Objective To review the latest research progress of fixation techniques of ankle arthrodesis.Methods The l iterature concerning the research of fixation techniques of ankle arthrodesis in recent years was reviewed. Then the characteristics and new research progress of different internal and external fixation techniques were analysed and compared. Results There are plenty of different types of internal and external fixation devices, each with distinct characteristics. Now it is widely considered that internal fixation is the first choice for end-stage ankle arthropathy. However, under the circumstances that patients with serious bone defect, chronic active infection, or extensive soft tissue damage are not suitable for internal fixation, ankle arthrodesis with external fixation is still a safe and effective method. Conclusion For severe or end-stage ankle arthropathy, ankle arthrodesis is a mature therapeutic way with exact effect. Researches on these two aspects, expansion of indications of internal fixation and comparison and combination of internal and external fixation techniques, need to be deepened, which is of great significance for choosing a better fixation method and acquiring a better therapeutic effect.
Objective To evaluate the short-term effectiveness of Ilizarov technique combined with steel needle internal fixation in treating Charcot neuroarthropathy (CN) of the foot and ankle. Methods Between June 2020 and December 2023, 12 patients with Eichenholtz stage Ⅲ CN of the foot and ankle were treated with Ilizarov technique and steel needle internal fixation. There were 9 males and 3 females with an average age of 48.6 years (range, 19-66 years). The disease duration ranged from 1 to 16 months (mean, 6.8 months). Ankle joint involvement predominated in 7 cases, while midfoot involvement occurred in 5 cases; 3 cases presented with skin ulceration and soft tissue infection. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 31.2±9.0, 36-Item Short-Form Health Survey (SF-36)-Physical Component Summary (PCS) score was 32.6±6.8, and Mental Component Summary (MCS) score was 47.8±8.4. Postoperative assessments included wound healing, regular X-ray film/CT evaluations of fusion status, and effectiveness via AOFAS and SF-36-PCS, MCS scores. ResultsAll operations were successfully completed without neurovascular complication. Two patients experienced delayed wound healing requiring intervention, and the others achieved primary healing. All patients were followed up 15-43 months (mean, 23.3 months). Imaging confirmed successful joint fusion within 13-21 weeks (mean, 16.8 weeks). At last follow-up, the AOFAS score was 72.5±6.4, and the SF-36-PCS and MCS scores were 63.2±8.4 and 76.7±5.3, respectively, all of which improved compared to preoperative levels, with significant differences (P<0.05). Conclusion Ilizarov technique combined with steel needle internal fixation effectively restores walking function and achieves satisfactory short-term effectiveness in CN of the foot and ankle.
Objective To evaluate the short-term effectiveness of talonavicular arthrodesis for Müller-Weiss disease. Methods Between May 2013 and February 2015, 13 patients with Müller-Weiss disease were treated with talonavicular arthrodesis. There were 11 females and 2 males with an average age of 59 years (range, 42-67 years). The disease duration was 8-20 years (mean, 13 years). According to Maceira stage, there were 7 cases of stage Ⅲ, 6 cases of stage Ⅳ. The foot longitudinal arch height measured on weight-bearing X-ray films was (43.1±1.8) mm; the Meary angle and talocalcaneal angle measured on lateral X-ray films were (–2.8±2.3)° and (5.8±2.4)°, respectively; the calcaneal valgus angle measured on Saltzman position X-ray films was (–2.0±0.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 43.5±12.4, and visual analogue scale (VAS) score was 7.3±1.5. Results All the patients were followed up 14-39 months (mean, 20 months). The symptoms of foot pain and intermittent claudication disappeared in all patients. All cases achieved bony union, the fusion time was 12-16 weeks (mean, 13 weeks). There was no complications such as wound infection, skin necrosis, or internal fixator broken. At last follow-up, the foot longitudinal arch height, Meary angle, talocalcaneal angle, and calcaneal valgus angle were (52.5±2.2) mm, (1.3±2.2)°, (16.5±3.7)°, and (0.4±0.7)°, respectively; the AOFAS score and VAS score were 83.8±9.1 and 1.0±0.4, respectively; all were significantly improved when compared with preoperative ones (P<0.05). Conclusion If the subtalar and calcaneocuboid joints are relatively healthy, talonavicular arthrodesis may be a reliable and effective surgical option for Müller-Weiss disease that is resistant to conservative treatment.
ObjectiveTo explore the feasibility and short-term effectiveness of ankle arthrodesis by ankle osteotomy-tool. MethodsA retrospective analysis was made on the data of 38 patients with end-stage ankle arthritis undergoing ankle arthrodesis between February 2009 and March 2012. There were 24 males and 14 females, with an average age of 67 years (range, 40-85 years). The left ankle was involved in 18 cases and the right ankle in 20 cases. There were 20 cases of post-traumatic arthritis, 7 cases of avascular necrosis of talus, 5 cases of rheumatoid arthritis, 5 cases of primary osteoarthritis, and 1 case of post infective arthritis. The disease duration ranged 3.2-6.1 years (mean, 4.7 years). The ankle osteotomy-tool was used to remove the joint surfaces, and proximal humeral locking plate combined with compression screws were used for internal fixation. ResultsThe operation time was 40-90 minutes (mean, 60 minutes). The healing of incisions by first intention was obtained in the other cases except 1 case of superficial infection, which was cured after dressing change. Thirty-eight patients were followed up 10 to 36 months (mean, 23 months). The ankles in 4 patients started to swell repeatedly when they walked early after operation and the swelling subsided at 1 year after rehabilitation therapy. The X-ray films showed that bone fusion was obtained at 12 weeks after operation on average (range, 10-19 weeks). No internal fixation failure or malunion occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was improved significantly from 43.11±17.49 at preoperation to 85.03±13.17 at last follow-up (t=14.412, P=0.000). The short-form 36 health survey scale (SF-36) showed that physical component summary score was increased significantly from preoperative 54.30±12.32 to postoperative 77.95±8.21 (t=7.723, P=0.000), and mental component summary score was significantly increased from preoperative 63.16±8.30 to postoperative 77.05±10.12 (t=2.523, P=0.021). According to the patients' satisfaction, 32 patients were very satisfied, 5 patients were satisfied, and 1 patient was not satisfied. The subjective satisfaction of patients was 97.37%. ConclusionAnkle arthrodesis by lateral malleolus osteotomy with ankle osteotomy-tool and internal fixation using proximal humeral locking plate and compression screws has the advantages of simple operation, less complications, rigid fixation, and high fusion rate. It may obtain a good short-term effectiveness.
ObjectiveTo review the research progress of interphalangeal arthrodesis in the treatment of interphalangeal joint deformity.MethodsThe literature about interphalangeal arthrodesis at home and abroad was extensively consulted, and the indications, fusion methods, fixation methods, complications, and so on were summarized and analysed.ResultsThe indications of interphalangeal arthrodesis are hammer toe, claw toe, and mallet toe. From the different forms of fusion surface, fusion methods include end-to-end, peg-in-hole, conical reamer type, and V-shape arthrodesis. There are three kinds of fixation methods: Kirschner wire fixation, stainless-steel wire suture fixation, and intramedullary fixation, and there are many kinds of intramedullary fixation. The complications of interphalangeal arthrodesis include vascular injury, fixation related complications, and postoperative complications.ConclusionInterphalangeal arthrodesis is a good way to correct some deformities of toes, but the incidence of various complications can not be ignored, and there is still a lack of clinical research on interphalangeal arthrodesis.
Objective To compare the effectiveness of talonavicular-cuneiform joint fusion with iliac bone grafting and without bone grafting in the treatment of Müller-Weiss diseases (MWD). Methods The clinical data of 44 patients (44 feet) with MWD who received talonavicular-cuneiform joint fusion between January 2017 and November 2022 and met the selection criteria was retrospectively analyzed. Among them, 25 patients were treated with structural iliac bone grafting (bone grafting group) and 19 patients without bone grafting (non-bone grafting group). There was no significant difference (P>0.05) in age, gender composition, body mass index, disease duration, affected side, Maceira stage, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, anteroposterior/lateral Meary angle, and Pitch angle between the two groups. Operation time, operation cost, and postoperative complications were recorded in the two groups. AOFAS and VAS scores were used to evaluate the function and pain degree of the affected foot. Meary angle and Pitch angle were measured on the X-ray film, and the joint fusion was observed after operation. The difference (change value) of the above indexes before and after operation was calculated for comparison between groups to evaluate the difference in effectiveness. Results The operation was successfully completed in both groups, and the incisions in the two groups healed by first intention. The operation time and cost in the bone grafting group were significantly more than those in the non-bone grafting group (P<0.05). All patients were followed up. The median follow-up time was 41.0 months (range, 16-77 months) in the non-bone grafting group and 40.0 months (range, 16-80 months) in the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case, internal fixation stimulation in 2 cases, and pain at the iliac bone harvesting area in 1 case of the bone grafting group. There was skin numbness of the medial dorsalis of the foot in 1 case and muscle atrophy of the lower limb in 1 case of the non-bone grafting group. There was no significant difference in the incidence of complications between the two groups (P>0.05). At last follow-up, the AOFAS scores of the two groups significantly improved when compared with those before operation, while the VAS scores significantly decreased, the anteroposterior/lateral Meary angle and Pitch angle significantly improved, and the differences were significant (P<0.05). There was no significant difference in the change values of outcome indicators between the two groups (P>0.05). There was no delayed bone union or bone nonunion in both groups, and joint fusion was achieved at last follow-up. Conclusion In the treatment of MWD, there is no significant difference in effectiveness and imaging improvement of talonavicular-cuneiform joint fusion combined with or without bone grafting. However, non-bone grafting can shorten the operation time, reduce the cost, and may avoid the complications of bone donor site.
Objective To investigate the effectiveness of calcaneal V-shaped osteotomy combined with subtalar arthrodesis in the treatment of Stephens Ⅱand Ⅲ calcaneal fracture malunion. MethodsThe clinical data of 24 patients with severe calcaneal fracture malunion treated by calcaneal V-shaped osteotomy combined with subtalar arthrodesis between January 2017 and December 2021 were retrospectively analyzed. There were 20 males and 4 females with an average age of 42.8 years (range, 33-60 years). Conservative treatment of calcaneal fracture failed in 19 cases and operation failed in 5 cases. Stephens classification of calcaneal fracture malunion was type Ⅱ in 14 cases, and type Ⅲ in 10 cases. Preoperative Böhler angle of calcaneus was 4.0°-13.5° (mean, 8.6°), Gissane angle was 100°-152° (mean, 119.3°). The time from injury to operation was 6-14 months (mean, 9.7 months). American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analogue scale (VAS) score were used to evaluate the effectiveness before operation and at last follow-up. Bone healing was observed and the healing time was recorded. The talocalcaneal height, talus inclination angle, Pitch angle, calcaneal width, and hindfoot alignment angle were measured. Results Necrosis of the cuticle edge of the incision occurred in 3 cases, which were cured by dressing change and oral administration of antibiotic therapy. The other incisions healed by first intention. All the 24 patients were followed up 12-23 months, with an average of 17.1 months. The foot shape of the patients recovered well, the shoes were restored to the size before injury, and there was no anterior ankle impingement. Bone union was achieved in all patients, and the healing time ranged from 12 to 18 weeks, with an average of 14.1 weeks. At last follow-up, no adjacent joint degeneration occurred in all patients; 5 patients had mild foot pain during walking, which had no significant impact on daily life and work; no patient needed revision surgery. The AOFAS ankle and hindfoot score was significantly higher than that before operation (P<0.001), the results were excellent in 16 cases, good in 4 cases, and poor in 4 cases, and the excellent and good rate was 83.3%. The VAS score, talocalcaneal height, talus inclination angle, Pitch angle, calcaneal width, and hindfoot alignment angle were significantly improved after operation (P<0.001). ConclusionCalcaneal V-shaped osteotomy combined with subtalar arthrodesis can effectively relieve hindfoot pain, correct talocalcaneal height, restore talus inclination angle, and reduce the risk of nonunion after subtalar arthrodesis.
Objective To evaluate the effect of triple arthrodesison treating complications of calcaneus fractures. Methods From 1990to 2001, 12 patients with the complications of calcaneus fractures underwent the triple arthrodesis(subtalar,talaronavicular and calcaneocuboid joints). Ollier incision was applied to all patients. Peroneal tenolysis was required in 2 patients and a decompression and transposition of tibialnerve in 1 patient.Of the 12 patients, 7 were males and 5 were females. Their ages ranged from 29 to 64 years. Complications, like pain and deformity, occurred 5 to 22 months after the operation(18 months on average).Preoperative score, fibulocalcaneal distance, Bohler angle, differenceof talardeclination angle and height of hind foot were 40.00±5.22, 0.41±0.03 cm, 12.00±3.40°, 17.00±3.32° and 4.12±0.35 cm respectively. Results All patients were followed up from 3 to 13 years with an average of 7 years. Postoperative score, tibulocalcaneal distance, B[AKo¨]hler angle, difference of talar declination angle and height of hind foot were 75.00±6.46，0.73±0.02 cm， 31.00±5.61°，9.00±3.15° and 6.75±0.62 cm respectively. There were significant differences in these indexes(P＜0.05). Conclusion To evaluate the complications of calcaneus fractures and to adopt proper operative procedures are necessary. To restore theheight of hind foot and the anatomical relationship between hind foot and calcaneus is the key factor to success.
ObjectiveTo summarize the progress in the application of ankle and hindfoot arthrodesis. MethodThe domestic and foreign related literature about the application of ankle and hindfoot arthrodesis was reviewed, summarized, and analyzed. ResultsAnkle and hindfoot arthrodesis include the multi-joint fusion and the single joint fusion, and they involve tibiotalar joint, subtalar joint, talonavicular joint, and calcaneocuboid joint. The methods of fixation include screw, plate, intramedullary nail, and external fixation. ConclusionsDifferent terminal illnesses of ankle and hindfoot have different choices in both the fusion location and the method of fixation, appropriate program for therapeutic purposes can also alleviate complication simultaneously.
Objective To discuss the effect of the calcaneocuboid arthrodesis on three-dimensional kinematics of talonavicular joint and its clinical significance. Methods Ten freshfrozen foot specimens, three-dimensional kinematics oftalonavicular joint were determined in the case of neutral position, dorsiflexion, plantoflexion, adduction, abduction, inversion and eversion motion by meansof threedimensional coordinate instrument（Immersion MicroScribe G2X） before and after calcaneocuboid arthrodesis under non-weight with moment of couple, bending moment, equilibrium dynamic loading. Calcaneocuboid arthrodesis was performed on these feet in neutral position and the lateral column of normal length. Results A significant decrease in the three-dimensional kinematics of talonavicular joint was observed（P＜0.01）in cadaver model following calcaneocuboid arthrodesis. Talonavicular joint motion was diminished by 31.21%±6.08％ in sagittal plane; by 51.46%±7.91％ in coronal plane; by 36.98%±4.12％ in transverse plane; and averagely by 41.25%±6.02％. Conclusion Calcaneocuboid arthrodesis could limite motion of the talonavicular joints, and the disadvantage of calcaneocuboid arthrodesis shouldn’t be neglected.