ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ankle arthrodesis is used to treat patients with joint destructive processes that are not responsive to nonoperative measures. The procedure has traditionally been performed using open techniques. Recently, arthroscopic techniques have been applied to successfully fuse the ankle joint. This paper describes the indications for the procedure, the operative technique, and postoperative care. Arthroscopic ankle arthrodesis is a minimally invasive procedure that reliably results in a high rate of fusion with a low incidence of complications.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Most of the ankle arthrodesis procedures performed at the authors' institution over the last 10 years have used a miniarthrotomy technique. This technique involves two 1.5 cm incisions, one anteromedial and one anterolateral, through which the ankle joint is visualized. Debridement of cartilage and synovium, as well as subchondral bone resection, is performed using curettes, rongeurs, and flexible chisels. The ankle is ideally positioned in the neutral position in the sagittal plane, with minimal valgus (up to 5°) and external rotation of 5° to 10°. The arthrodesis is secured with three 6.5-mm cannulated screws inserted percutaneously. The success rate of this technique has been extremely favorable when compared with the success rates reported in the literature for more extensive methods of arthrodesis. The advantages of the miniarthrotomy technique are decreased soft tissue and periosteal dissection, technical ease as compared with more demanding methods, and rapid healing time comparable to that reported for other ankle arthrodeses.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Research and development of total ankle replacement is a rapidly expanding field, but ankle fusion remains the “gold standard” in the treatment of ankle arthritis. The transfibular approach is one of the most popular techniques in clinical practice. It offers the advantages of excellent exposure, the ability to minimize wound problems by developing full thickness flaps, and the availability of the distal fibula for local bone graft. Either internal or external fixation may be used, and it has been shown to have a high rate of fusion with low complication rates. With proper alignment of the fusion, the long-term results have shown 80–100% success rate. Long-term studies have raised questions about development of osteoarthritis in adjacent joints (Saltzman) and this has stimulated more research into the field of joint arthroplasty.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Arthrodesis is the standard treatment of end-stage arthrosis of the ankle. With internal compression techniques high fusion and satisfaction rates as well as acceptable complication rates have been achieved. From January 1986 until June 1998, 137 ankle arthrodeses were performed in 133 patients. The technique consisted of cartilage excision, anatomic repositioning of the talus, fusion using bone graft, and cannulated lag screws. Malleoli were spared in all cases.Ninety percent of patients fused after the index surgery, and 94% fused after revision surgery. Eighty-eight percent of patients were satisfied and had less pain, and 85% had increased function.Progressive arthrosis in surrounding joints developed in 33 of 41 ankles (80%) with greater than 24 month radiographic follow up. Despite this, only two of these patients required extension of their fusion. The anatomic compression arthrodesis technique (ACAT) provides many advantages, including minimal soft tissue disruption, ease of deformity correction, early rehabilitation, and a high rate of union.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

It is not rare for a patient to have disease of the ankle and one or more hindfoot joints. Arthritic degeneration is commonly seen as a late result of trauma, while major deformity may develop with neuromuscular disorders. When symptoms no longer respond to nonoperative measures, combined fusion of the ankle and hindfoot joints is often a good option. The goal of such surgery is to restore alignment and relieve pain. The multiply fused foot is far inferior to the normal condition, with stiffness and varying degrees of aching almost universal. Surgery is usually performed through a lateral transfibular approach. Alignment in the ankle, hindfoot, and forefoot must be precisely restored. Then rigid internal fixation with lag screws maintains the position until fusions have healed. Finally, muscle balance must be restored to prevent the development of deformity in the remaining joints. With good technique, high rates of union and patient satisfaction can be achieved. However, distal joint degeneration can be expected in long-term follow up. For this reason, we have begun performing total ankle replacement in extremities with multiple fusions.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

This manuscript serves to educate the reader as to pedorthic and orthotic principles and tools available to the surgeon when managing those with ankle fusions. Footwear, footwear modifications, foot orthoses, and ankle foot orthoses with be illustrated as necessary postoperative recommendations after primary ankle arthrodeses or in light of secondary complications.The document also serves to inform the reader of biomechanical objectives, including replacing lost motion, protection of associated articulations, and the accommodation for any leg length discrepancies created from the surgery.Footwear and footwear modifications should be very closely evaluated and discussed when managing patients with ankle fusions to insure higher quality outcomes.Foot orthoses and ankle foot orthoses may be necessary if dealing with a nonunion or a malalignment case. This paper will explore these options when and if faced with secondary complications from this type of surgery.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Avascular necrosis of the talus, especially with associated degenerative arthritis, is a challenging surgical problem. The impaired healing potential of the bone and the associated collapse and deformity of the ankle and hindfoot are obstacles to achieving a satisfactory surgical result. Several surgical techniques for ankle and hindfoot arthrodesis may be considered in the presence of avascular necrosis of the talus. These include tibiotalar arthrodesis with screw fixation, tibiotalocalcaneal arthrodesis, and tibiocalcaneal arthrodesis. The latter two techniques can be used with a variety of fixation methods, most notably with retrograde intramedullary nailing. Each technique requires both clinical and radiographic evaluation for preoperative decision-making. The indications for each as well as potential complications are discussed. A case presentation of each surgery is presented and the authors' current postoperative protocol is described.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ankle replacement with contemporary devices may be an effective choice for treatment of the severely arthritic ankle in selected patients. As with any operative procedure, it is necessary to adopt criteria for defining the outcome and how to manage unsuccessful results. Salvage of failed total ankle arthroplasty (TAA) is challenging due to extensive bone loss, osteopenia, disturbed soft tissue envelope, and hindfoot pathology. A description of operations featuring implant removal and arthrodesis for failed TAA, including indications, preoperative planning, specific techniques, results, complications, and postoperative management is discussed.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ankle fusion continues to be a widely used technique for treatment of degenerative conditions of the tibiotalar joint. The functional results are dependent on obtaining a solid arthrodesis. The authors have found an increased incidence of nonunion in certain patient populations. Specifically, the patients at high risk include the diagnoses: Avascular necrosis of the talus with or without collapse; nonunion of tibiotalar or subtalar arthrodesis; history of previous pseudoarthrosis from previous procedures in other anatomic locations; cigarette smoking, alcohol abuse or other metabolic disorders. The spine fusion and fracture literature show good clinical results using an implantable direct current electrical stimulator as an adjunct to internal fixation to enhance fusion and bone healing. In this manuscript the authors describe their indications and detailed technique for use of implantable bone growth stimulation as an adjuvant in selected high-risk patients groups. Early clinical results and common complications are also reported.

ISSN:1536-0644    

出版商:OVID    

年代:2002

数据来源: OVID