established and accepted surgical procedure utilized for the treatment of various hindfoot conditions including primary or posttraumatic subtalar osteoarthritis, hindfoot valgus deformity, hindfoot varus deformity, complex acute calcaneal fracture, symptomatic residual congenital deformity, tarsal coalition, and other conditions causing pain and deformity about the hindfoot. Union rates associated with isolated subtalar joint arthrodesis are generally thought to be favorable, though reports have varied significantly, with non-union rates ranging from 0 to 46%. Various fixation constructs have been recommended for STJ arthrodesis. The purpose of this study was to compare radiographic union in a 2-screw fixation technique to a 3-screw fixation technique for patients undergoing primary isolated STJ arthrodesis. To this end, we retrospectively reviewed 54 patients; 26 in the 2-screw group and 28 in the 3-screw group. We found the median time to radiographic union to be 9 weeks for the 2-screw cohort and 7 weeks for the 3-screw cohort. Additionally, we found that the 2-screw fixation cohort had a radiographic non-union rate of 26.9% while the 3-screw cohort had no non-unions. We conclude that the use of a 3-screw construct for isolated STJ arthrodesis has a lower non-union rate and time to union when compared to the traditional 2-screw construct and should be considered as a fixation option for STJ arthrodesis.     

First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw

Various fixation constructs exist to address hallux valgus when performing a first tarsometatarsal joint arthrodesis. The goal of this present study is to compare complication rates, and degree and maintenance of angular correction between a dorsomedial locking plate with intercuneiform compression screw construct versus traditional crossing solid screw fixation construct. The plate plus intercuneiform compression screw construct fixation utilized a combined sagittal saw and curette method of joint preparation while the crossed screw fixation group utilized a curette and bur technique. A retrospective review was conducted of consecutive patients who underwent a midfoot fusion using either constructs. Sixty four total feet in 56 patients were enrolled in the study. Twenty four consecutive patients (32 feet) who underwent a midfoot arthrodesis using the locking plate and intercuneiform fixation were fully fused (100%) by 10 weeks postoperatively, with no incidents of nonunion and one deep vein thrombosis event. Thirty two consecutive patients (32 feet) who underwent midfoot arthrodesis with crossing screw fixation had 2 nonunion events, one that was asymptomatic and the other that required a revision midfoot fusion. There was a statistically significant improvement from the pre-operative intermetatarsal angle, hallux abductus angle compared to the 10 week and 1 year radiographs (p < .05) for the entire cohort for both fixation constructs. There was a statistically significant increase in American College of Foot and Ankle Surgery first ray scores from pre-op to 1 year follow-up for both fixation constructs. Overall, the dorsomedial locking plate plus intercuneiform compression screw fixation construct better maintains Intermetatarsal angle (IMA) correction at midterm follow-up compared to the traditional crossing screw construct. Both cohorts overall demonstrate similar fusion rates at 10 weeks, nonunion events, incidences of broken hardware, hardware removal, deep vein thrombosis, neuritis at 1 year postoperatively, and hallux varus.     

Radiographic Outcomes of Talonavicular Joint Arthrodesis With Varying Fixation Techniques in Stage III Adult Acquired Flatfoot Reconstruction

Utilization of the talonavicular joint (TN) arthrodesis as an isolated procedure or in combination with hindfoot arthrodesis has been described in the literature for treatment of numerous hindfoot conditions. When used in isolation or with concomitant hindfoot arthrodesis, the TN joint has demonstrated nonunion rates reported as high as 37% in the literature. Despite previous research, there remains a lack of agreement upon the ideal fixation technique for TN joint arthrodesis with and without concomitant subtalar joint arthrodesis. The purpose of this study was to retrospectively compare the radiographic and clinical results of TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs in the treatment of advanced hindfoot malalignment in stage III adult-acquired flatfoot deformity. We retrospectively reviewed 105 patients who underwent TN joint arthrodesis as part of double arthrodesis procedure utilizing 4 separate fixation constructs. Our results demonstrated a nonunion rate of 16.2%, with 17 nonunions identified within our patient population. One (2.4%) nonunion was observed in the 3-screw cohort, 7 (33.3%) nonunions were observed in the 2-screw cohort, 4 (16.0%) nonunions were observed in the 2-screw plus plate cohort, and 5 (29.4%) nonunions were observed in the 1-screw plus plate cohort. The difference in nonunion rate between the 4 cohorts was statistically significant. Based on these results, we conclude that the use of a 3-screw construct for TN joint arthrodesis as part of double arthrodesis procedure demonstrates a statistically significant reduction in nonunion rate and should be considered a superior fixation construct for this procedure.     

A retrospective comparison of four plate constructs for first metatarsophalangeal joint fusion: static plate, static plate with lag screw, locked plate, and locked plate with lag screw

The primary treatment for progressive first metatarsophalangeal (MTP) joint arthritis is arthrodesis. Multiple fixation types have been used to accomplish fusion including plating. There have been no published articles reporting the outcomes of these 4 plate and/or screw constructs. We present our experience with 138 first MTP joint fusions using these constructs. A retrospective comparison and radiographic chart review of 132 patients (138 feet) was performed to compare different constructs in regards to successful union and time to fusion. All operations were performed by 4 fellowship-trained foot and ankle surgeons. The radiographs were independently read by 2 authors not involved in the index procedures. Radiographic fusion was determined by bridging cortices across the joint line. The mean time to union (in days) and rate of fusion were static plate: 59, 95%, static plate with lag screw: 56, 86%, locked plate: 66, 92%, and locked plate with lag screw: 53, 96%. There was not a statistically significant difference between the groups in regards to patient age, time to weight bearing, time to fusion, or rate of fusion. We report on the results of fusion comparing 4 different plate and/or screw constructs for first MTP joint fusion. The data reveal no significant difference in time to fusion or rate of fusion between static and locked plates, with or without a lag screw.     

Intramedullary Screw Fixation Versus Traditional Plating for Distal Fibula Fractures

The traditional method of treating fibular fractures in unstable ankle injuries involves open reduction and internal fixation with a plate and screw construct. Less invasive percutaneous fixation techniques with intramedullary fibular screws have been utilized for many years to reduce wound and implant complications while maintaining a stable ankle mortise. However, there have been no direct case-control studies comparing percutaneous intramedullary fibular screw fixation to the traditional open reduction and internal fixation with plates and screws. In our study, we compared radiographic and clinical outcomes for unstable ankle fractures in which the fibula fracture was treated with either a percutaneous intramedullary screw or by open reduction and internal fixation with a plate and screw construct. We retrospectively reviewed 69 consecutive patients from 2011 to 2019 with unstable ankle fractures treated with intramedullary fibular screws and compared them to 216 case-control patients treated with traditional plate and screw construct over the same time period. The average follow-up for the intramedullary screw group was 11.5 months and 15.2 months for the plate and screw group. We collected general demographic data, measured intraoperative and final follow-up talocrural angles, Kellgren-Lawrence osteoarthritis grade, union rates, implant removal rates, infection rates, and American Orthopedic Foot and Ankle Society ankle-hindfoot scores. The intramedullary screw group had a statistically significant lower rate of delayed implant removal (8.7% vs 23.6%) and there was no detectable difference in other measures.     

Union Rates With the Use of Structural Allograft in Lapidus Arthrodesis: A Comparison Between Two Fixation Constructs

Although structural allograft has been previously described as acceptable practice for reconstructive foot and ankle surgery, results for an allograft bone wedge in Lapidus arthrodesis are unknown. Additionally, there is no consensus on the superiority of a single fixation construct in Lapidus cases. Our objective was (1) to report union rates for Lapidus arthrodesis with and without the use of an allograft bone wedge and (2) to determine if fixation construct impacts rates of union when using structural allograft. A review was performed for Lapidus cases with fixation constructs of 2 crossed compression screws (CS) and a medial locking plate with single transarticular screw (MPS), both with and without use of an allograft bone wedge. Inclusion required a CT scan to evaluate bony union. There was no significant difference in union rates (p = .41) between the use (90%) and the nonuse (97%) of an allograft bone wedge. Union rates were significantly different (p = .04) when comparing CS fixation (85%) and MPS fixation (98%). The comparative results between the fixation constructs highlight the importance of compression across the arthrodesis site as part of a robust fixation construct. Our findings demonstrate that the use of an allograft bone wedge in Lapidus arthrodesis may mitigate complications due to metatarsal shortening while providing satisfactory rates of union.     

Percutaneous Intramedullary Screw Fixation of Distal Fibula Fractures: A Case Series and Systematic Review

The current reference standard for unstable ankle fractures is open reduction and internal fixation using a plate and lag screws. This approach requires extensive dissection and wound complications are not uncommon. The use of intramedullary screw fixation might overcome these issues. The aim of our study was to provide an overview of the published data regarding intramedullary screw fixation of fibula fractures combined with a small consecutive case series. We performed a search of published studies to identify the studies in which fibula fractures were treated with percutaneous intramedullary screw fixation. Additionally, all consecutive patients treated for an unstable ankle fracture in a level 1 trauma center using an intramedullary screw were retrospectively included. The literature search identified 6 studies with a total of 180 patients. Wound infection was seen in 1 patient (0.6%), anatomic reduction was achieved in 168 patients (93.3%), and a loss of reduction was seen in 2 patients (1.1%). Implant removal was deemed necessary in 3 patients (1.7%) and nonunion was seen is 2 patients (1.1%). A total of 11 patients, in whom no wound complications occurred, were included in our study. The follow-up duration was a minimum of 12 months. A secondary dislocation was seen in 1 patient, and delayed union was observed after 7.5 months in 1 other patient. In conclusion, intramedullary screw fixation is a safe and adequate method to use for fibula fractures, with a low risk of wound complications. Additional research regarding functional outcome is warranted.     

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%.     

Biomechanical comparison of a 2 and 3 proximal screw-configured antegrade piriformis intramedullary nail with a trochanteric reconstruction nail in an unstable subtrochanteric fracture model

OBJECTIVE: The objective of this study was to test the stiffness and ultimate load to failure of new intramedullary (IM) nail proximal screw configurations as compared to a trochanteric reconstruction nail. METHODS: Twenty-one synthetic composite femurs were mounted on a Material Testing System and tested in axial compression 5 times. The femurs had an 1 of 2 IM nail types inserted with 1 of 3 proximal screw configurations: a 3-screw configuration with 2 transverse screws and a screw angled into the femoral neck; a 2-screw design with a single transverse screw and a single screw angled into the femoral neck; 2 parallel screws angled into the femoral neck. There were 7 specimens in each group. An unstable fracture (OTA/AO 32-C3.2) was created. and the stiffness of these constructs was tested in compression 5 times. Each construct was then loaded to failure in compression. RESULTS: The 3-screw construct provided more axial stiffness (214 N/mm +/- 75) than either the 2-screw construct (123 N/mm +/- 32) or the trochanteric reconstruction nail (127 N/mm +/- 21) (P = 0.017 and 0.035 for 3-screw vs. 2-screw and recon respectively, P = 0.45 for 2-screw vs. recon). Load-to-failure testing demonstrated similarity among the different screw configurations (3-screw = 2230 N +/- 265, 2-screw = 2283 N +/- 260, Reconstruction nail = 2121 N +/- 156) (P = 1.0 all groups). CONCLUSIONS: The proximal 3-screw configuration provided more stiffness than either the 2-screw configuration or trochanteric reconstruction nail. The 2-screw configuration performed equally to a standard trochanteric reconstruction nail in stiffness testing. The ultimate loads to failure for the 3 tested constructs were not significantly different.     

Biomechanical Analysis of Acetabular Revision Constructs : Is Pelvic Discontinuity Best Treated With Bicolumnar or Traditional Unicolumnar Fixation?

Pelvic discontinuity in revision total hip arthroplasty presents problems with component fixation and union. A construct was proposed based on bicolumnar fixation for transverse acetabular fractures. Each of 3 reconstructions was performed on 6 composite hemipelvises: (1) a cup-cage construct, (2) a posterior column plate construct, and (3) a bicolumnar construct (no. 2 plus an antegrade 4.5-mm anterior column screw). Bone-cup interface motions were measured, whereas cyclical loads were applied in both walking and descending stair simulations. The bicolumnar construct provided the most stable construct. Descending stair mode yielded more significant differences between constructs. The bicolumnar construct provided improved component stability. Placing an antegrade anterior column screw through a posterior approach is a novel method of providing anterior column support in this setting.     

关节突自体骨移植后路腰椎间盘植骨融合固定术的临床分析

目的探讨关节突自体骨移植后路腰椎间盘植骨融合固定术治疗椎间盘退变的远期疗效。方法自2001年10月至2007年10月本组收治腰椎退变病人50例(平均53.2岁),用这一方法进行椎间融合,平均随访3年。用日本矫形协会标准(JOA)评分:痊愈率、并发症和X线片的结果进行综合的评定。结果关节突自体骨移植后路腰椎间盘植骨融合固定术,椎间融合率(92.0%),临床效果(JOA评定治愈率78.3%),在治疗椎间盘退变、椎体滑脱锥体骨折取得了良好的效果,术后有3个病人出现了并发症。结论关节突自体骨移植后路腰椎间盘植骨融合固定术治疗椎间盘退变疾病手术疗效满意,显著提高融合率,预防神经根管狭窄、神经卡压的发生,减少术后断钉和椎体滑脱复发等问题。     

Combined Medial Column Arthrodesis with Open Reduction Internal Fixation of Central Column for Treatment of Lisfranc Fracture-Dislocation: A Review of Consecutive Cases

Lisfranc fracture-dislocations can be devastating injuries with significant long-term sequelae with or without surgical intervention. The main goal of treatment is to minimize the common long-term complications including pain, progressive arch collapse, degenerative joint disease, hardware failure, and reoperation. Partial primary fusion involving the first, second, and third tarsometatarsal joints has become a common approach for primarily dislocation injuries, with open reduction and internal fixation (ORIF) favored for Lisfranc injuries involving fracture. ORIF commonly requires revision surgery for hardware removal or delayed fusion. Major revision creates hardship for the patient due to the prolonged recovery required, and even “simple” hardware removal can be traumatic to local nerve, artery, and tendon structures. A common injury pattern includes the findings of primary dislocation and instability of the first tarsometatarsal joint with oftentimes comminuted fracture to the second and third tarsometatarsal joints, which does not fit the standard surgical approach. We report a review of our preferred surgical approach consisting of medial column primary arthrodesis combined with central column ORIF and lateral column temporary pinning. We undertook an institutional review board-approved review of 35 consecutive Lisfranc injuries treated with this hybrid approach. Mean follow-up time was 22.14?±?22.39 (range 2.5 to 84) months. All but 2 (5.71%) patients had radiographic evidence of union at 10 weeks. Complications included 3 with neuritis, 1 with medial column nonunion that was treated with a bone stimulator, and 1 with revision of second metatarsal nonunion. The present retrospective series highlights our experience with isolated primary fusion of the medial column in both subtle and obvious Lisfranc injuries.     

Dual Window Approach With Two-Side Screw Fixation for Isolated Talonavicular Arthrodesis

Isolated talonavicular arthrodesis is a commonly performed surgical intervention. Nonunion is a dreaded complication. The aim of the present study was to analyze the clinical and radiologic outcome of talonavicular arthrodesis using a dual approach with 2-side screw fixation. From February 2012 to September 2014, isolated talonavicular arthrodesis was performed on 17 joints of 16 patients (mean age 59.12 years). All procedures were performed by a single surgeon. The incidence of union, visual analog scale scores, and complications were analyzed. Radiographic union was achieved in all 17 cases (100%) at a mean period of 13.12 weeks. The visual analog scale scores had improved significantly (p < .001) at a mean follow-up of 48.53 weeks. One patient (6%) had minimal wound problems, and one (6%) showed prolonged swelling postoperatively. We have concluded that the dual window approach with 2-side screw fixation for isolated talonavicular arthrodesis results in excellent clinical and radiographic results and high fusion rates.     

Percutaneous anterior occiput-to-axis screw fixation: technique aspects and case series

Background contextPosterior occipitocervical fusion techniques have been previously described; however, traditional open anterior approaches are plagued by exposure difficulty. A minimally invasive percutaneous anterior occipitocervical fixation approach avoids this difficult exposure procedure.PurposeThis article describes a novel technique of percutaneous anterior occiput-to-axis screw fixation and its clinical outcomes.Study designTechnique report.MethodsAnteroposterior, lateral and open-mouth views, and computed tomography scans are preoperatively obtained to appraise the feasibility of surgery. We extend our experience of using percutaneous anterior transarticular screw fixation to occiput-to-axis screw fixation. This procedure was performed on six patients.ResultsThe operation was successfully performed on all patients without technical difficulties, and no vertebral artery, nerve injury or soft tissue (such as esophageal) complications occurred. All six patients followed up 10 to 39 months (averaged 20.5 months). Bone union was achieved in five patients, and the one patient lacking bone union was stable at final follow-up. The syringomyelia of four patients is almost complete reduction. No screw loosening or breakage has occurred.ConclusionsWith the correct puncture point, angle of insertion, and use of the appropriate tools, we suggest that percutaneous anterior occiput-to-axis fixation technique is a feasible, safe, and minimally invasive procedure.     

Use of a headless compressive screw for distal interphalangeal joint arthrodesis in digits: clinical outcome and review of complications

PURPOSE: Arthrodesis of the distal interphalangeal joint (DIPJ) or thumb interphalangeal joints can be necessary to treat pain, deformity, or instability associated with arthritis. Compression and rigid fixation are thought to influence fusion rates and time to union favorably. The purpose of the study was to review the clinical outcome and complications associated with the use of a fully threaded headless compression screw for DIPJ arthrodesis. METHODS: Twenty-seven distal interphalangeal or thumb interphalangeal fusions were performed with an axial Mini-Acutrak screw in 22 patients. Charts, surgical reports, and preoperative and postoperative x-rays were reviewed to determine the incidence, time to union, and complications. The minimal follow-up period was 3 months. RESULTS: Twenty-three of the 27 arthrodeses achieved bony union. Complications included symptomatic nonunion (n=1, treated with secondary fusion), asymptomatic nonunion (n=2, left untreated), infection (n=4; 2 patients required implant removal that resulted in nonunion but declined revision) and nail bed injury (n=3). CONCLUSIONS: The Mini-Acutrak screw technique achieves healing rates that are comparable with but not superior to other techniques. Its main advantages are ease of execution, fully buried hardware, and early mobilization; however, the procedure is associated with complications and meticulous technique is required to avoid them. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

2种内固定方法治疗98例踝关节骨折的疗效比较

目的比较闭合复位经皮空心螺钉内固定与传统切开复位内固定治疗踝关节骨折的疗效。方法 2004年3月～2009年8月收治的98例非粉碎型内外踝双骨折根据内固定方法不同分为闭合复位经皮空心螺钉内固定(闭合复位组)和传统切开复位内固定(切开复位组),比较2组患者的手术时间、术中出血量、骨折愈合时间、骨折愈合后外踝有无疼痛及术后1年AOFAS足踝评分。结果闭合复位组术中出血量、术后切口感染发生率及骨折愈合后外踝出现疼痛发生率明显优于切开复位组(P<0.05)。闭合复位组51例术后随访16～81个月,平均29.7月,骨折全部愈合;切开复位组42例随访17～80个月,平均28.3月,4例出现切口红肿、皮缘坏死,经换药后切口愈合,无深部感染发生,1例出现骨折不愈合。结论与传统切开复位内固定比较,闭合复位经皮空心螺钉内固定治疗踝关节骨折具有出血少、术后切口并发症发生率低、骨折愈合后外踝疼痛发生率低的优点,并能获得与切开复位内固定等同的踝关节功能。     

Crossed Screw Fixation Versus Dorsal Plating for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Cohort Study

Multiple fixation techniques for first metatarsophalangeal joint arthrodesis have been described with an average fusion rate of 93.5%. This retrospective cohort study assesses the association between crossed screws (vs dorsal plating) and medical comorbidities and the outcome radiographic union. Bivariate tests of association and multivariable logistic regression were employed to assess differences across fixation type and outcomes. We identified 305 patients who underwent a first metatarsophalangeal joint arthrodesis during the study period. Crossed screw fixation was used in 158 (51.8%) patients while dorsal plating (tubular or anatomic locking plate) was used in 147 (48.2%) patients. Dorsal plating was utilized more often in patients with rheumatoid arthritis (p = .019) and history of smoking (p = .044). At 12 weeks post-operatively there were no significant differences in fusion rates between the two groups (crossed screw group = 95.3% vs dorsal plate group (referent) = 93.5%, Adjusted odds ratio (AOR) 1.39, 95% confidence interval [CI] 0.45-4.26). Not smoking was associated with a greater odds of fusion at 12 weeks (96.2% for nonsmokers vs 75.0% for smokers (referent), AOR 0.07, 95% CI 0.02-0.28). Lower body mass index was associated with a greater odds of fusion at 12 weeks (AOR 0.90, 95% CI 0.82-0.99). Surgeons allowed weightbearing earlier with dorsal plate fixation (2 weeks (interquartile range [IQR] 2.6) versus 5 weeks (IQR 2.6) for crossed screw fixation, p = .001). Patients with multiple medical comorbidities were more likely to require revision surgery than patients having 0-1 comorbidities (p < .05). Crossed screws can provide an inexpensive yet effective option for first metatarsophalangeal joint arthrodesis.     

Distraction Arthrodesis of the Subtalar Joint Using Allogeneic Bone Graft: A Review of 15 Cases

Distraction arthrodesis of the subtalar joint is often used for the correction of neglected calcaneal fractures. Although different techniques have been advocated, there remains some debate as to the optimal type of bone graft for this purpose. This study retrospectively reviewed one surgeon's results for distraction arthrodesis of the talocalcaneal joint for 15 consecutive feet in 15 patients using 12 frozen femoral head and 3 freeze-dried iliac crest allografts. Indications for distraction arthrodesis in this series included neglected calcaneal fracture (n = 10), failed open reduction with internal fixation (n = 3), malunion after ankle fusion (n = 1), and subtalar joint arthritis with deformity (n = 1). The mean patient age was 47.5 (range 29 to 66) years, and the mean duration of follow-up was 20.6 (range 13 to 31) months. Complete union was achieved in 14 (93.33%) feet. Orthobiological agents were used in every case, including 7 (46.67%) platelet-rich plasma, 5 (33.33%) demineralized bone matrix combined with platelet-rich plasma, 2 (13.33%) platelet-rich plasma combined with an implantable electrical bone growth stimulator, and 1 (6.67%) demineralized bone matrix only. One (6.67%) patient developed a nonunion with collapse of the allogeneic graft, requiring revision with autogenous iliac crest bone graft. There were 8 (53.33%) minor complications, including 4 (26.66%) cases with inferior heel irritation, 2 (13.33%) with sural nerve paresthesia, and 2 (13.33%) with wound dehiscence. In conclusion, the use of allograft for subtalar joint distraction arthrodesis results in similar union rates as autogenous iliac crest grafting previously reported in the literature.     

Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation versus hook constructs

This retrospective study was undertaken to determine the effectiveness and cost of thoracic pedicle screws versus laminar and pedicle hooks in patients undergoing surgical correction of adolescent idiopathic scoliosis (AIS). Immediate preoperative and 6-week postoperative radiographs were examined in 25 consecutive cases of children with AIS who were divided into two groups, those with thoracic pedicle screw constructs and those with thoracic hook constructs. Endpoints collected included radiographic measures, complications, surgical time, implant cost, and quality-of-life measures. Ten children underwent spinal fusion using thoracic pedicle screw fixation and 15 underwent thoracic constructs composed of hooks. Similar sex and age distribution were noted in both groups, and among the 20 girls and 5 boys the average age was 14.5. The mean preoperative Cobb angle was 53.5 degrees for the screw group and 52.5 degrees for the hook group. Correction averaged 70.2% for the screw group and 68.1% for the hook group. There were no significant differences between the two patient groups in terms of percentage of or absolute curve change after surgery. The apical vertebral translation, end vertebral tilt angle, and coronal balance did not differ significantly between the two patient groups. Comparison of operative time and quality of life revealed no significant differences. Screw constructs were significantly more expensive than hook constructs. The correction obtained from thoracic pedicle screw fixation is comparable to traditional hook constructs in AIS. Surgery using either construct effectively corrects AIS.     

Tibiotalocalcaneal nail failure in a 60-year-old male: Case report and surgical technique

Tibiotalocalcaneal (TTC) arthrodesis is a hindfoot fusion that can treat numerous conditions including osteoarthritis, Charcot arthropathy, avascular necrosis of the talus, and severe deformity. The goal of fusion is to create solid union across the joint while correcting deformity, leaving a shoeable plantigrade foot. Multiple biomechanical studies have demonstrated similar performance when comparing the properties of plate and nail constructs for TTC arthrodesis. Plate fixation and retrograde intramedullary nailing (IMN) are successful in achieving TTC fusion and favorable postoperative outcomes. Despite generally favorable outcomes, TTC arthrodesis carries the risk of complications including nonunion, infection, hardware failure, and revision surgery. We present a case of an individual who presented with a complete break of the IMN after TTC arthrodesis. We also describe the technique used for extraction of the broken nail.