Biomechanical Considerations in Rearfoot Fusions.

This article discusses rearfoot fusions for foot and ankle surgeons. It establishes normal foot and ankle function primarily in the stance phase of gait. The foot is greatly affected by external and internal forces, which contribute to normal function or the need for compensatory mechanisms. As a result of compensation, many symptoms develop, often leading to debilitating disorders such as degenerative joint disease. The interaction of the ankle, subtalar, and midtarsal joints are outlined. Congenital deformities, trauma and abnormal compensation are reviewed along with corresponding sequelae. Surgery is often indicated to reduce symptoms, improve position, and help stabilize the foot.

A retrospective analysis evaluating allogeneic cancellous bone sponge for foot and ankle arthrodesis.

The present retrospective case crossover study was conducted to determine the effectiveness and safety data associated with the use of an allogeneic, cancellous bone sponge in an orthopedic foot and ankle population. We reviewed the medical records of 47 subjects (80 joints) who had undergone foot and/or ankle fusion with the cancellous bone sponge. The records were reviewed up to 12 months postoperatively. The joints included in the present study were 12 ankles, 3 ankle syndesmotic fusions (with concurrent total ankle arthroplasty), 17 subtalar joints, 17 talonavicular joints, 9 calcaneocubiod joints, 1 naviculocuneiform joint, 13 first tarsometatarsal joints, 6 lesser tarsometatarsal joints, and 2 first metatarsophalangeal joints. The endpoints of the present study were solid, sustained foot and ankle fusion, as demonstrated radiographically, and the occurrence of unexpected adverse effects related to the graft. The fusion rates were compared with those reported in other studies. The patient-reported outcome variables for the present study included the visual analog pain scale and the American Orthopaedic Foot and Ankle Score. The use of a cancellous sponge showed statistically significant improvements in pain and function and comparable or better fusion rates compared with outcomes reported in other published reports.

Use of a small bilateral external fixator for ankle fusion.

A variety of methods are available for surgeons to use in an effort to achieve fusion ankle arthrodesis. Among these, external fixation devices have proven to be effective. In this article, we describe the use of a small external fixation frame that is affixed to the medial and lateral aspects of transfixation pins, and used to compress the arthrodesis interface.

Difficult and controversial pediatric cases: a roundtable on conservative and surgical management.

Pediatric clinical management is highly specialized. Problems are complex and often complicated by other medical issues that dictate limitations on therapeutic options. Appropriate diagnosis and successful clinical management depend on the experience and skill of the surgeon. This roundtable discussion focuses on seven difficult cases and presents the views of three experienced and skilled experts in the field.