Tibiocalcaneal Fusion Research Articles

En bloc resection and reconstruction using a talar prosthesis for malignant talar bone tumor: a surgical technique.

En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis.

LIMB SALVAGE VERSUS BELOW-KNEE AMPUTATION FOR SEVERE ADULT LOWER LIMB DEFORMITY: A RETROSPECTIVE COMPARATIVE SERIES

IntroductionSevere, multiplanar, fixed, pantalar deformities present a challenge to orthopaedic surgeons. Surgical options include limb salvage or amputation. This study compares outcomes of patients with such deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA).MethodsFifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17 to 72 years) and median follow-up duration was 49.9 months (18.0 to 253.7 months). Patients with chronic regional pain syndrome, tumour, acute trauma or diabetic Charcot arthropathy were excluded. Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgical outcome and whether they would have the same surgery again.ResultsThere was no statistically significant difference in patient reported outcomes, satisfaction, or complication profile between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p=0.414). Similarly, there was no difference in the proportion of patients who would opt for the same procedure again (p=0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p=0.692).ConclusionThis study has shown that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative deformities of the lower extremity. Therefore, surgical decisions must be based on individual patient considerations. This data may also be useful in counselling patients when considering limb salvage versus amputation for severe deformity.

Reconstruction after Talar Tumor Resection: A Systematic Review

This systematic review investigated the functional outcomes and complications of reconstruction methods after talar tumor resection. A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases identified 156 studies, of which 20 (23 patients) were ultimately included. The mean Musculoskeletal Tumor Society scores in the groups reconstructed using tibiocalcaneal fusion (n = 17), frozen autograft (n = 1), and talar prosthesis (n = 5) were 77.6 (range 66-90), 70, and 90 (range 87-93), respectively. Regarding complications, sensory deficits were observed in one patient (6%) and venous thrombosis in two patients (12%) in the tibiocalcaneal fusion group, while osteoarthritis was observed in one patient (100%) in the frozen autograft group. No complications were observed in the talar prosthesis group. Reconstruction with talar prosthesis seems preferable to conventional tibiocalcaneal fusion after talar tumor resection because it offers better function and fewer complications. However, as this systematic review included only retrospective studies with a small number of patients, its results require re-evaluation in future randomized controlled trials with larger numbers of patients.

2 A Retrospective Analysis of the Definitive Management of Open Talus Fractures at a Major Trauma Centre and an Audit of BOAST 4 Guidelines

Abstract Currently, the management of open talus fractures is based upon BOAST 4 guidelines although there is no suggested definitive management, thus definitive management is based upon surgeon preference. This retrospective analysis aims to clarify the debate between ORIF and tibiocalcaneal fusion (FUSION). A review of open talus fractures from 2014–2021 returned foureen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, five cases were definitively managed with FUSION. We collected patient's age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group. FUSION is typically used as second line to ORIF or failed ORIF. However, there are a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time, that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate, and quality-of-life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

Aggressive giant cell tumour of the talus: a rare case report and challenges faced during its management

<p>Giant cell tumour (GCT) of the bone is a locally aggressive benign tumour that commonly occurs in the epiphyseal ends of long bones. Its occurrence in the small bones of the foot like the talus is rare. In this case report we described a case of aggressive GCT of the talus (Campanacci grade 3) in a twenty-one years old male diagnosed by the presence of a well-defined osteolytic lesion seen involving the talar body with cortical breach and soft tissue extension confirmed to be a GCT by closed needle biopsy. The patient was managed surgically by excision of the tumour mass in-toto along with the talus followed by tibio-calcaneal fusion using free fibular strut graft and Ilizarov frame. At 3 months follow up no evidence of fusion was seen and therefore secondary augmentation with a cortico-cancellous graft from the iliac crest was done to aid fusion and Ilizarov fixator was removed 6 months after the surgery. The patient at one year follow up had shown no signs of recurrence of the tumour and has a pain free, stable fused tibiocalcaneal joint with a bipedal unassisted gait. Our case report found excision of talus combined with tibio-calcaneal fusion using free fibular strut graft along with cortico cancellous iliac bone graft to have a good outcome in terms of aiding tibio-calcaneal arthrodesis and thereby providing pain relief and providing a stable foot to the patient.</p>

Increased Arthrodesis Rates in Charcot Neuroarthropathy Utilizing Distal Tibial Distraction Osteogenesis Principles.

Charcot neuroarthropathy of the hindfoot and ankle poses substantial challenges due to deformity, segmental bone loss, chronic infection, and difficulty with bracing. Hindfoot or ankle arthrodesis is often employed at high rates of complications and nonunion. This study reports 15 consecutive patients with Charcot neuroarthropathy who underwent tibiotalocalcaneal or tibiocalcaneal fusion with simultaneous distal tibial distraction osteogenesis with a mean follow-up period of 20.2 ± 5.66 months. Arthrodesis rate was 93.3% (14 patients) with mean time to fusion of 4.75 ± 3.4 months. One hypertrophic nonunion occurred at the arthrodesis site. Complete consolidation of 4 cortices was achieved at the distraction site in 93.3% of patients (14 patients) with a mean duration to consolidation of 9.8 ± 3.3 months. One patient experienced hypertrophic nonunion at the regeneration site. The authors report a technique to enhance arthrodesis rates in Charcot neuroarthropathy by combining distal tibial distraction osteogenesis with simultaneous tibiotalocalcaneal or tibiocalcaneal arthrodesis for hindfoot fusion and salvage. Distraction osteogenesis supports enhanced vascularity to the arthrodesis site.Level of Clinical Evidence: Level 4.

Fibular Strut Autograft as an Augmented Biological Plate: A New Modified Technique for Tibiocalcaneal Arthrodesis With Intramedullary Nail

Fibular Strut Autograft as an Augmented Biological Plate: A New Modified Technique for Tibiocalcaneal Arthrodesis With Intramedullary Nail

Minimally Invasive Management of a Rare Giant Cell Tumor of Talus: A Case Report and Literature Review

Category:Ankle; Hindfoot; OtherIntroduction/Purpose:Giant cell tumor (GCT) of small bones of hand and feet is rare. A benign but locally aggressive neoplasm with a tendency for local recurrence with undifferentiated mesenchymal stromal cells and the presence of abundant, multinucleated giant cells. It occurs in a slightly younger age group with usually an expansile and eccentric epiphyseo-metaphyseal region lytic lesion. A 22 yrs. old patient, presenting as lytic expansile lesion of talus, suspected Giant cell tumor (GCT) of talus preoperatively and intraoperatively and proven subsequently, is presented along with review of literature. This patient is the young and nearly 24th case reported in the literature for GCT of talus.Methods:Author reviewed the literature for the GCT of talus from 1964 to till 2021. The author reported a case of left ankle joint pain and swelling for 6 months in a 22 yrs. old male, which turns out to be aneurysmal bone cyst of talus on radiographs, Computed tomography and aspiration cytology. Campanacci grade II lesion was planned for the curettage and autologous bone grafting.Results:Retrospectively, the intraoperative biopsy confirmed the lesion as giant cell tumor with aneurysmal bone cyst. After 4 years the lesion showed the near complete resolution on radiographs and CT scan. However, because of the historical recurrence and metastasis reports of GCT, author is continuously monitoring patient's ankle with yearly follow up. Author reviwed the literarue for the GCT of talus from 1964 to till 2021. Author found total of 23 reported cases for GCT of talus in literature, out of which 2 cases showed recurrence and distant metastasis to chest which is 8.69 percent of total cases.Conclusion:Author concludes that the Campanacci grade I and II can be managed with mini-open lesional curettage and autologous bone grafting while grade III and IV needed osteotomy, en-bloc excisions and tibio-calcaneal fusion or below knee amputation in recurrent or aggressive lesions. As author found 8.69 percent cases of distant pulmonary metastasis out of total reported cases, he recommends yearly follow up of the lesions and look for distant metastasis in suspected cases.

Results of talectomy for inveterate or recurrent clubfoot

IntroductionThe aim of the present study was to define indications for talectomy in congenital paralytic, dystrophic or idiopathic, inveterate or recurrent, clubfoot. HypothesisTalectomy is a valid option for paralytic, dystrophic or idiopathic, inveterate or recurrent, clubfoot. Patients and methodsA single-center retrospective series comprised 52 clubfeet in 31 patients. Etiology was paralytic in 34 feet (65%) (17 arthrogryposes, 10 myelomeningoceles, 4 encephalopathies, 3 peripheral neuropathies), dystrophic in 6 (12%) and idiopathic in 12 (23%). In 27 feet, there was history of surgery (52%). Mean age at talectomy was 4.7 years. In 45 feet (87%), there were associated procedures (soft-tissue release, tendon surgery, calcaneal or lateral arch osteotomy, tibiocalcaneal fusion) and talectomy was isolated in 7 feet (13%). Mean follow-up was 9 years. Final assessment was based on the modified Ghanem and Seringe classification (G&S) and the Ankle-Hindfoot Scale (AHS). ResultsAll feet required at least one complementary procedure, either in the same step or as revision. Revision surgery was performed in 17 cases (33%), including all 7 feet with isolated talectomy (7 calcaneal tendon lengthenings, 10 mid- or hind-foot osteotomies, 6 tibiocalcaneal fusions, one calcaneocuboid fusion, and 2 progressive corrections by external fixator). Finally, 33 feet (63%) had good G&S results, 44 (85%) were pain-free, and 40 (77%) were plantigrade. DiscussionTalectomy for paralytic or dystrophic inveterate or recurrent clubfoot provided satisfactory medium-term results. Associated to other procedures, it achieves a pain-free plantigrade foot in most cases. Tibiocalcaneal fusion has an analgesic effect. Talectomy may, however, not be indicated in idiopathic clubfoot, given the patients’ high functional demand and the existence of alternative treatments. Level of evidenceIV, retrospective series.

Limb salvage versus below knee amputation for severe adult lower limb deformity — A retrospective, comparative series

BackgroundThis study compares outcomes of patients with severe, multiplanar, fixed, pantalar deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA). MethodsFifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17–72 years) and median follow-up duration was 49.9 months (24.0–253.7 months). Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgery and whether they would have the same surgery again. ResultsThere was no statistically significant difference in functional outcomes, satisfaction, or complications between the groups. Twenty-two patients undergoing PTF (81.5%), 6 patients undergoing TCF (75%), and 15 patients undergoing BKA (93.8%) were satisfied overall (p = 0.414). There was no difference in the proportion of patients who would opt for the same procedure again (p = 0.142): 23 in the PTF group (85.2%), 8 in the TCF group (100%), and 11 in the BKA group (68.8%). Seven patients undergoing PTF (25.9%), 2 patients undergoing TCF (25%) and 6 patients undergoing BKA (37.5%) had major complications (p = 0.692). ConclusionThis study concludes that PTF, TCF and BKA can all provide an acceptable outcome in treatment of severe, degenerative pantalar deformities. This data may be useful in counselling patients when considering salvage versus amputation in such cases. Level of evidenceLevel 3(Original) Clinical Research Article.

Treatment results of teratologic arthrogryposis in a case of Freeman-Sheldon syndrome

Freeman-Sheldon syndrome (FSS) is a very rare genetic disorder, also called “whistling-face syndrome.” Patients with this condition have distinctive facial appearance of small mouth and pursed lips, and skeletal malformations such as talipes equinovarus, hip dysplasia, camptodactyly, and scoliosis. The reports for the arthrogryposis of such cases by management are rare. A 2-year-old girl with FSS presented with hypertelorism, increased philtrum length, small nose and nostrils, and pursed lips, with skeletal deformities including (1) bilateral windmill vane hands, (2) bilateral rigid talipes equinovarus, and (3) bilateral high riding hip dislocation. To provide the patient with a pair of plantigrade feet for future standing, we performed a bilateral clubfoot soft tissue release and total talectomy with tibiocalcaneal fusion. For the bilateral high riding hip dislocation, we chose the nonoperative treatment by rehabilitation, given that the pelvis was relatively stable and in a leveled position. At the 25-year follow-up, she walked independently with mild waddling gait without support, on a stable, plantigrade foot. From the outcome, performing radical soft-tissue release with talectomy to obtain a plantigrade foot and conservative treatment for the bilateral hip dislocation to ensure a leveled pelvis may be a proper option for such cases.

İleri evre Charcot artropatisinin tedavisi için tibiokalkaneal artrodez: Diyabetes mellituslu hastaların en az 2 yıllık takibi ile klinik ve radyolojik sonuç analizi

Aim: Charcot arthropathy (CA) described by Jean-Martin Charcot is a noninfectious degenerative and destructive process of the bones, joints and soft tissues in the area of the foot and ankle which associated with peripheral neuropathy. The purpose of this study was to evaluate the outcomes of tibiocalcaneal fusion using a retrograde hind foot ankle nail fixation system in 5 Charcot patients. Material and Methods: Between 2014 and 2016, a total of 5 patients (4 women and 1 man) who underwent tibiocalcaneal arthrodesis for the treatment of advanced CA (Brodsky type 4) were evaluated. The demographic characteristics, clinical (AOFAS scores, early and late complications) and radiological (time for a union) evaluation parameters and patient satisfaction were analyzed before and after surgery. Results: The mean preoperative AOFAS score was 64.8 ± 8.55 and mean postoperative score was 82.6 ± 12.99. The difference between preoperative AOFAS and postoperative AOFAS scores were statistically significant. During the clinical and radiological follow-up; infection, implant failure, and peri-implant fractures were checked and complications were recorded. Conclusion: AOFAS scores were recorded before surgery after full weight bearing and it was found that talocalcaneal arthrodesis which was achieved with intramedullary nailing significantly increased AOFAS score compared to the preoperative AOFAS score.

Tibiocalcaneal arthrodesis via bone transport technique for traumatic talus infection or defect

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

Tibiotalocalcaneal Arthrodesis With the Hindfoot Arthrodesis Nail: A Prospective Consecutive Series From a Single Institution

Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure. We report a series of 20 patients who underwent TTCA using an intramedullary nail. Of the 20 patients, 7 (35%) had diabetes mellitus. The patient experiences and outcomes were analyzed. Their mean age was 61.1 (range 39 to 78) years. The minimum follow-up period was 13 (mean 28, range 13 to 49) months. Surgical indications included diabetic Charcot arthropathy in 7 (35%), hindfoot osteoarthritis in 10 (50%), and severe equinovarus deformity in 3 (15%). A calcaneal spiral blade was used in 2 patients (10%). Significant improvements (p < .05) were observed in 5 of 8 Short-Form 36-item Health Survey components, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (p < .001), and visual analog scale for pain (p < .001). The mean length of the hospital stay was 6.7 (range 1 to 27) days. Of the 20 patients, 76.9% had improvement in their activity postoperatively. Also, 81.8% were able to resume their preoperative work after a mean of 7.89 (range 3 to 24) months. Overall, 19 patients (95%) reported favorable outcomes. Superficial wound infection (n = 4; 20%) and deep wound infection (n = 3; 15%) were the most common complications (35%), with 1 case (5%) culminating in a below-the-knee amputation. Radiographic union was achieved in 16 of the tibiotalar joints (80%), 16 subtalar joints (80%), and 4 tibiocalcaneal fusions (20%). In a subgroup analysis of 7 patients with diabetes mellitus (35%), the incidence of wound complications and fusion was comparable to that of the primary cohort. TTCA performed with an intramedullary nail appears to offer a reliable and safe alternative for patients with severe ankle and hindfoot pathologic entities, including those with diabetes mellitus.

Tibio-calcaneal fusion by retrograde intramedullary nailing in charcot neuroarthropathy

IntroductionCharcot’s neuroarthropathy of ankle leads to instability, destruction of the joint with significant morbidity that may require an amputation. Aim of surgical treatment is to achieve painless stable plantigrade foot through arthrodesis. Achieving surgical arthrodesis in Charcot’s neuroarthropathy has a high failure rate. We assess the outcomes of retrograde intramedullary interlocked nailing in tibio-talar arthrodesis for Charcot’s neuroarthropathy. Materials and Methods42 diabetic patients with a mean age of 49 year underwent ankle tibio-talar arthrodesis using retrograde nailing for Charcot’s neuroarthropathy. The postoperative complications have been discussed and their management outlined. The outcomes were measured radiologically and clinically. Follow up was done after 6 weeks, 3 months, 6 months and 1 year. Results14 patients (33.3%) achieved uneventful uncomplicated fusion. Thirty three patients had varus deformity. Nine patients had valgus deformity. Using Paired t test, it showed statistically significant improvement in the functional outcomes (AOFAS& EQ-5D-5L) over the follow up time, despite of the mild deterioration of radiological angles in the final follow up visit compared to the postoperative radiological findings. ConclusionRetrograde nailing is one of the best options for tibio-talo-calcaneal arthrodesis in the high-risk Charcot’s neuroarthropathy population. It could be done through small incisions with lower soft tissue complications, its load-sharing properties allows a considerable compression across the ankle and talocalcaneal joints with early weight bearing and with satisfactory functional outcomes.

Intermediated-term Results of Salvage Procedure using Tibiocalcaneal Fusion and Strut-fibular Graft for Ankle Arthropathy with Severe Bone Defect

Category: Ankle Arthritis, Diabetes Introduction/Purpose: Severe bone defect around the ankle joint is a challenging problem in salvage operation. It has been considered as one of major factors leading to the failed fusion, because it can be difficult to make the rigid internal fixation and the compact bone filling. This retrospective study was performed to evaluate the clinical outcomes of the tibiocalcaneal fusion combined with strut-fibular graft as a salvage procedure for end-stage ankle arthropathy with severe bone defect. Methods: Twenty-eight patients were followed for more than 3 years after tibiocalcaneal fusion using the locking compression intramedullary(IM) nail and strut-fibular graft. The mean age was 57.6 years, and the mean follow-up period was 4.2 years. The clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society(AOFAS) scores, Foot and Ankle Ability Measure(FAAM) score. The subjective satisfaction score, postoperative complications, and the reoperation rate were evaluated. As the radiographic evaluation, the period to fusion, the degree of shortening compared with contralateral limb, and the degenerative change on adjacent joints were analysed. Results: AOFAS score significantly improved from preoperative average 28.8 points to 80.4 points at final follow-up (p&lt;0.001). FAAM score had significantly improved from preoperative average 33.5 points (daily activity), 15.4 points (sports activity) to 79.8 points, 68.4 points at final follow-up (p&lt;0.001). The period to fusion were average 18.2 weeks (tibia-fibular graft) and 19.5 weeks (calcaneus-fibular graft), respectively. 26 patients (92.8%) except for 2 patients achieved complete fusion. The degree of limb shortening was maintained from preoperative average 12.8 mm to 14.5 mm at final follow-up (p=0.236). There were 3 cases of postoperative wound infection, 3 cases of superficial peroneal nerve injury, 4 cases of metal irritation, 3 cases of degenerative changes on adjacent joint, and 2 cases of reoperation following the failed fusion. Conclusion: Tibiocalcaneal fusion using the locking compression IM nail and strut-fibular graft appear to be an effective salvage procedure for end-stage ankle arthropathy with severe bone defect. Although longer operation time and more postoperative complications have happened as compared to the cancellous bone graft alone, this surgical technique can contribute to the pain relief and improvement of gait ability through a satisfactory fusion rate and minimization of limb shortening.

Pedicled Sensate Composite Calcaneal Flap in Children With Congenital Tibial Pseudoarthrosis.

The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait. Unfortunately, in some situations, particularly when amputation is performed conventionally, the stump is also associated with complications. Future surgical revisions are often needed, particularly in children, because of stump overgrowth. Between 2008 and 2010, three patients diagnosed with congenital pseudoarthrosis of the tibia associated with neurofibromatosis who were indicated for TT amputation with calcaneal flap after failure of all previous surgical reconstructive procedures were selected. The chosen method for osteosynthesis was an external fixator of Ilizarov. At 12 weeks of follow-up, the stump had healed in all three patients, and tibiocalcaneal fusion was achieved without complications. All patients were prosthetized and had an asymptomatic gait. After a minimum follow-up of 6 years, all three cases with the pedicled sensate composite calcaneal flap still had a strong, full weight-bearing surface and have adapted easily to the conventional prosthesis, providing a painless stump with excellent functionality. With a 0 rate of needed revisions, all 3 cases with the pedicled sensate composite calcaneal flap preserving the hind foot still have a strong, full weight-bearing surface and have easily adapted to the conventional prosthesis, providing a painless and excellent functional stump that could last a lifetime. Level IV.

Talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for treatment of equinus deformity in adults.

Severe equinovarus foot deformity in adults is a challenging problem. Conservative treatment rarely is effective, and operative options are limited. The aim of this study was to evaluate the results of talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation for the treatment of severe equinovarus deformity in adults. Twelve patients (average age 39 years, range 15-70 years) with severe equinovarus deformities of the foot were treated with talectomy and tibiocalcaneal arthrodesis with intramedullary nail fixation between March 2010 and February 2013. Average follow-up was 20 months (range 10-37 months). Tibiocalcaneal fusion was achieved in all patients at an average of 12 weeks (range 8-17 weeks). Preoperatively, all patients had severe, irreducible equinovarus deformities; at last follow-up, almost all feet had mild residual deformity, but were plantigrade and did not require a brace or orthosis. The average AOFAS ankle score improved from 41.1 (range 8-66) preoperatively to 78.4 (range 67-86) postoperatively (P = .02). There was a similar improvement in the average VAS score from 6.3 (range 2-10) preoperatively to 0.8 (range 0-4) postoperatively (P = .02). The combination of talectomy and tibiocalcaneal arthrodesis was effective in correcting severe rigid equinovarus deformity in adults. Removal of the talus resulted in laxity of the soft tissues, making correction of the deformity easier. Tibiocalcaneal arthrodesis achieved a stable foot without the problems associated with talectomy alone. Level IV, case series.

Open Fracture Dislocation of the Talus With Total Extrusion

Open fractures with complete extrusion of talus are high-energy injuries. While treating these injuries, union of the fracture, vascularity of the body, and possibility of infection are main issues predicting less favorable outcomes. At present, there are no recommended treatment protocols for the management of such injuries. Early debridement, wound care, anatomic reduction, and adequate fixation are key factors in the management of compound injuries of the talus. There are few reports in the literature on successful reimplantation of talus when it is completely extruded. Encouraging functional outcomes of reimplantation of extruded talus suggest that excision of the talus with or without tibiocalcaneal fusion should be kept as a salvage procedure. We report a case of a farmer who sustained fracture of the talar neck. Both head and body fragments were completely extruded from the wound on the anterolateral aspect of the ankle. The patient was treated 18 hours postinjury. Thorough debridement of wound and bony fragments was done. Talus was reimplanted and fixation was performed with Kirschner wires. At 3-year follow-up, satisfactory functional outcome was noted with AOFAS (American Orthopaedic Foot and Ankle Society) score of 83 and MOXFQ (Manchester-Oxford Foot Questionnaire) scale score of 23. The purpose of presenting this case is to demonstrate the successful outcome of reimplantation of talus. Therapeutic, Level IV: Case study.

Outcome of arthrodesis of the hindfoot as a salvage procedure for complex ankle pathology using the Ilizarov technique

Achieving arthrodesis of the ankle can be difficult in the presence of infection, deformity, poor soft tissues and bone loss. We present a series of 48 patients with complex ankle pathology, treated with the Ilizarov technique. Infection was present in 30 patients and 30 had significant deformity before surgery. Outcome was assessed clinically and with patient-reported outcome measures (Modified American Orthopaedic Foot and Ankle Society (MAOFAS) scale and the Short-Form (SF-36)). Arthrodesis was achieved in 40 patients with the Ilizarov technique alone and in six further patients with additional surgery. Infection was eradicated in all patients at a mean follow-up of 46.6 months (13 to 162). Successful arthrodesis was less likely in those with comorbidities and in tibiocalcaneal fusion compared with tibiotalar fusion. These patients had poor general health scores compared with the normal population before surgery. The mean MAOFAS score improved significantly from 24.3 (0 to 90) pre-operatively to 56.2 (30 to 90) post-operatively, but there was only a modest improvement in general health; the mean SF-36 improved from 44.8 (19 to 66) to 50.1 (21 to 76). There was a major benefit in terms of pain relief. Arthrodesis using the Ilizarov technique is an effective treatment for complex ankle pathology, with good clinical outcomes and eradication of infection. However, even after successful arthrodesis general health scores remain limited.