Transarticular cross-screw fixation. A technique of ankle arthrodesis.

Many techniques of ankle arthrodesis have been described. Failure rates of up to 40% have been reported in the past. In this study, a technique for internal fixation of ankle fusions was employed using transarticular crossed-screw fixation. This provides bony coaptation, compression, and immobilization necessary for reliable union. Thirty-five patients had ankle arthrodesis with this technique of internal fixation and 12 patients had ankle fusions with Charnley compression arthrodesis. Follow-up evaluation averaged two years. The fusion rate was 100% (35 fusions of 35 attempts) with the transarticular crossed-screw technique and 83% (ten fusions of 12 attempts) with compression arthrodesis.

Arthroscopic debridement of the arthritic knee.

Arthroscopic debridement was carried out in 49 knees of 44 patients. These patients, who had a primary diagnosis of arthritis, were older than 50 years of age. Two-thirds had roentgenographic evidence of severe arthritis. Age, weight, compartment location of arthritis, and presurgical range of motion did not affect surgical results. Symptoms of long duration, arthritic severity as evidenced by roentgenograms, and malalignment predicted poor results. Conversely, shorter duration of symptoms, mechanical symptoms, mild to moderate roentgenographic changes, and crystal deposition correlated with improved results. Surgery offered no benefit for 39% of the patients. Another 9% had temporary improvement, averaging 15 months, but were judged failures at the final follow-up examination. Good or excellent results were achieved in 52% of the patients and maintained through the final follow-up examination in 40% of the patients. Of these, two-thirds had no visible deterioration within a 33-month average follow-up period.

Talonavicular dislocations and midfoot arthropathy in neuropathic diabetic feet. Natural course and principles of treatment.

Talonavicular dislocations, sometimes associated with other midtarsal arthropathy, occasionally occur in patients with diabetic neuropathy. The natural course and rationale of treating this diabetic arthropathy is presented, based on the literature and the authors' experience with eight cases. Appropriate management depends on the acuteness of the injury, the degree of deformity, and the degree of bone fragmentation. If the injury is acute and alignment is acceptable, immobilization and protective weight bearing may prevent progression of the neuropathic joint destruction. If dislocation is acute with marked deformity but there is little fragmentation and the foot has intact circulation, reduction and surgical arthrodesis may be indicated. If dislocation is chronic, with bone fragmentation and severe deformity, proper management consists of wearing custom-molded shoes with stiff rocker-bottom soles. Patellar tendon weight-bearing braces may be added if needed. For patients in this last category, surgical treatment is recommended as a last resort only if soft-tissue breakdown cannot be prevented by appropriate footwear and bracing alone.

Multistaged surgical management of posttraumatic segmental tibial bone loss.

Fracture nonunions associated with segmental diaphyseal bone loss challenge present methods of sustaining bone length and securing bony union. In the tibia, single-stage grafting procedures to accomplish this reconstruction requires major tissue sacrifice from adjacent areas and often results in amputation. A series of nine patients with tibial segmental diaphyseal bone loss were treated with multistaged surgical reconstruction. All nine were patients with severe trauma, with soft-tissue loss and local sepsis, who were candidates for amputation. The follow-up period averaged 5.5 years. All of the patients achieved healed, stable legs. All but one were fully ambulatory without a brace eight to 15 months after the first stage of bone grafting. There were several minor complications, which were satisfactorily treated. Multistaged bone graft operations were relatively low-risk, with a high incidence of success for treatment of major tibial segmental bone loss.

Treatment of septic olecranon and prepatellar bursitis with percutaneous placement of a suction-irrigation system. A report of 12 cases.

Ten cases of septic olecranon bursitis and two cases of septic prepatellar bursitis were treated in the period from 1975 to 1980 with antibiotics and percutaneous tube placement for suction-drainage and local antibiotic irrigation. All patients had positive bacterial cultures: Staphylococcus aureus in nine, beta-hemolytic Streptococcus in two, and Staphylococcus epidermidis in one. Intravenous antibiotics, local suction-drainage, and irrigation with a solution of 1% kanamycin and 0.1% polymyxin controlled the infection in each case. The antibiotic treatment averaged 19 days, compared with 24 days in a series in which suction-irrigation was not used. In contrast with studies in which aspiration or incision and drainage were performed, there were no complications or recurrences. Percutaneous suction-irrigation appears to be a safe, effective method of treatment that is particularly beneficial in severe cases of septic bursitis in which continuous drainage is desirable.

Profunda femoris arterial laceration secondary to intertrochanteric hip fracture fragments: a case report.

A 54-year-old man incurred a major arterial injury from intertrochanteric fracture fragments. Brisk bleeding from such an injury may not be controllable through the incision used for internal fixation of the hip fracture. A separate standard vertical groin incision allows exploration, control of bleeding, and repair of either superficial or deep femoral arterial systems.