Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot.

We studied twelve patients who had a stress fracture of the tibia and one patient who had a stress fracture of the fibula after arthrodesis of the ankle or the foot. A second stress fracture subsequently developed in two patients. All but two patients were managed non-operatively, and the fractures healed uneventfully. One patient who was managed operatively had a below-the-knee amputation to treat a painful non-union of a tibial fracture, and the other had interlocking intramedullary nailing for a displaced fracture. All but one of the arthrodesis sites had fused before the stress fracture occurred. All of the stress fractures that occurred after arthrodesis of the ankle were in the middle and distal aspects or the distal aspect of the tibia, while those that occurred after triple arthrodesis were in the distal aspect of the fibula or the medial malleolus. Although six of the thirteen patients still had uncorrected alignment and deformity after the arthrodesis, optimum alignment after the arthrodesis did not preclude the occurrence of a stress fracture. We conclude that stress fracture must be considered in the differential diagnosis of pain months or even years after solid fusion at the site of an ankle or triple arthrodesis.

Late reconstruction of the midfoot and tarsometatarsal region after trauma.

The management of painful arthritis and deformity after trauma to the midfoot starts with careful assessment by physical examination and appropriate investigation to identify the affected joints. Conservative treatment may be very effective and includes the use of NSAIDs, custom insoles with arch support, and a rocker-bottom sole with extended steel shank with or without a SACH heel. If this treatment fails, usually a year after the injury, then arthrodesis of all the symptomatic joints with restoration of the arch and alignment of the weight-bearing surface is the recommended treatment. The long-term results of these fusions may be compromised by the subsequent development of arthritis in adjacent joints.

Lumbar spondyloptosis. A long term follow up of three cases.

This paper reports the long term results of 3 patients with lumbosacral spondyloptosis who were treated by closed reduction, followed by 6 to 12 weeks plaster cast immobilisation, posterior fusion and finally anterior fusion after a further 3 to 6 months. The follow up was from 7.5 to 10.5 years. Spondyloptosis was diagnosed by estimating the slip angle and the percentage slip. The initial slip angle ranged from 40 degrees to 55 degrees with 46%-91% slip. The average improvement in the slip angle after reduction was 82% with 74% improvement in slip. There was some loss of correction in every case by the end of treatment: the average improvement in slip angle was 59% (36%-78%) with an average 52% (25%-69%) correction of slip. Fusion was obtained in every case and the clinical results were very satisfactory.