OBJECTIVETo evaluate the methods and results of arthroscopy-assisted ankle arthrodesis.

METHODSFrom January 2001 to May 2009, 25 patients with end-stage ankle joint pathology were treated with arthroscopy-assisted ankle arthrodesis. There were 18 males and 7 females with an average age of 47.5 years (ranged, 32 to 70 years). The locations were left ankle in 10 cases and right ankle in 15 cases, including 13 cases of post-traumatic osteoarthritis, 10 cases of Kaschin-Beck disease and 2 cases of rheumatoid arthritis. At pre- and post-operation, the 10-point VAS score for ankle pain was obtained; the ankle functional was evaluated by the American Orthopaedic Foot & Ankle Society ankle and hindfoot score, which include pain, activity limitations, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, ankle-hind-foot stability, and alignment.

RESULTSAll the patients were follow-up,with a mean period of 27.5 months (ranged, 20 to 35 months). All the patients were free of pain and the gait was improved. There were no complications, such as neurovascular injuries, infection or hardware failure. All the patients achieved fusion in a mean of 11.7 weeks (ranged, 8 to 15 weeks). Overall, the mean 10-point visual analog scale (VAS) score decreased from (8.60 +/- 0.96) preoperatively to (1.20 +/- 0.82) postoperatively (t=27.326, P=0.000). After operation, the items of pain, activity limitations, maximum walking distance, walking surfaces, gait abnormality, sagittal motion, hindfoot motion, ankle-hind-foot stability, and alignment improved. AOFAS score was significantly increased from (36.44 +/- 9.90) points preoperatively to (82.44 +/- 4.96) points postoperatively (t=-19.178, P=0.000).

CONCLUSIONArthroscopy-assisted ankle arthrodesis offered minimal trauma, high fusion rates, rapid recovery and low morbidity. This study confirmed the efficacy of the arthroscopy-assisted ankle arthrodesis for ankle joint pathology.

Adult ; Aged ; Ankle Joint ; surgery ; Arthrodesis ; methods ; Arthroscopy ; methods ; Female ; Humans ; Male ; Middle Aged

PURPOSE: Digits injured by punch press machines show peculiar types with segmental loss of middle part of digits. Although the distal parts of finger survived, thr results is frequently unfavorable with respect to function and appearance after inappropriate reconstruction. METHODS: From August 2008 to February 2013, five digits injured by punch press machines in four patients were managed. Pinch strength, two-point discrimination and active range of motion were measured to evaluate finger function. RESULTS: Three digits with a preserved amputated segment underwent replantation. Partial necrosis occurred in one digit in which local flap was performed. Secondary tendon graft was performed in the other digits. Two digits without segment was reconstructed by arthrodesis after shortening the length. The patients were generally satisfied with function and appearance. CONCLUSION: Reconstruction of digits injured by punch machines are technically difficult. Replantation is the best method in cases of preserved segment, while arthrodesis with shortening is appropriate in cases without segment.
Amputation ; Arthrodesis ; Discrimination (Psychology) ; Fingers ; Humans ; Methods ; Necrosis ; Pinch Strength ; Range of Motion, Articular ; Replantation ; Tendons ; Transplants

OBJECTIVETo evaluate the functional outcomes of modified limited "L" incision beside the Achilles tendon with distraction bone block arthrodesis in treatment of subtalar osteoarthritis.

METHODSFrom March 2009 to September 2012, a total of 22 cases of old calcaneus fractures with subtalar osteoarthritis were treated with modified limited "L" incision and distraction bone block arthrodesis including 13 males and 9 females with a mean age of 35.3 years old (ranged 22 to 49). The mean time from calcaneal fracture was 21 months (ranged 11 to 32). According to the Stephens-Sanders classification, 16 cases were type II and 6 were type III. The modified-AOFAS ankle-hindfoot score was used for functional outcomes evaluation.

RESULTSThere was one incision necrosis and no infection, implant failure, bone-graft absorbed or talus necrosis was note at the follow-up time. A total of 21 cases were followed up for a mean time of 29 months (ranged from 18 to 46 months). All of the cases reached a bony union within 4 months postoperation. The mean modified-AOFAS ankle-hindfoot score was 82.6 points (ranged from 66 to 92 points),reached a significantly improvement in comparing with the mean preoperative score (50.8 points,ranged from 32 to 65 points, P < 0.01).

CONCLUSIONThe modified limited"L" incision beside the Achilles tendon with distraction bone block arthrodesis is an acceptable and alternative treatment method for subtalar osteoarthritis. This method is easy to use and with less complication. It can correct the main pathological changes and reach good functional outcomes.

Adult ; Arthrodesis ; methods ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Subtalar Joint ; surgery

OBJECTIVETo introduce the application of Ilizarov technique in ankle fusion with serious pathology and failed ankle arthrodesis.

METHODThe medical records and images of 9 cases of complex ankle fusion using Ilizarov external fixator were analyzed. Among the 9 cases, 6 received revisional ankle fusion, and 3 primary fusion for septic arthritis. All the cases were followed up for an average of 18.1 months.

RESULTSSix cases showed good results, i.e, no or mild pain, occasional limp and stable fusion and 3 cases fair results, i.e, moderate pain, persistent limp or occupational restriction, and stable fusion.

CONCLUSIONIlizarov technique is one of the effective method for the treatment of complex ankle arthrodesis.

Adult ; Aged ; Ankle Joint ; surgery ; Arthrodesis ; methods ; Female ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Salvage Therapy

Arthrodesis ; Arthroplasty, Replacement ; adverse effects ; methods ; Contraindications ; Hemiarthroplasty ; Humans ; Metatarsophalangeal Joint ; physiology ; surgery ; Range of Motion, Articular

The method of ankle arthrodesis is variable but compression arthrodesis has been widely used because of better results than non-compression arthrodesis. Twenty-one cases of ankle arthrodesis were carried out at department of orthopaedic surgery of Korea Veterans Hospital from January 1980 to June 1986, and were analysed clinically. The results obtained were as follows; l. Among 11 cases of compression arthrodesis, Charnleys method was done in 8 cases and Monofixateur in 3 cases. 2. Among 10 cases of non-compression arthrodesis, Chuinard-Peterson method was done in 7 cases and anterior 'sliding graft in 3 cases. 3. The average duration of immobilization after ankle arthrodesis was 11.7 weeks, and average 4.2 weeks were less needed in the compression arthrodesis than non-compression arthrodesis. 4. The postoperative complications were developed in 8 cases (38%): wound infection in 4 cases,skin necrosis in 3 cases and incisional neuroma in 1 case. 5. Bony union was obtained in 20 cases(95.2%) out of 21 cases at average 15.7 weeks, and in the non-compression arthrodesis and in the cnmpression arthrodesis, respectively, 90% at 17.7 weeks and 100% at 13.9 weeks.
Ankle Joint ; Ankle ; Arthrodesis ; Hospitals, Veterans ; Immobilization ; Korea ; Methods ; Necrosis ; Neuroma ; Postoperative Complications ; Transplants ; Wound Infection

Spondyliolisthesis is the major structural changes in the spine and is more directly related to the low back pain syndrome. The many operative techniques have been used but each of them had several disadvantage as well as advantage. Since the anterior lumbar fusion in spondylolisthesis was introduced by Carpener in 1932, many authors have reported the favorable results regard to anterior arthrodesis in spine. Ideally the system of spine fixation is mechanically efficient and anatomical restoration of deformed structure. The anterior interbody fusion is more satisfactory to this deal fixation of spine than any other surgical method. We reviewed the cases of fifty seven patients who underwent anterior interbody fusion with autoiliac bone grafts for spondylolisthesis and were followed for one to twelve years. 1. The most common type was isthmic type in 61% and the degenerative type was observed in 25%. 2. The fifty lumbar vertebra slipping was observed most commonly and in two patinets, L4 and L5 vertebra slipped simultaenously. 3. In radiological results, we obtained complete fusion of grafts to vertebra in 73%, incomplete fusion in 15% and absorption of graft noticed in seven patients(12%). 4. We obtained the favorable results in 84% patients clinically. 5. The clinical results was not correlated with roentgenografic evidence of union. 6. Anterior discectomy and arthrodesis with autoiliac bone graft was a safe procedure in grade I and II spondylolisthesis but in grade III, the procedure was not recommended. 7. The simple Knight-Kim back brace was satisfactory to immobilization after anterior interbody fusion without graft union failure.
Absorption ; Arthrodesis ; Braces ; Diskectomy ; Humans ; Immobilization ; Low Back Pain ; Methods ; Spine ; Spondylolisthesis ; Transplants

Pott's paraplegia has been frequently serious complication of tuberculous spondylitis, although antituberculous drugs have improved the prognosis and healing of the disease. There are much controvercy on treatement of Pott's paraplegia, which comprises immobilization with or without anterolateral antituberculous drugs, immobilization and early posterior arthrodesis, anterolatear decompression and radical anterior decompression with anterior spinal fusion. The method of anterior decompression and anterior interbody fusion which was introduced by Hdgson since 1956 has good reults. The author analyzed 27 consecutive cases of Pott's parsplegia operated at orthopedic departement, In Je Paik Hospital from May 1980 to August 1988. The results were as follows, 1. Number of cases in child was nine(33%), both sexes were similar. 2. Regions of spine involved were most common at thoracic spine(62%). Number of affected vertebrae was averaged 3.3 vertebrae. 3. There were nineteen early(70%) and eight late(30%) paraplegia. 4. There were two complete and twenty five incomplete paraplegia. 5. In operative finding, inflammatory products and sequestrated material was extrinsic factor in early in paraplegia. 6. The recovery of the paraplegia occur in twenty cases(74%) 7. The recovery of paraplegia after treatment was far better in type of early onset, type of incomplete paraplegia less than one year duration. 8. The radical anterior decompression and anterior interbody fusion was considered as recommendable method for remove of all pathologic foci, recovery of paraplegia and healing the tuberculosis with stability.
Arthrodesis ; Child ; Decompression ; Humans ; Immobilization ; Methods ; Orthopedics ; Paraplegia ; Prognosis ; Spinal Fusion ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal

PURPOSE: This study was designed to evaluate the mid-term results and efficacy of subtalar distraction double bone-block arthrodesis for calcaneal malunion. MATERIALS AND METHODS: From January 2004 to June 2007, we operated on 6 patients (10 cases). There were 5 males (9 cases) and 1 female (1 case), four of which presented with bilateral calcaneal malunion. Seven cases were operated on initially. The period between initial injury and arthrodesis was 23 months, and the average follow up period was 58 months. In operation, we applied an extensile lateral approach and arthrodesis was performed through a tricortical double bone-block and cannulated screws. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined to assess union and various parameters. RESULTS: The mean age of the patients was 41 years. All cases achieved radiologic union at the final follow-up. The mean AOFAS Ankle-Hindfoot scale (maximum of 94 points) increased from 43.3 points preoperatively to 85.4 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed improvements of 5.6 mm in talo-calcaneal height, 1.8degrees in talocalcaneal angle, 5.1degrees in talar declination angle and 5.3degrees in talo-first metatarsal angle. CONCLUSION: Subtalar distraction two bone-block arthrodesis provides overall good results not only in the short term but also the mid-term with significant improvement in clinical and radiologic outcomes. This procedure warrants consideration for managing calcaneal malunion with loss of height and subtalar arthritis.
Adult ; Arthrodesis/methods ; Calcaneus/*injuries/surgery ; Female ; Fractures, Malunited/*surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo review the operative technique of trephine arthrodesis of subtalar joints and evaluate its clinical effect.

METHODSFrom June 1998 to October 2006, we performed subtalar arthrodesis on 38 feet of 34 patients for a variety of painful disorders of hindfoot with trephine technique. Clinical and radiologic follow-up evaluations were performed for 45 months on average (range, 21 to 110 months) after arthrodesis.

RESULTSNo severe complications were found in this study except one patient with dropfoot and two with skin necrosis. The average ankle-hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) was improved from 48.3 preoperatively to 79.2 postoperatively (P<0.05). The pain scores of visual analogue scales (VAS) decreased from 7.2 (range, 3 to 10) preoperatively to 2.6 (range, 1 to 6) postoperatively (P<0.05). Subjectively, the patients experienced improvements in pain, function, cosmesis, and shoewearing. Overall, 30 patients were satisfied and all patients would have this procedure again under similar circumstances. Postoperative radiology showed that complete union was found in 35 feet 6 months after operation, with the successful union rate of 92.1%. There was an increase in arthritic scores for 5 ankles, 4 talonavicular joints, 4 calcaneocuboid joints, and 4 midfoot joints. Nonunion occurred in 3 subtalar joints with anterolateral approach, which required revision arthrodesis.

CONCLUSIONIsolated subtalar arthrodesis with trephine method is an effective procedure for painful malalignment of hindfoot.

Adult ; Aged ; Arthrodesis ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pain Measurement ; Subtalar Joint ; surgery