Purpose: Tibiotalocalcaneal (TTC) fusion using a femoral head allograft is commonly performed for complex ankle pathologies, but radiographic nonunion is not uncommon. This paper describes the clinical course of patients with radiographic nonunion after TTC fusion and explores the clinical relevance of a possible “stable nonunion” pattern. Materials and Methods: Thirty-eight patients who underwent TTC fusion using femoral head allograft between 2014 and 2023 were reviewed retrospectively. Among them, 10 cases (26.3%) with radiographic nonunion were included. Nonunion was defined as the absence of osseous union at the tibiotalar or subtalar joint on plain radiographs at 6 months postoperatively. Serial follow-up radiographs were also reviewed. The clinical outcomes were assessed using the Visual Analog Scale (VAS), Foot and Ankle Ability Measure (FAAM), and RAND Short Form-36 (SF-36). This study was designed as an exploratory retrospective case series of the nonunion group. Results: Ten cases were identified as radiographic nonunion. Despite the persistent nonunion, the mean VAS decreased from 6.2 to 1.2 (p<0.001). Several SF-36 domains and the FAAM Activities of Daily Living score also improved. No hardware failures or reoperations were observed during follow-up. Conclusion Some patients with radiographic nonunion after TTC fusion using a femoral head allograft showed pain reduction and functional improvement without hardware failure or reoperation. These findings suggest that radiographic nonunion may not always indicate immediate clinical failure. Nevertheless, the results should be interpreted cautiously because of the small sample size, lack of a comparison group, and the absence of a CT-based union assessment.

Atorvastatin and ezetimibe are frequently co-administered to treat patients with dyslipidemia for the purpose of low-density lipoprotein cholesterol control. However, pharmacokinetic (PK) drug interaction between atorvastatin and ezetimibe has not been evaluated in Korean population. The aim of this study was to investigate PK drug interaction between two drugs in healthy Korean volunteers. An open-label, randomized, multiple-dose, three-treatment, three-period, Williams design crossover study was conducted in 36 healthy male subjects. During each period, the subjects received one of the following three treatments for seven days: atorvastatin 40 mg, ezetimibe 10 mg, or a combination of both. Blood samples were collected up to 96 h after dosing, and PK parameters of atorvastatin, 2-hydroxyatorvastatin, total ezetimibe (free ezetimibe + ezetimibe-glucuronide), and free ezetimibe were estimated by non-compartmental analysis in 32 subjects who completed the study. Geometric mean ratios (GMRs) with 90% confidence intervals (CIs) of the maximum plasma concentration (C(max,ss)) and the area under the curve within a dosing interval at steady state (AUC(τ,ss)) of atorvastatin when administered with and without ezetimibe were 1.1087 (0.9799–1.2544) and 1.1154 (1.0079–1.2344), respectively. The corresponding values for total ezetimibe were 1.0005 (0.9227–1.0849) and 1.0176 (0.9465–1.0941). There was no clinically significant change in safety assessment related to either atorvastatin or ezetimibe. Co-administration of atorvastatin and ezetimibe showed similar PK and safety profile compared with each drug alone. The PK interaction between two drugs was not clinically significant in healthy Korean volunteers.
Atorvastatin Calcium* ; Cholesterol ; Cross-Over Studies ; Drug Interactions* ; Dyslipidemias ; Ezetimibe* ; Humans ; Lipoproteins ; Male ; Pharmacokinetics ; Plasma ; Volunteers*