A case of smoking cessation leading to union of an established non-union following ankle fusion

The effects of smoking on bony union after fracture and after surgery for fusion have been widely reported. In the case of ankle fusion in particular, smoking has been shown to increase the relative risk of non-union 16 times when compared to non-smokers. It has also been well documented that cessation of smoking both before and after surgery reduces the risk of non-union to near that of non-smokers.We report the case of a heavy smoking patient who developed an established non-union of his ankle 2 years after surgery for arthrodesis that went on to clinical and radiographic union within 6 months of stopping smoking.     

Functional and radiological outcome of ankle fusion. A 33 case report

Abstract: Our study concerned 33 fusions. It was about 12 women and 20 men. The average of age was 46.8 years. Postoperative follow-up was 6.5 years. In 85% of cases, origin of hurts was traumatic, neurological in 6% of cases and primary degenerative in 9% of cases.Patients underwent preoperative and postoperative clinical and radiological examination. We make functional study of ankle that finds 51.5% of good and very good results. We studied position of the foot in various plans. We also studied effects of ankle fusion on subtalar and midfoot joints by means of radiological views. These joints were seat of degenerative arthritis with aggravation in 73% of cases for subtalar joint with regard to preoperative state. This would entail poor functional result for gravest cases. According to this study and after 10 years of minimum follow-up, it appears that ideal position of fusion is 90° or slight flexum in sagittal plan, some degrees of valgus in frontal plan and external rotation of 10° to 15° to facilitate progress of step.     

Takedown of ankle fusion and conversion to total ankle replacement

The painful ankle arthrodesis is an unsolved clinical problem. In many cases, transtibial amputation may be the best option for functional recovery. Recent reports of early success with second generation ankle implants show takedown of the problematic ankle fusion and conversion to total ankle arthroplasty may be an alternative to amputation. This study is a retrospective review of 23 ankles in 22 patients scheduled to have this procedure. Four patients were lost to followup, leaving 19 ankles in 18 patients at an average followup of 39 months. Three patients chose to have an amputation because of continued pain. In the remaining 16 ankles, the mean AOFAS ankle-hind foot outcome score improved from 42-68. Patients who had a clear source of pain with the ankle arthrodesis (such as subtalar arthrosis) had a better result than patients without a clear source of pain. All the patients who had the lateral malleolus resected during previous arthrodesis had complicated courses after arthroplasty. For patients with a definable source of pain and who have not had previous malleolar resection, conversion of a failed ankle arthrodesis to total ankle arthroplasty may be a viable alternative to amputation.     

Fracture of the polyethylene component in an ankle arthroplasty: a case report

A 57-year-old female underwent total ankle arthroplasty for post-traumatic arthrosis using the Agility Total Ankle System. The talar component was placed in varus malalignment. Her postoperative course was remarkable for 19 months of satisfactory function followed by the acute onset of intense pain and decreased range of motion. There was no history of trauma. After failing a short course of observation, revision surgery of the arthroplasty was performed. Operative findings revealed a complete fracture of the polyethylene. This report details the first case of such a complication and discusses the importance of component alignment in the prevention of polyethylene insert failure.     

Voiding dysfunction due to long-standing labial fusion in an elderly woman: a case report

Labial adhesions or fusion in the elderly are rare, and only few cases are described in the English literature. We describe a case of near-complete labial fusion in an elderly woman presenting with voiding difficulty, its management and literature review.     

Use of intramedullary nonvascularized fibular graft with external fixation for revisional Charcot ankle fusion: a case report

We describe a case of Charcot ankle arthropathy in a 43-year-old male patient who underwent revision surgery for tibiotalocalcaneal arthrodesis with a retrograde intramedullary nonvascularized fibular graft. After 3 months of postoperative stabilization with a ring external fixator, successful radiographic union was identified. The findings obtained at 33 months postoperatively showed maintenance of solid fusion and restoration of hindfoot alignment without any complications.     

Fanconi's syndrome in an adult. A case history.

A case of the Fanconi syndrome in an adult presenting with life-threatening hypokalaemia is described. Amino-aciduria, glycosuria, high phosphate and uric acid clearances with reduced plasma levels of these two substances, reduced urinary concentrating power and abnormal urinary potassium loss with a systemic acidosis, were the essential biochemical abnormalities. Osteomalacia was shown by a radiological bone survey.     

Anterior ankle dislocation without associated fracture: a case with an 11 year follow-up

Ankle dislocations without concomitant malleolar fractures, also called pure ankle dislocations, are rare injuries. We present what appears to be the third documented case of a true anterior pure ankle dislocation described in international literature. The mechanism, the management and the complications of this rare injury, are also discussed.     

Splenogonadal fusion: a case report

Splenogonodal fusion is a rare congenital abnormality. We present the case of a continuous splenogonadal fusion diagnosed in the course of a laparoscopy for left non-palpable testis in a 1-year-old boy. This case illustrates that even though testicular salvage is the recommended approach, various anatomical features might preclude conservation.     

Heterotopic gastric mucosa leading to recurrent intussusceptions: Report of a case

Although most cases of intussusception during childhood are caused by viral enlargement of the Peyer’s patches, the remainder of the cases may be due to congenital anomalies, such as heterotopic gastric mucosa (HGM). This report presents a case of HGM in a 4-year-old boy. The patient presented with acute abdominal signs with a right lower quadrant mass. His medical history indicated three episodes of recurrent intussusceptions. The abdominal ultrasound examination detected an intussusception. A laparotomy revealed an ileocolic intussusception and reduction was accomplished. During exploration, an intraluminal mass in the ileum, which was the lead point, was discovered by palpation. An enterotomy showed a 2-cm-diameter crater-shaped mucosal thickening. An ileal resection and anastomosis was performed. The histopathological examination revealed HGM. Heterotopic gastric mucosa is supposed to be of vitellointestinal tract origin and may cause intussusception as being a lead point in the ileum. Despite its rarity, HGM should be considered in cases of recurrent intussusceptions and diagnostic studies should be performed. A laparotomy is required for the diagnosis and treatment in complicated cases. Surgical management should include reduction of the intussusception and careful manual examination of the ileum which may expose such pathology. An intestinal resection and anastomosis is sufficient to prevent complications.     

Splenogonadal fusion. Report of a case

We present a new case of splenogonadal fusion in a 27 years old male. This anomaly is the result of an embryological fusion between gonad and spleen. Occasionally there is an association with other congenital alterations (peromelia). Usually it occurs in the left scrotum and, although described in both sexes, it is more frequent in males. Its only symptom is palpable tumor and this makes the surgical approach the only way to make the diagnosis. A frozen section study can avoid unnecessary radical surgery.     

Villonodular synovitis. An uncommon localization: the ankle. Apropos of a case

The authors report an uncommon soft tissue tumor, a diffuse giant cell tumor of tendon sheath. The location is uncommon too, the ankle, behind tibial shaft and forward achilleus tendon. The primary diagnosis of ankle and leg lymphoedema, has been for a long time. But CT Scan and MRI allowing the discovery of a firm and multinodular mass, have permitted surgical excision and histological diagnosis. This case agrees with the literature review. The pigmented villonodular synovitis is rather uncommon in comparison to localized form. Young people and lower extremities are more affected; symptoms are of relatively long duration. Histological examination gives diagnosis but surgical excision has to remove the tumor completely as possible because of local recurrence rate of about 50%.     

Chronic pain after ankle fracture: an arthroscopic assessment case series

BACKGROUND: The purpose of this study was to document findings of ankle arthroscopy in patients with residual complaints after an appropriately treated ankle fracture. METHODS: Patients who had ankle arthroscopy at the Alpine Orthosports Clinic between 1998 and 2000 were identified by a retrospective review of the ankle arthroscopy database. Fifty patients were identified who had arthroscopy for complaints after ankle fracture. The mean duration from injury to arthroscopy was 20.5 +/- 33.5 months, with a range of 2 to 184.6 months. RESULTS: There were 37 isolated fractures and 13 combination fractures. The Danis-Weber classification was used for lateral malleolar fractures. There were five type A, 14 type B, and 11 type C lateral malleolar fractures. RESULTS: Synovitis was present in 46 ankles and was located anterolaterally in 36. Synovitis was noted in 26 of the 30 ankles that had a lateral malleolar fracture. Arthrofibrosis was found in 20 ankles, with anterolateral joint involvement in 16. There was chondral damage noted in 45 ankles, 30 located on the talus and 15 on the tibia. Spurs were found in 15 ankles, and nine had loose bodies or debris. There were two postoperative complications: one patient had bleeding from a portal and the other had an area of paresthesia at the anterolateral portal site. CONCLUSION: Synovitis and chondral damage were more frequent than arthrofibrosis and spurs. Synovitis and arthrofibrosis were found most frequently in the anterolateral aspect of the joint. Also, the higher the lateral malleolar fracture was in relation to the syndesmosis, the higher was the occurrence of talar chondral damage.