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James Richman, Adam Cota, Steven Weinfeld
BACKGROUND: Surgical strategies to address deformities of the ankle and hindfoot in patients with Charcot arthropathy include the use of retrograde intramedullary nails and ring fixators. The literature has not shown superiority of one technique over the other. This study presents a single surgeon's case series of Charcot arthropathy patients treated with either a ring fixator or retrograde intramedullary nail to achieve tibiotalocalcaneal arthrodesis. METHODS: We performed a retrospective analysis of 27 consecutive patients with Charcot arthropathy who underwent a tibiotalocalcaneal arthrodesis using either a retrograde intramedullary (IM) nail (n = 16 patients) or a ring fixator (RF) (n = 11 patients) by a single surgeon...
October 2, 2016: Foot & Ankle International
Ji-Cheng Gong, Bing-Hua Zhou, Xu Tao, Cheng-Song Yuan, Kang-Lai Tang
BACKGROUND: Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for tibiotalocalcaneal arthrodesis because of their special design. This study aimed to evaluate the clinical outcomes of patients undergoing tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint. METHODS: From 2010 to 2015, 23 patients with severe ankle and subtalar arthropathy underwent tibiotalocalcaneal arthrodesis...
2016: Journal of Orthopaedic Surgery and Research
Benjamin C Taylor, Dane C Hansen, Ryan Harrison, Douglas E Lucas, Daniel Degenova
BACKGROUND: Ankle fragility fractures are difficult to treat due to poor bone quality and soft tissues as well as the near ubiquitous presence of comorbidities including diabetes mellitus and peripheral neuropathy. Conventional open reduction and internal fixation in this population has been shown to lead to a significant rate of complications. Given the high rate of complications with contemporary fixation methods, the present study aims to critically evaluate the use of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures...
2016: Iowa Orthopaedic Journal
Carlo Biz, Bramir Hoxhaj, Roberto Aldegheri, Claudio Iacobellis
The aim of the present longitudinal prospective study was to evaluate the clinical, functional, and radiologic outcomes and patient satisfaction of those who had undergone minimally invasive surgery (MIS) for tibiotalocalcaneal arthrodesis with an intramedullary nail. The 28 patients, who had consecutively undergone surgery with the MIS technique, were evaluated clinically and radiographically at 1, 2, 3, and 6 months after surgery and at last follow-up examination. For the clinical evaluation, the American Orthopaedic Foot and Ankle Society scale and visual analog scale for the foot and ankle were used in the preoperative and final follow-up examinations...
August 11, 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Devrim Özer, Avni İlhan Bayhan, Abdi Keskin, Seçkin Sarı, Mehmet Akif Kaygusuz
OBJECTIVES: The aim of this study was to evaluate the short-term clinical and radiological results of tibiotalocalcaneal arthrodesis (TTCA) with proximal humeral locking plate. MATERIAL AND METHODS: Eight patients (7 female, 1 male; average age 53 years (range: 24-67)) who underwent TTCA with proximal humeral locking plate between 2009 and 2011, were retrospectively evaluated with AOFAS hindfoot scale and Maryland foot score system. The mean follow up was 32.6 months (range: 23-54)...
August 2016: Acta Orthopaedica et Traumatologica Turcica
Julia Evers, Martin Schulze, Dominic Gehweiler, Martin Lakemeier, Michael J Raschke, Dirk Wähnert, Sabine Ochman
BACKGROUND: Tibiotalocalcaneal arthrodesis (TTCA) using intramedullary nails is a salvage procedure for many diseases in the ankle and subtalar joint. Despite "newly described intramedullary nails" with specific anatomical shapes there still remain major complications regarding this procedure. The following study presents a modified biomechanical test setup for investigations of the hindfoot. METHODS: Nine fresh-frozen specimens from below the human knee were anaysed using the Hindfoot Arthrodesis Nail (Synthes) instrument...
2016: BMC Musculoskeletal Disorders
Kaj Klaue, H Zwipp, T Mittlmeier, N Espinosa
Tibiotalocalcaneal arthrodesis has recently become more popular as a form of reconstructive surgery. The precise anatomical orientation and the functional extrinsic musculature of the hindfoot are essential for a satisfactory result. Fixation of the arthrodesis is a mechanical problem. Straight and angulated nails are not anatomically or mechanically ideal. A circular arc nail can fix the tibia, the talus and the calcaneus in anatomical alignment. This is a pure "bone nail", in contrast to the "intramedullary nail," which is driven through an existing opening in long bones...
October 2016: Der Unfallchirurg
Beau J Kildow, Christopher E Gross, Samuel D Adams, Selene G Parekh
: Background Tibiotalocalcaneal arthrodesis is a salvage procedure for patients with complex disease of the ankle and subtalar joints. Despite the clinical efficacy and mechanical advantage of intramedullary nails, complications, such as nonunion, are common. It may be possible to sustain compression in the face of bone resorption and implant loosening over the course of healing using a novel pseudoelastic intramedullary nail with an internal nitinol element. Methods We identified 15 patients with average age of 54...
July 7, 2016: Foot & Ankle Specialist
L Daniel Latt, Kathryn Elizabeth Smith, Kenneth Michael Dupont
: Hindfoot (tibiotalocalcaneal or TTC) arthrodesis is commonly used to treat concomitant arthritis of the ankle and subtalar joints. Simultaneous fusion of both joints can be difficult to achieve especially in patients with impaired healing due to smoking, diabetes mellitus, or Charcot neuroarthropathy. Conventional intramedullary fixation devices allow for compression to be applied at the time of surgery, but this compression can be lost due to bone resorption or settling, leading to impaired healing...
July 7, 2016: Foot & Ankle Specialist
Troy M Gorman, Timothy C Beals, Florian Nickisch, Charles L Saltzman, Mikayla Lyman, Alexej Barg
BACKGROUND: Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach. QUESTIONS/PURPOSES: We asked (1) what proportion of patients treated with this technique achieved osseous union; (2) what complications were observed; (3) were any patient-demographic or health-related factors associated with the likelihood that a patient would have a complication develop? METHODS: Between December 2001 and July 2014, 42 patients received a posterior blade plate...
October 2016: Clinical Orthopaedics and related Research
Martinus Richter, Stefan Zech
BACKGROUND: The aim of the study was to analyze the clinical aspects including 2-year follow-up of tibiotalocalcaneal arthrodesis (TTCA) with a triple-bend retrograde intramedullary nail (A3, Stryker, Airview Boulevard, MN, USA). METHODS: All patients with TTCA with A3 between October 18, 2011 and April 29, 2013 were included. Visual Analogue Scale Foot and Anklenkle (VAS FA), indications for surgery, details of surgery, radiographic measurements, and complications were analyzed...
June 2016: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Kyle S Peterson, W Drew Chapman, Christopher F Hyer, Gregory C Berlet
Tibiotalocalcaneal arthrodesis is a salvage procedure for severe hindfoot/ankle deformities, arthritis, avascular necrosis of the talus, failed total ankle replacement, and Charcot neuroarthropathy. The methods for fixation include anterior and lateral plates, screws, retrograde intramedullary nails, and external fixation. The purpose of the present report was to describe the short-term radiographic outcomes and technique using a posterior approach with an anatomic-specific locking plate for tibiotalocalcaneal arthrodesis...
September 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Michael J Coughlin, Caio Nery, Daniel Baumfeld, James Jastifer
OBJECTIVE: The objective of this study was to evaluate the short-term clinical and radiographic results from a TTC fusion procedure using a lateral locking plate specifically designed for this purpose. METHODS: All the fourteen patients were evaluated using a variety of methods, including a visual analogue scale (VAS), the AOFAS hindfoot score and a subjective satisfaction scale. The average follow-up was 10 months. RESULTS: The average AOFAS score improved from 41 points preoperatively to 63 points postoperatively...
July 2012: Revista Brasileira de Ortopedia
Federico G Usuelli, Camilla Maccario, Luigi Manzi, Christopher Edward Gross
BACKGROUND: Patients with arthritis or severe dysfunction involving both the ankle and subtalar joints can benefit from tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. TTC fusion is considered by many as a salvage operation resulting in a stiff ankle and hindfoot, considerably limiting global foot function. With the evolution of prosthetic design and operative techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis...
July 2016: Foot & Ankle International
Leonardo Ribeiro Bastos, Ricardo Cardenuto Ferreira, Marcelo Tomanik Mercadante
OBJECTIVE: To evaluate the clinical, functional and radiographic results from talar neck fractures in patients treated at the Foot and Ankle Surgery Group of Santa Casa de Sao Paulo. METHOD: We evaluated 20 patients. The mean follow-up time was 71 months. One fracture was classified as Hawkins Type I, 12 as Hawkins type II, five as Hawkins type III, two as Hawkins type IV and four fractures were open. RESULTS: One patient was treated conservatively, 16 were treated with open reduction and internal fixation (three with primary subtalar arthrodesis), one was treated with talectomy and two with tibiotalocalcaneal arthrodesis...
July 2010: Revista Brasileira de Ortopedia
Spencer J Monaco, Nick Lowery, Brandon Crim
: Tibiotalocalcaneal arthrodesis with an intramedullary nail is a procedure reserved for patients who have conditions affecting the ankle joint and subtalar joint. The most common complications include nonunion, malunion, delayed union, infection, periprosthetic fracture, hardware failure, lateral plantar nerve injury, and wound healing. Significant bone void may result if the hardware requires removal secondary to one of these complications. The purpose of this article is to report on 2 cases of infected intramedullary nails, which were revised with fibular inlay strut grafts...
March 23, 2016: Foot & Ankle Specialist
Maxime-Louis Mencière, Linda Ferraz, Patrice Mertl, Joël Vernois, Antoine Gabrion
The main complications of open tibiotalocalcaneal arthrodesis are wound healing disorders and nonunion. Our hypothesis was that arthroscopy and interlocking intramedullary nailing decrease these complications. We retrospectively reviewed six patients (mean age: 58 years; mean preoperative Kitaoka score: 51/100) having undergone arthroscopic tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing between January and November 2011 for equinus deformity of the hindfoot and subtalar instability of neurological origin...
March 2016: Acta Orthopaedica Belgica
Sarah Ettinger, Christian Plaass, Leif Claassen, Christina Stukenborg-Colsman, Daiwei Yao, Kiriakos Daniilidis
Charcot neuropathy (CN) is a severe joint disease that makes surgical planning very challenging, because it is combined with ankle instability, serious deformities, and recurrent ulceration. The aim of the present study was to examine the rate of bone fusion after external or internal fixation in patients with CN. We retrospectively examined 58 patients with CN who had undergone reconstruction of the ankle either with tibiotalocalcaneal or tibiocalcaneal arthrodesis. The mean age was 59.1 (range 26 to 81) years at surgery...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Jennifer L Mulhern, Nicole M Protzman, Amari M White, Stephen A Brigido
Subsidence of the talar component results in significant morbidity after total ankle replacement. When recognized, prompt revision could be needed to preserve the function of the implant; however, this is not always the case. In situations in which the implant cannot be revised, tibiotalocalcaneal arthrodesis might be necessary to salvage the extremity. The purpose of the present report is to describe the use of a custom titanium alloy truss to fill a bony void created by explantation of the implant components...
July 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
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