Imaging of ankle replacements.

Significant innovations in the field of total ankle replacement surgery have occurred since the early disappointing experiences with first-generation devices. In recent years, total ankle arthroplasties are commonly placed in patients with end-stage ankle osteoarthrosis, supplanting ankle arthrodesis as the procedure of choice at some institutions. Careful clinical and preoperative radiographic evaluation is helpful to plan concomitant ligament release, ligament reconstruction, or osteotomy. Careful attention to radiographic signs of early hardware loosening or subsidence can prompt intervention while bone loss is still minimal, and computed tomography has an adjunct role in the evaluation of periprosthetic lucency and osteolysis.

Effect of delayed treatment on open tibial shaft fractures.

Open tibial shaft fractures were analyzed retrospectively to determine the effect of treatment timing on infection and nonunion rates. The cases of 77 patients with 81 open tibial shaft fractures were reviewed. Patients were treated with initial wound cleansing and splinting in the emergency department and then formally with operative irrigation and débridement and stabilization, which included intramedullary (IM) nailing, external fixation, open reduction and internal fixation, or splinting. All tibial shaft components ultimately were treated with IM nailing. Mean time to operative treatment was 12.97 hours (SD, 10.8 hours). There were 7 infections (8.6%) and 3 nonunions (3.7%). Time was found not to be a significant factor in predicting either infection or nonunion. Increased severity of fracture was a significant factor in predicting infection rate. The infection rate for fractures treated first with external fixation and then with IM nailing was significantly higher than that for fractures treated with IM nailing alone. In addition, a relation was found between patients who received multiple débridements and development of infection. These results show that infection and nonunion rates were not adversely affected by longer time to operative treatment (up to 48 hours) when adequate trauma department open fracture care and early initiation of antibiotics were coupled with standardized and thorough débridement in the operative theater.