Naviculocuneiform joint arthrodesis in a cohort of 36 patients.

BACKGROUND: Arthrodesis of the naviculocuneiform joint (NCJ) can be performed in isolation or in conjunction with arthrodesis of other joints, often in the presence of deformity. In the literature there is relative rarity of articles reporting on results and complications of NCJ arthrodesis. PATIENTS AND METHODS: Thirty-six patients (36 feet) with symptomatic NCJ arthritis underwent arthrodesis. Mean age was 59.1 years (SD 13.1; range 26-78) and 24 were women. Adjuvant procedures were performed simultaneously in 29 patients, whilst 17 had planovalgus and 1 had cavovarus foot deformity. RESULTS: Union of the NCJ arthrodesis was achieved in 35 out of 36 (97.2 %) patients, whilst one patient developed non-union. Mean time to union was 13.1 weeks (SD 3.8; range 8-24). Two patients (5.6 %) developed deep infection and 5 patients (13.9 %) required secondary surgical procedures. Twenty-three patients (63.9 %) rated the outcome as good or excellent, 11 (30.6 %) as fair and 2 (5.6 %) as poor. CONCLUSIONS: NCJ arthrodesis was part of a more complex procedure in most of the patients. Whilst union was achieved in almost all patients and complication rate was acceptable, only 64 % rated their outcome as good or excellent. LEVEL OF CLINICAL EVIDENCE: IV.

Arthroscopic Subtalar Joint Arthrodesis: Topical Review.

BACKGROUND: Advances in foot and ankle arthroscopy over the last 2 decades have allowed for subtalar joint arthrodesis to be performed arthroscopically. The potential advantages of the arthroscopic technique include higher fusion rates, lower complications, reduced perioperative morbidity, and accelerated rehabilitation. Arthroscopic arthrodesis may, however, not be appropriate in the setting of complex deformity correction or the need for other open procedures. METHODS: Surgical techniques of arthroscopic subtalar joint arthrodesis are described. Outcomes and complications associated with these procedures are presented, based on a comprehensive literature review. Thirteen Level IV studies of moderate quality were included. RESULTS AND CONCLUSION: Excellent arthrodesis union rates were achieved (average 96%, range 86%-100%), at a weighted average union time of 8.8 weeks (95% confidence interval 7.9-9.7). The overall complication rate was 21% (87/415 feet; range 10%-36.4%). Metal irritation was the most common complication (11.2%), followed by nerve injury (4.2%) and infection (0.9%). Similar fusion rates have been reported when comparing arthroscopic and open arthrodesis. Complication rates are also similar, excerpt for infection, which may be lower with arthroscopy. Three different approaches were used to access the subtalar joint with similar union and complication rates. There was no evidence that the use of bone graft or more than 1 screw improved outcomes. The superiority of arthroscopic subtalar fusion over open techniques cannot be demonstrated by the available studies. LEVEL OF EVIDENCE: Level IV, case series.

Ankle fractures in diabetic patients.

Surgical complications are more common in patients with complicated diabetes (presence of inner organ failure, neuropathy).Of all patients undergoing ankle fracture fixation, approximately 13% are diabetic and 2% have complicated diabetes mellitus.Non-operative management of ankle fractures in patients with complicated diabetes results in an even higher rate of complications.Insufficient stability of ankle fractures (treated operatively, or non-operatively) can trigger Charcot neuroarthropathy, and result in bone loss, deformity, ulceration, and the need for amputation.Rigid fixation is recommended. Hindfoot arthrodesis (as primary procedure or after failed ankle fracture management) can salvage the limb in approximately 80% of patients.Early protected weight bearing can be allowed, provided rigid fixation without deformity has been achieved. Cite this article: EFORT Open Rev 2020;5:457-463. DOI: 10.1302/2058-5241.5.200025.