Tibiocalcaneal arthrodesis using a simple external fixator.

Tibiocalcaneal arthrodesis has been a salvage option for conditions with extensive loss of the talar body. In conditions that preclude the use of internal fixation, external compression arthrodesis has been the preferred technique to achieve fusion about the hindfoot. Since Sir John Charnley elucidated the technique of compression arthrodesis using compression clamps, various modifications and techniques of external compression arthrodesis have been described. Various clinical and biomechanical studies have established the superiority of triangular transfixation in external compression arthrodesis. We have described a simple technique of compression arthrodesis after the principle of triangular transfixation using easily available hardware from Ilizarov instrumentation. This technique is relatively inexpensive in terms of the cost of the materials, uses a modular construct, and allows multiplanar correction of the hindfoot. It can be used intraoperatively to distract the hindfoot joints, especially in the presence of fibrosis and poor skin conditions. We believe this device can be a reasonable alternative to the conventional external fixation techniques for tibiocalcaneal arthrodesis.

Tuberculosis of and around the ankle.

Osteoarticular tuberculosis of the ankle joint is rare, and diagnostic delays are common with this condition. The aim of our report is to highlight the varied clinical and radiologic presentation of this entity. We present a retrospective review of 16 patients with tuberculosis in and around the ankle joint who were surgically treated during a 6-year period. The incidence of ankle joint involvement in extraspinal osteoarticular tuberculosis was 15.7% in our unit. The most common presentation in our series was chronic septic arthritis, followed by periarticular osseous lytic lesion. Tuberculous synovitis, tenosynovits, and retrocalcaneal bursitis were also seen. Osteopenia, the hallmark of osteoarticular tuberculosis, might not be seen in all forms of tuberculosis affecting this joint. Chemotherapy remains the mainstay of treatment. Adjuvant surgery is often required to establish the diagnosis and in the treatment of patients with deformity and widespread destruction of articular cartilage owing to delayed presentation.

A simple solution for wound coverage by skin stretching.

Viscoelastic properties of skin, ie, creep and stress relaxation, allow it to stretch beyond its normal state within a short period of time. Presented here is a technique of "wound coverage by skin stretching" that uses this principle. Kirschner wires were passed through the skin edges on either side of the wound margins. Dynamic traction was applied with traction bands improvised by the surgeon from surgical glove wrist rings. We used this method in eight patients to close 10 wounds that were not feasible to close with direct methods. We have found that this simple, economic, and effective method provides rapid functional wound closure when bone and other structures are exposed. It does not require specialized training or devices. Careful attention to the described surgical technique gives good results and few complications.

Practical considerations in the making and use of high-dose antibiotic-loaded bone cement.

Local antibiotic delivery with antibiotic loaded acrylic bone cement has been used extensively in the management of chronic osteomyelitis and implant related infections. Though newer drug delivery vehicles are being investigated, it remains the most widely used local antibiotic delivery vehicle in orthopaedic surgery. Self-made antibiotic loaded bone cement beads, which are cheaper and antibiotic specific, have been shown to elute less effectively than commercial antibiotic loaded cement beads. We offer several tips for increasing the elution and effectiveness of antibiotic loaded bone cement in clinical practice.