Tibiotalar arthrodesis in the rheumatoid foot.

The results of 14 open ankle arthrodeses in 13 patients with rheumatoid arthritis are reviewed. Ten arthrodeses were treated with Charnley compression clamps (six of these were combined with a fibular strut graft). Three had cannulated screws and one had a fibular strut graft and a short leg walking cast. The mean followup time was 41.2 months. There were five nonunions and one delayed wound healing. The results of the patients treated with fibular strut grafts are far better than the results in patients treated with open ankle arthrodesis without grafting procedure. This seems a promising technique in a patient population with rheumatoid arthritis.

Synovial osteochondromatosis: an unusual cause for subacromial impingement.

Impingement syndrome is usually caused by encroachment on the rotator cuff of the acromion, coracoacromial ligament, acromioclavicular joint or coracoid process. Bursal causes of impingement are rare but include rheumatoid thickening, and thickening from previous and iatrogenic causes such as sutures, pins, or wires left from previous surgery. We report a case of synovial osteochondromatosis presenting as chronic impingement syndrome. Synovial osteochondromatosis may be difficult to differentiate from chronic calcific tendinitis, but we describe a radiological sign and its anatomical basis that can differentiate between the two. If densities are seen on plain radiographs distal to the greater tuberosity, then loose bodies within the subacromial bursa should be considered.

Arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist.

The arthroscopic treatments (suture, debridement and "wafer" resection of the distal ulna) performed for TFCC lesions in 42 patients were retrospectively reviewed. Overall results were disappointing, with a better outcome for isolated lesions, for sutured TFCC's and degenerative lesions.