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.

PURPOSE: To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications. METHODS: We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume. RESULTS: Among 92 recipients, the mean volume was 44.53 ± 176.43 cm³ and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm³ was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm³ were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm³, and serum creatinine level at one month were significant factors. CONCLUSION: Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm³ or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
Cone-Beam Computed Tomography ; Creatinine ; Dialysis ; Early Intervention (Education) ; Humans ; Imaging, Three-Dimensional ; Kidney Transplantation ; Kidney* ; Lymphocele* ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Tissue Donors ; Transplant Recipients* ; Ultrasonography

PURPOSE: To analyze the risk factors for postoperative lymphocele, for predicting and preventing complications. METHODS: We evaluated 92 kidney transplant recipients with multidetector CT (MDCT) at 1-month posttransplantation. From admission and 1-month postoperative records, data including diabetes, dialysis type, immunosuppressant use, steroid pulse therapy, and transplantation side were collected. Lymphocele volume was measured with 3-dimensional reconstructed, nonenhanced MDCT at one month postoperatively. The correlations between risk factors and lymphocele volume and between risk factors and symptomatic lymphocele (SyL) were analyzed. The cutoff was calculated by using the receiver operating characteristic (ROC) curve for SyL volume. RESULTS: Among 92 recipients, the mean volume was 44.53 ± 176.43 cm³ and 12 had SyL. Univariable analysis between risk factors and lymphocele volume indicated that donor age, retransplantation, and inferiorly located lymphocele were statistically significant. The ROC curve for SyL showed that 33.20 cm³ was the cutoff, with 83.3% sensitivity and 93.7% specificity. On univariable analysis between risk factors and SyL, steroid pulse, inferiorly located lymphocele, and >33.20 cm³ were statistically significant. Multivariable analysis indicated that steroid pulse, >33.20 cm³, and serum creatinine level at one month were significant factors. CONCLUSION: Risk factors including donor age, retransplantation, steroid pulse therapy, and inferiorly located lymphocele are important predictors of large lymphoceles or SyL. In high-risk recipients, careful monitoring of renal function and early image surveillance such as CT or ultrasound are recommended. If the asymptomatic lymphocele is >33.20 cm³ or located inferiorly, early interventions can be considered while carefully observing the changes in symptoms.
Cone-Beam Computed Tomography ; Creatinine ; Dialysis ; Early Intervention (Education) ; Humans ; Imaging, Three-Dimensional ; Kidney Transplantation ; Kidney* ; Lymphocele* ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Tissue Donors ; Transplant Recipients* ; Ultrasonography