This study is on the assessment of clinical outcomes following ankle arthrodesis among patients who had posttraumatic osteoarthritis of the ankle and infected open primary ankle injury at specialized hospitals in Kaduna, Kaduna State, Nigeria, with the aim of determining the mechanism of injury, mode of treatment and treatment outcome. A retrospective study research design was employed for all the patients to collect data from the two specialized hospital records. The data were analyzed using Pearson and chisquare test tool. The results revealed that Motor vehicular crashes (MVCs) are the leading mechanism of injury, accounting for 66.7%, majority of patients underwent ankle arthrodesis using Charnley’s compression clamp, and on the functional outcomes measured using the AOFAS Ankle-Hind foot scale, findings show that they were favorable, with over 80% of patients achieving good-to-excellent results. The paper recommended that further research with larger cohorts and randomized controlled designs is warranted to more definitively compare the long-term efficacy and safety profiles of Charnley’s clamp versus trans articular screw fixation in ankle arthrodesis.

This study is on the assessment of clinical outcomes following ankle arthrodesis among patients who had posttraumatic osteoarthritis of the ankle and infected open primary ankle injury at specialized hospitals in Kaduna, Kaduna State, Nigeria, with the aim of determining the mechanism of injury, mode of treatment and treatment outcome. A retrospective study research design was employed for all the patients to collect data from the two specialized hospital records. The data were analyzed using Pearson and chi-square test tool. The results revealed that Motor vehicular crashes (MVCs) are the leading mechanism of injury, accounting for 66.7%, majority of patients underwent ankle arthrodesis using Charnley’s compression clamp, and on the functional outcomes measured using the AOFAS Ankle-Hind foot scale, findings show that they were favorable, with over 80% of patients achieving good-to-excellent results. The paper recommended that further research with larger cohorts and randomized controlled designs is warranted to more definitively compare the long-term efficacy and safety profiles of Charnley’s clamp versus trans articular screw fixation in ankle arthrodesis.

Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.

У статті наведено дані результатів хірургічного лікування 12 пацієнтів (24 стопи) з тяжким ступенем hallux valgus у поєднанні з гіпермобільністю I плеснеклиноподібного суглоба при виконанні коригуючого Lapidus артродезу. Згідно з бальною шкалою AOFAS в 11 (91,7 %) пацієнтів отримано добрий результат лікування і в 1 (8,3 %) хворого — задовільний. Методика Lapidus артродезу дозволяє коригувати всі основні компоненти деформації при hallux valgus і мінімізувати можливі рецидиви деформації у пацієнтів із гіпермобільністю I плеснеклиноподібного суглоба на відміну від традиційних коригуючих остеотомій I плеснової кістки за рахунок переривання однієї зі значимих ланок патогенезу деформації.

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:Hallux rigidus is a common and painful degenerative condition of the great toe limiting a patient's physical function and quality of life. The purpose of this study was to investigate pre- and postoperative physical function (PF) and pain interference (PI) levels of patients undergoing synthetic cartilage implant hemiarthroplasty (SCI) versus arthrodesis (AD) for treatment of hallux rigidus using the Patient Reported Outcome Measurement Information System (PROMIS).Methods:Pre- and postoperative PROMIS PF and PI t-scores were analyzed for patients who underwent either SCI or AD. Postoperative final PROMIS t-scores were obtained via phone survey. Linear mixed model analysis was used to assess differences in PF and PI at each follow up point. Final follow-up scores were analyzed using independent sample t-tests.Results:Total 181 (59 SCI, 122 AD) operatively managed patients were included for analysis of PROMIS scores. Final phone survey was performed at mean 33 (14-59) months postoperatively, with 101 patients (40 SCI, 61 AD) successfully contacted. Mean age of the SCI cohort was younger than the AD cohort (57.5 versus 61.5 years-old, p = 0.01). Average PF t-scores were higher in the SCI cohort compared to AD cohort at baseline (47.1 versus 43.9, respectively; p = 0.01) and at final follow up (51.4 versus 45.9, respectively; p < 0.01). A main effect of superior improvement in PF was detected in SCI group (+4.3) versus AD group (+2) across time intervals (p < 0.01). PI t-scores were similar between the two procedures across time points.Conclusion:The SCI cohort reported superior PF t-scores at all follow-up time points compared to the arthrodesis group. No differences were found for PI or complication rates between the two treatment groups during this study timeframe.

Hallux rigidus is a common and painful degenerative condition of the great toe limiting a patient's physical function and quality of life. The purpose of this study was to investigate pre- and postoperative physical function (PF) and pain interference (PI) levels of patients undergoing synthetic cartilage implant hemiarthroplasty (SCI) vs arthrodesis (AD) for treatment of hallux rigidus using the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS PF and PI t scores were analyzed for patients who underwent either SCI or AD. Postoperative final PROMIS t scores were obtained via phone survey. Linear mixed model analysis was used to assess differences in PF and PI at each follow-up point. Final follow-up scores were analyzed using independent sample t tests. Total 181 (59 SCI, 122 AD) operatively managed patients were included for analysis of PROMIS scores. Final phone survey was performed at a minimum of 14 (mean 33, range, 14-59) months postoperatively, with 101 patients (40 SCI, 61 AD) successfully contacted. The mean final follow-up was significantly different for SCI and AD: 27 vs 38 months, respectively (P < .01). The mean age of the SCI cohort was lower than the AD cohort (57.5 vs 61.5 years old, P = .01). Average PF t scores were higher in the SCI cohort at baseline (47.1 and 43.9, respectively, P = .01) and at final follow-up (51.4 vs 45.9, respectively, P < .01). A main effect of superior improvement in PF was noted in the SCI group (+4.3) vs the AD group (+2) across time intervals (P < .01). PI t scores were similar between the 2 procedures across time points. The SCI cohort reported slightly superior PF t scores preoperatively and at most follow-up time points compared with the arthrodesis group. No differences were found for PI or complication rates between the 2 treatment groups during this study time frame. Level IV, case series.

Introduction: Extrapulmonary tuberculosis (EPTB) accounting for 10% of all cases and the involvement of the musculoskeletal system was only 3%, in which the spinal TB is the most common form. The incidence of ankle TB was found to be less than 1% of all musculoskeletal TB and often misdiagnosed. In Indonesia, the prevalence of TB is 660 from 100,000 people. There is no known data for EPTB, including musculoskeletal TB. The diagnosis of tuberculosis infection in a joint is difficult. Untreated ankle TB and diagnostic delay may result in local cartilage destruction and functional disability, leading to a poorer prognosis. This systematic review aims to find out if early surgical treatment of ankle TB affects the outcomes and the importance of laboratory tests of ankle TB. Our hypothesis predicts better outcomes with earlier surgical treatment for ankle TB. Methods: EBSCO, Proquest, Pubmed, ScienceDirect, and Google Scholar were searched using the terms “ankle”, “tuberculosis”, “arthroscopy”, “debridement” and “open”. After identification and review of the included study publications, these variables were extracted from the studies: authors, publication year, place, age, delayed onset of surgery, clinical findings, laboratory and diagnostic findings, surgery technique, tuberculosis drug, and outcome.The inclusion criteria included studies on arthroscopic or open debridement surgical management of ankle tuberculosis, English-language studies, and articles published between 2004-2019. The exclusion criteria included studies that perform arthrodesis and patients with multi-drug resistance tuberculosis. Results: After an initial search of 59 studies, 19 duplicates were removed and the final remaining 11 studies were used for inclusion (6 case-control studies, 4 case series, and 1 cohort). The studies considered were all published between 2010 and 2019. In total, there are 103 patients with a mean age of 43.8 years (7-90) treated for ankle TB with arthroscopy debridement, open debridement, and synovectomy. The mean delayed time of surgery is 10.9 months (1-80) and outcomes were evaluated over a mean of 35.5 months postoperatively (1.5-260). All patients were treated with Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE) with mean of treatment of 10 months (ranges from 4-21). No patients were lost to follow up. Conclusion: Early debridement is recommended to improve outcomes in managing ankle TB.

Charcot arthropathy of the knee is a relatively rare and poorly understood condition. Diagnosis requires detailed history of the patient, radiological investigation and exclusion of other causes of arthropathy. Conservative treatment is sufficient only in early stages. In late stages, either arthrodesis or total knee arthroplasty is the treatment of choice. We report a case of a 65-year-old woman who presented with Charcot arthropathy in both knees, after a spinal fracture 35 years ago, which caused cauda equine syndrome with diminished sensation of both legs. She underwent bilateral total knee arthroplasty using hinged knee prosthesis. J Med Cases. 2020;11(2):49-53 doi: https://doi.org/10.14740/jmc3412

Introduction: Osteoarticular tuberculosis more frequently occur on weight bearing joints. 1,8 On late stage tuberculosis osteoarthritis choices of surgical treatment involved synovectomy, osteotomy, arthrodesis, and arthroplasy 11 Results on functional outcome after surgery would be useful to decide appropriate treatments and prognosis. Method: This descriptive analytic study involved all lower extremity tuberculosis osteoarthritis that underwent surgical procedure at Cipto Mangunkusumo hospital in 5 years periods from 2008 to 2012. Follow up performed for minimal 6 months after surgery. Patients were evaluated using Lower Extremity Functional Score (LFES) and functional score according the joints involved, including Harris Hip Score (HHS), Knee Society Score (KSS), and Foot & Ankle Disability Index (FADI). Results: Study only involved late stage cases with average age at surgery was 30.04 (SD 16,67) years old. Average follow-up 33.68 months (SD 18.67). There are significant difference (p<0.001) of the LFES between preoperative (27.41), 6 months after surgery (42.19) and on last follow up (63.04). There were also difference (p<0.001) on Functional Score (HHS, KSS and FADI) preoperative (27.48), 6 months after surgery (60.11) and on last follow up (82.56). There is positive correlation between time of follow up and LEFS on last follow up. On last follow up, there is also significant difference of LEFS between groups that had arthrodesis and arthroplasty (p 0.045.) Conclusions: Results of surgical treatment gave significant improvement on functional outcome of the joint involved. The result however is correlated to the type of joints involved, type of surgery performed and the time after surgery.

Background and aim:Ankle arthrodesis has been considered for many years the surgical Gold Standard for the treatment of advanced ankle arthritis; prosthetic replacement of the tibio-talar joint played a secondary role in the treatment of the degenerative pathology of the ankle in relation to the higher rate of failures and complications compared to ankle fusion. The introduction of last generation ankle prostheses lead to better outcome, a lower rate of complication and a longer survival of the implants. Patient Specific Instrumentation (PSI) represents one of the most recent innovations introduced on the market of ankle arthroplasty: PSI is proposed as a surgical technique capable of making ankle arthroplasty more accurate and more reproducible compared to ankle replacements performed with standard referencing guides.Methods:Aim of the study is to report early clinical (AOFAS score) and radiographic outcomes (alignement of tibial component) obtained from a single surgeon experience (FC) by implanting the same ankle prosthesis (Infinity, Wright Medical Technologies) using a standard (STD) or a PSI instrumentation.Results:Unlike no difference in the average increment of normalized sub score related to function in each group (PSI vs STD), the analysis of normalized pain sub score pointed out a greater average improvement in the PSI group (+75%) compared to the STD group (+62%); this result has been adovacated to the absence of post operative gutter impingement syndrome in the PSI group compared to the STD referencing group. The analysis of post operative radiographic angles revealed a more accurate and reproducible positioning of the components in the PSI group compared to the STD group. Furthermore, ankle arthroplasty performed with PSI instrumentation reported a reduction of both surgical times and the need of intraoperative fluoroscopy compared with a standard instrumentation.Conclusions:With limitations related to the short follow up and the low number of patients, PSI ankle arthroplasty achived more accurate and reproducible clinical and radiographic results compared to standard referencing instrumentation; long-term follow-up are needed to demonstrate whether a better positioning of the implant is associated with an increased survival of the prosthesis and therefore justifies the additional costs associated with this technology. (www.actabiomedica.it)

Objective To compare the effect of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis, and to compare the advantages and disadvantages of the two methods. Methods From February 2012 to September 2017, 39 patients with phases Ⅱ and Ⅲ thumb carpometacarpal osteoarthritis underwent surgical treatment. 22 cases were performed with trapeziometacarpal arthrodesis and 17 cases were performed with trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI). Postoperatively, objective and subjective evaluation were performed on the two groups, respectively. The objective evaluation included grip strength, pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score. The subjective evaluation included visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score. The data of the two methods were compared and their differences were observed. Results In the comparison between arthrodesis and arthroplasty group, the differences of pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score were obvious, but there was no significant difference in grip strength, VAS and DASH score. Conclusion For patients with progressive thumb carpometacarpal osteoarthritis, carpometacarpal arthroplasty or arthroplasty can significantly relieve joint pain and improve grip strength. Arthrodesis can improve thumb pinch strength better, while arthroplasty can improve thumb mobility better. The patients are consciously satisfied with the effects of the two surgical methods. Key words: Thumb; Carpometacarpal joints; Arthrodesis; Arthroplasty

Arthrodesis of the talonaviculocuneiform joints for type 3 Müller-Weiss disease

Objective To evaluate the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation. Methods From February 2014 to June 2017, 15 patients (15 feet) with intra-articular calcaneal fracture associated with peroneal tendon dislocation were treated at Department of Foot and Ankle Surgery, Orthopaedics Hospital of Zhengzhou. There were 9 males (9 feet) and 6 females (6 feet), and 8 left feet and 7 right feet. The patients were aged from 20 to 55 years (average, 42.5 years). After reduction of calcaneal fractures, titanium plates and screws were used for fixation. The bone canal was established on the lateral malleolus, and the torn superior peroneal retinaculum was fixed to the lateral malleolus by suture after reduction of the peroneal tendon. The ankle joint was immobilized with a plaster brace in the metatarsal flexion for 6 weeks. The postoperative outcomes were evaluated by the American Orthopaedic Foot & Ankle Society (AOFAS) score and visual analogue scale (VAS); complications were recorded. Results All the 15 patients were followed up for 12 to 36 months (average, 20.5 months). All the calcaneal fractures fully healed and no re-dislocation of the peroneal tendon occurred. The AOFAS hindfoot-ankle scores ranged from 80 to 95 points, averaging of 87.4 points; the VAS scores ranged from 0 to 5 points, averaging 1.5 points. Delayed wound healing was observed in one case but primary healing was achieved eventually with regular dressing change. Another case presented with symptoms of injury to the cutaneous branch of the sural nerve which disappeared after oral administration of neurotrophic drugs for 6 months. Another case suffered from subtalar arthritis accompanied by persistent pain which disappeared after subtalar arthrodesis. No other complications were observed in the other patients. Conclusion In the surgical treatment of intra-articular calcaneal fractures associated with peroneal tendon dislocation, the peroneal tendon dislocation should be treated simultaneously with the intra-articular calcaneal fracture to achieve satisfactory clinical outcomes. Key words: Calcaneus; Fractures; Fracture fixation, internal; Peroneal tendon; Dislocation

Objective To evaluate distractor-assisted reduction for Lisfranc injury complicated with compressive fracture of lateral foot column. Methods A retrospective study was conducted of the 18 patients who had been treated surgically at Department of Foot and Ankle Surgery, Zhengzhou Orthopaedics Hospital between May 2014 and March 2017 for Lisfranc injury complicated with compressive fracture of lateral foot column. They were 10 males and 8 females, with an average age of 38.4 years (from 25 to 65 years). The injury involved the right foot in 11 cases and the left foot in 7. Their concomitant injuries were 12 compressive cuboid fractures and 6 compressive fractures of the calcaneal anterior process. According to the Chiodo-Myerson classification, there were 13 cases of three-column injury, 3 ones of middle-lateral column injury and 2 ones of medial-lateral column injury. All the injuries were closed. After the condition of foot soft tissues permitted, open reduction assisted by a distractor and internal fixation with a mini locking plate was performed. Functional outcomes were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scores and visual analogue scale (VAS) at the final follow-ups and complications during follow-up. Results The 18 patients were followed up for one to 4 years (average, 2 years). Their AOFAS hindfoot-ankle scores ranged from 55 to 96 points (average, 80.4 points); their VAS ranged from 0 to 6 points (average, 1.5 points). Radiographic evidence of degeneration was noted in 10 patients. Of them, 2 reported persistent pain which was cured by arthrodesis after conservative therapy failed and one presented with symptoms of injury to sural and cutaneous nerves which disappeared after oral administration of neurotrophic drugs for half a year. No such complication as skin necrosis, infection or implant failure occurred in other patients. Conclusion Open distractor-assisted reduction and internal fixation of lateral foot column with a mini locking plate, combined with bone graft if necessary, is an effective treatment for Lisfranc injury complicated with compressive fracture of lateral foot column, because it can effectively restore the alignment of lateral column and result in satisfactory therapeutic effects. Key words: Cuboid bone; Calcaneus; Foot joints; Fractures, bone; Fracture fixation, internal

Objective To observe operative results of tibiotalocalcaneal arthrodesis (TTC) via lateral transfibular ap-proach in the treatment of severe ankle and subtalar diseases. Methods Eighteen patients treated with TTC via lateral transfibu-lar approach from January 2015 to December 2017 were retrospectively analyzed. There were 11 males and 7 females from 39 to 76 years old, with an average age of 53.4 years. Preoperative diagnoses included traumatic arthritis (3 cases), osteoarthritis (10 cas-es), talar necrosis (3 cases), failure of ankle fusion (1 case) and Charcot-Marie-Tooth disease (1 case). Ankle and hindfoot deformi-ty included varus (10 cases), valgus (6 cases), equinus (1 case) and equinovarus (1 case). All cases were classified into stage-3 ar-thritis according to Morrey-Wiedeman classification. All patients sustained pain and stiffness in the ankle and hindfoot as well as walking dysfunction. Preoperative and 1 year postoperative visual analogue scale (VAS) and American Orthopaedic Foot and An-kle Society (AOFAS) ankle-hindfoot scale were collected. Postoperative joint fusion and complications were observed. Results Follow-up ranged from 12-47 months, averaging 25.4 months. Preoperative VAS scores were 6-9, averaging 7.1±1.0, while postop-erative VAS scores at 1 year follow-up were 0-2, averaging 0.9±0.8, which decreased significantly. Preoperative AOFAS scores were 24-59, averaging 40.6±11.5, while postoperative AOFAS scores at 1 year follow-up were 68-84, averaging 75.3±5.8, which increased significantly. 8 cases were good and 10 cases were fair according to AOFAS scores at 1 year follow-up. The excellent and good rate was 44.4% (8/18). All joints were fused successfully without implants loosening or breakage. All patients satisfied with operative results at 1 year follow-up. Lateral distal wound dehiscence happened in 1 case of traumatic arthritis and the wound was finally healed after debridement and vacuum assisted closure (VAC). Two cases of osteoarthritis presented with dorsal lateral foot numbness and became asymptomatic after neurotrophic medication. One case of osteoarthritis complained of discomfort in the lateral heel caused by implants prominence and implants were removed at 1 year after surgery. Postoperative complication rate was 22.2% (4/18) . Conclusion TTC via lateral transfibular approach with cannulated screws and locking plate system is safe and ef-fective. Joint fusion rate is high and complication rate is low. During operation, attention should be paid to restoring hindfoot align-ment, soft tissue balance, proper bone graft and joint compression. Key words: Subtalar joint; Arthrodesis; Arthritis

Objective To investigate the short-to medium-term therapeutic effects of a new internal fixation device, intraosseous internal fixation (IO-FIX), in the foot-ankle arthrodesis. Methods From August 2016 to December 2018, 32 patients (40 feet) underwent foot-ankle arthrodesis with IO-FIX at De-partment of Orthopaedic Surgery, The Ninth People’s Hospital of Shanghai.They were 6 males and 26 fe-males, aged from 23 to 83 years (61.7±15.1 years).There were 28 cases (36 feet) of hallux valgus, 2 cases (2 feet) of ankle arthritis, one case (1 foot) of ankle rheumatoid arthritis and one case (1 foot) of naviculocuneiform arthrosis.The therapeutic effects were assessed in terms of imaging evaluation, American Orthopaedic Foot and Ankle Society (AOFAS) score, fusion rate and full weight-bearing time. Results The follow-up ranged from 3.0 to 31.3 months (mean, 12.6 months).The total fusion rate was 95.0%(38/40); the total AOFAS score increased significantly from preoperative 41.9±9.5 to postoperative 86.9±4.7 (P< 0.05).The 28 patients (36 feet) with hallux valgus achieved a successful fusion rate of 97.2%(35/36) and full weight-bearing at 8 weeks after operation.Their fusion time ranged from 45 to 64 days (57.1 days).Their metatarsophalangeal angle was decreased significantly from 52.1°±13.5° preoperatively to 13.4°±4.9° postoperatively and their 1-2 intermetatarsal angle significantly from 14.5°±2.4° to 8.9°±2.4° (P<0.05). Their AOFAS ankle-hindfoot score was improved significantly from 41.8±9.9 to 87.0±4.8 (P<0.05). All the 3 cases of ankle arthrodesis achieved good bone union and full weight-bearing within 12 weeks and their AOFAS ankle-hindfoot score was improved significantly from preoperative 43.4±3.5 to 86.3±3.5 at the final follow-up. Conclusion In foot-ankle joint arthrodesis, due to advantages of stable fixation, zero profile, limited soft tissue irritation, reinforced bone bridge and easy reproducibility, IO-FIX can lead to satisfactory short-to mid-term therapeutic effects. Key words: Foot; Arthrodesis; Internal fixators

Objective To evaluate the surgical techniques and clinical outcomes of ankle distraction arthroplasty with platelet-rich plasma (PRP) injection for post-traumatic ankle arthritis. Methods From May 2012 to May 2017, 32 patients with post-traumatic ankle arthritis were treated at Department of Or-thopaedic Surgery, Shanghai Sixth People’s Hospital.They were 22 males and 10 females, with an age of 32.6±5.8 years (from 18 to 40 years).Their course of disease was 14.0±2.8 months (from 6 to 24 months).After failure of the conservative management for at least 6 months, they received ankle distraction arthroplasty with PRP injection.American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the final overall outcomes.Range of motion (ROM) of the ankle joint and complications were also recorded postoperatively. Results Pin tract infection occurred in 12 patients but responded to alcohol care.All the patients were followed up for an average of 36 months (from 18 to 60 months).The VAS score decreased significantly from preoperative 6.8±1.2 to postoperative 1.8±1.4; the AOFAS ankle-hindfoot score increased significantly from preoperative 38.5±6.2 to 80.3±8.1 at the final follow-up; dorsal expansion and plantar flexion of the ankle increased significantly from pre-operative 8.3°±7.0° and 24.7°±6.4° to 12.8°±6.5° and 31.4°±5.3° at the final follow-up, respectively(all P<0.05).Two patients had to receive salvage arthrodesis after conservative management failed to re-lieve their symptoms or delay the progression of their post-traumatic arthritis. Conclusion Ankle dis-traction arthroplasty with PRP injection is an effective ankle preserving surgery which can relieve symptoms, improve functions and delay progression of post-traumatic ankle arthritis. Key words: Ankle joint; Arthritis; Arthroplasty; Platelet-rich plasma

Objective To evaluate the efficacy of posterolateral water inflow portal of arthroscopic ankle arthrodesis. Methods The patients who underwent arthroscopic ankle arthrodesis in Center for Joint Surgery, Southwest Hospital from July 2005 to July 2017 were followed up. The posterolateral water inflow portal was established from March 2014 to improve the efficiency of surgery. The patients from July 2005 to March 2014 were enrolled into the control groups and the patients from March 2014 to July 2017 were enrolled into the observation groups. The operation time, the AOFAS score and the bone fusion time were compared between the two groups by t test or rank sum test. Results Seventy-eight cases were followed up, including 43 cases in the observation group and 35 cases in the control group. The average follow-up time was (47±24) months. All the patients achieved bone fusion at (15±3) weeks after surgery, pain relief and gait improvement. One patient in the control group had surgical wound bad healing which was cured by change dressing. There was no joint infection, deep venous thrombosis in either groups. Five patients were found subtalar arthritis over all follow-up periods. The operative time of the observation group was (89±8) min, which was significantly less than (109±10) min of the control group (t=9.290, P 0.05). There was no significant difference in bone fusion time between the two groups (P>0.05). Conclusion The posterolateral water inflow portal can significantly shorten the operation time and improve the efficiency of arthroscopic ankle arthrodesis, but there is a learning curve about this technique. Key words: Ankle; Osteoarthritis; Arthrodesis; Arthroscopy; Treatment

Objective To investigate the clinical efficacy of tibiocalcaneal arthrodesis using bone transport technique in the treatment of traumatic talus infection or loss. Methods A retrospective case series study was conducted to analyze the clinical data of 15 patients with talus infection or loss admitted to the provincial hospital affiliated to Shandong University from June 2011 to October 2017. There were 13 males and two females, aged from 19 to 47 years, with an average age of 27 years. Thirteen patients had talus infection and two patients had talus loss. All patients underwent tibiocalcaneal fusion with external fixator using bone transport technique, including four patients treated with annular external fixator and 11 with unilateral external fixator. Six patients with severe infection underwent debridement at stage I and osteotomy at stage II, and the other nine underwent debridement and osteotomy at the same time. The length of new bone, the fixation time of external fixator and complications were recorded. The American Orthopedic Foot and Ankle Society (AOFAS) score was used to evaluate the efficacy. Results All patients were followed up for 18-35 months, with an average of 26 months. The length of new bone in proximal tibial osteotomy area was 5-16 cm, with an average of 9 cm. The external fixators were removed after bone healing at docking site and maturation of new bone. The fixation time of external fixator ranged from 13 to 27 months, with an average of 18 months. No complications such as needle breakage, recurrence of infection and calcaneal varus occurred, and the length of both lower limbs was equal. AOFAS score was increased from preoperative (42.0±3.6)points (31-55 points) to (76.0±4.2)points (69-86 points) at the last follow-up. Conclusion Tibiocalcaneal arthrodesis using bone transport technique is proved to be effective in treating traumatic talus infection or loss, which can repair the bone defect after debridement, improve the ankle-hindfoot function and improve the quality of life. Key words: Talus; Infection; External fixators; Arthrodesis

Objective To investigate the treatment options for early and delayed postoperative infection of tibial plateau fracture. Methods A retrospective case series study was conducted to analyze 21 patients with postoperative infection of tibial plateau fracture admitted to the Second Affiliated Hospital of Medical College of Zhejiang University from February 2013 to February 2017. There were 16 males and five females, aged 28-68 years, with an average age of 51.9 years. Infection control was achieved in all patients through debridement and local application of antibiotic calcium sulfate or bone cement in all patients and gastrocnemius muscle flap transfer was conducted if necessary. The implants were retained in the 12 patients with early infection through thorough debridement and antibiotic therapy. Of all the nine patients with delayed infection, the implant of one patient was removed after local wound dressing until fracture union and the following debridement closure was performed; two patients with severe damage of knee joint had no chance of reconstruction, with one patient treated with lower femoral amputation and another with replacement of plate by external fixator at stage I and arthrodesis at stage II. The implants were replaced by external fixator followed by debridement and antibiotic therapy in the remaining six patients with delayed infection, among which stage II bone grafting was performed in three patients with bone defect. Infection, bone healing and knee function score of Hospital for Special Surgery (HSS) were evaluated in all patients at regular intervals. Results All patients were followed up for 18-60 months, with an average of 37.4 months. All patients were treated with antibiotic calcium sulfate or bone cement to control infection. Ten patients with infection underwent gastrocnemius muscle flap transfer, and the wounds were healed well with no recurrence of fracture and infection. The implants of 12 patients with early infection were successfully retained, and the fractures were healed. According to HSS scoring criteria, the knee joint function results were excellent in seven patients, good in three, and moderate in two, with an overall excellent and good rate of 83% (10/12). Infection was controlled in nine patients with delayed infection, and fractures or bone defects were healed in seven patients with delayed infection except patients receiving amputation and joint fusion. According to HSS scoring criteria, knee joint function results were excellent in one patient, good in three, moderate in two and poor in one, with an excellent and good rate of 57% (4/7). Conclusions Patients with early postoperative infection of tibial plateau fracture may attempt to retain the implants through early debridement and antibiotic therapy. For patients with delayed infection, although implants may also be retained in stable cases with ongoing fracture healing, removal of implants instead by external fixator is recommended and infection can mostly be controlled by debridement and antibiotic therapy. Meanwhile, gastrocnemius muscle flap transfer and antibiotic calcium sulfate or bone cement contributing to the control of infection can achieve good clinical results. Key words: Tibial fractures; Infection; Treatment