• Journal of Korean Foot and Ankle Society
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• v.26 no.4
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• pp.151-156
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• 2022

The proportion of patients with end-stage ankle arthritis is increasing. The leading surgical methods for treating patients with end-stage ankle arthritis are ankle arthrodesis and total ankle arthroplasty. Ankle arthrodesis is considered the standard treatment for end-stage ankle arthritis. Many studies have been conducted on the two procedures, but it is unclear which is superior, and total ankle arthroplasty cannot be said to be a clear indication. Therefore, this review compares the advantages and disadvantages of two representative surgical methods for treating end-stage ankle arthritis.

• Journal of Veterinary Science
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• v.24 no.2
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• pp.28.1-28.7
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• 2023

A three-year-old female spayed Lurcher was referred for the treatment of a highly comminuted distal tibial articular fracture. Resection of the area of comminution with a transverse osteotomy of the tibial diaphysis and talar ridges was performed, followed by modified pantarsal arthrodesis and a calcaneotibial screw. The treatment resulted in 7 cm of tibial shortening, equating to a 28% reduction in the total tibial length. Radiographic union of the arthrodesis was successful. Fair use of the pelvic limb was documented long-term. Combined acute limb shortening and modified pantarsal arthrodesis resulted in an acceptable outcome and could be considered in cases of highly comminuted distal tibial fractures.

• Journal of Korean Foot and Ankle Society
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• v.19 no.4
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• pp.171-175
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• 2015

Purpose: Tibiotalocalcaneal arthrodesis has been used as a treatment option for severe deformity including Charcot arthropathy, avascular necrosis of the talus, and severe osteoarthritis of the ankle and subtalar joint. The purpose of this study was to evaluate the result of the surgical outcome of tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail. Materials and Methods: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail was performed by one surgeon in 36 cases. Clinical and radiological finding was evaluated using assessment of fusion time, 5th metatarsal-tibial angle, possibility of postoperative complication, visual analogue scale for pain and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: Union was achieved in 33 cases at an average of 23 weeks (11~29 weeks). There were 3 cases of nonunion and 1 case of reoperation. Nail-tibial angle tended to be larger in nonunion cases. AOFAS score showed significantly poor outcome at malalignment (${\geq}5^{\circ}$), negative value of 5th metatarsal-tibial angle. Conclusion: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail is considered a useful treatment option for severe destruction and deformity involving ankle and subtalar joint.

• Journal of Korean Foot and Ankle Society
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• v.5 no.2
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• pp.142-148
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• 2001

Purpose: To investigate the short term result of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of rheumatoid arthritis, using a lag screw and dorsal mini-plate. Materials and Methods: From December 1999 to September 2001, The first metatarsophalangeal arthrodesis of 14 cases (9 patients) was underwent, using a lag screw and dorsal mini-plate. The follow-up period was averaged in 14.6 months. The subjective findings with respect to pain, functional aspect of ability to stand and walk, and to shoe-wearing were evaluated. The objective findings, such as the gross alignment and the radiological measurements for the hallux valgus angle, 1,2 intermetatarsal angle, and dorsiflexion angle were also studied. Results: After the arthrodesis of the first metatarsophalangeal joint, the subjective improvement in pain, function and alignment was graded as excellent in seven (50%) feet, good in seven (50%) feet, and fair or poor in none. The hallux valgus angle and 1,2 intermetatarsal angle were reduced from $44.1{\pm}7.1$ and $15.5{\pm}6.2$ degrees to $13.6{\pm}2.6$ and $10.2{\pm}2.2$ degrees respectively. The dorsiflexion angle was measured in $20.3{\pm}3.7$ degrees after the fusion. The radiological fusion was observed at average 8 weeks after the operation in all cases. The overall complication of the procedure was few, except the delayed wound healing in one. Conclusion: The arthrodesis of the first metatarsophalangeal joint using a lag screw and dorsal mini-plate was regarded as an excellent method of various operative modalities to correct the rheumatoid hallux valgus deformity.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.140-145
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• 2010

Purpose: The diabetic charcot neuroarthropathy of ankle is an infrequent site (around 5%), but is definitely the location that, because of the instability and progressive deformity it involves, cause ulceration in a high percentage of patients, and this can then become a reason for amputation. However, the treatment of this disastrous disease is still challenging. We analyzed the clinical and radiological results of ankle arthrodesis by our fixation method in Charcot neuroarthropathy. Materials and Methods: Seven cases that were diagnosed as charcot neuroarthropathy of ankle arthrodesis were followed for more than 16 months postoperatively. Mean age was 57 years, and the mean follow-up period was 27 months. Anterior approach was used in arthrodesis, and internal fixation by 3 or more cannulated screws and hybrid type external fixation were used. Auto iliac bone for grafting was combined in all cases. External fixator was kept for 3 months without weight-bearing. Then, boots brace was applied for more 3 months allowing partial weight-bearing. Four cases had minor complications such as pin site infection. Preoperative and postoperative AOFAS score, time to fusion and postoperative complications were checked. Results: Postoperative fusion was completed in all cases, and the mean time to fusion was 3.4 months. No postoperative complication was checked. At the last follow-up, the mean AOFAS score had increased from 54 points to 72 points. Patient's satisfaction was over 80%. Conclusion: Satisfactory results were obtained after ankle arthrodesis using internal and hybrid type external fixation combined with auto iliac bone graft in charcot neuroarthropathy with minor complications.

• Journal of Korean Foot and Ankle Society
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• v.13 no.1
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• pp.68-74
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• 2009

Purpose: This study was designed to evaluate the results and efficacy of subtalar distraction two bone-block arthrodesis for calcaneal malunion. Materials and Methods: From January 2004 to June 2007, we operated on 8 patients (12 cases). There were 7 male patients and 1 female patient; their mean age was 42 years. 8 cases among them were operated initially. The period between initial injury and arthrodesis was 21 months. At an average follow up was 19 months. In operation, we used extensile lateral approach and arthrodesis was performed through tricortical two bone-block and cannulated screws. The Ankle-Hindfoot scale was used for clinical evaluation. In radiologic analysis, plain X-ray and CT were examined union and various parameters. Results: All cases achieved radiologic union at the final follow-up. The mean Ankle-hindfoot scale (maximum of 94 points) increased from 43.4 points preoperatively to 84 points at the final follow-up. The radiologic analysis of the pre- and postoperative standing lateral radiographs showed and average increase of 5.5 mm in talo-calcaneal height, $5.1^{\circ}$ in talocalcaneal angle, $6.1^{\circ}$ in talar declination angle and decrease of $5.7^{\circ}$ in talo-first metatarsal angle. Conclusion: The short term results of subtalar distraction two bone-block arthrodesis is promising, but longer follow-up was needed.

• Journal of Korean Foot and Ankle Society
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• v.6 no.2
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• pp.156-160
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• 2002

Purpose: To analyze the clinical outcome of triple arthrodesis for the posttraumatic arthritis after calcaneal fractures. Materials and Methods: We retrospectively reviewed 22 posttraumatic arthritis patients who underwent a triple arthrodesis from March 1991 to May 1998. The mean duration of follow up was 74 months(range, 36-123 months). The pain, function and alignment were evaluated by the modified ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society(AOFAS) clinically and the union rate, the duration of union and the degenerative change of adjacent joints radiographically were evaluated. Results: The mean duration from injury to arthrodesis was 33 months (range, 12-132 months). The AOFAS score improved from 36.4 points(range, 14-64) preoperatively to 67.6(range, 25-90) postoperatively. The union rate was 90.1% radiographically, the mean duration of union was 14.3 weeks(range, 12-21 weeks) and the degenerative change in the adjacent joint was showed in 12 patients(54.5%). There were 2 cases of talonavicular nonunion, one superficial wound infection and one partial skin necrosis. Conclusion: Triple arthrodesis for posttraumatic arthritis after calcaneal fractures is a useful method for relief of pain and correction of posttraumatic hindfoot deformity, as an evidenced by the satisfactory clinical outcome. Although a high prevalence of subsequent arthritis of the ankle and midtarsal joint was noted radiographically, we found that it was not clinically relevant.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.202-207
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• 2014

Purpose: The purpose of this study was to evaluate the radiological and clinical outcomes of tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of talus, combined arthritis of the ankle and subtalar joint, failure of previous ankle arthrodesis, and failed total ankle arthroplasty. Materials and Methods: Eighteen consecutive patients (10 men and 8 women) with an average age of 54 years (range, 42~72 years) underwent tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail fixation. The mean duration of follow-up was 16 months (range, 12~23 months). Radiological evaluation included assessment of the union status of ankle and subtalar joints. Clinical evaluations included visual analogue scale (VAS) for pain and patient satisfaction, and postoperative complications were analyzed. Results: Radiological union was achieved in 14 ankle joints (77%) and 16 subtalar joints (88%) at an average of 16 weeks (range, 14~40 weeks) and 14 weeks (range, 12~24 weeks), respectively. The preoperative VAS were 4.6 (range, 4~8) at rest and 8.2 (range, 7~10) during walking, and the postoperative VAS were 2.2 (range, 0~3) and 4.6 (range, 4~6), respectively (p<0.05). There were 6 nonunions (4 ankle joints and 2 subtalar joints), 3 tibia fractures, 2 delayed union of ankle joints, and 2 breakage of the implant. Conclusion: Tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail may be considered as a viable option in patients with complex hindfoot problems.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.183-188
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• 2014

Purpose: The accepted general management principle after ankle arthrodesis is to maintain non-weight bearing for 6 to 8 weeks. The aim of this study was to report clinical outcome of patients allowed early weight bearing after arthroscopic arthrodesis. Materials and Methods: We analyzed medical records and radiographs to determine fusion rate and complication risk of 22 sequential patients allowed to walk under short leg cast within 3 days after arthroscopic ankle arthrodesis using 2 screws from January 2008 to June 2012. The minimum follow-up period was 18 months, and the mean age of the patients was 67 years. Results: The mean visual analog scale was decreased from 8.9 points preoperatively to 2.3 points after 12 months. Complete ankle fusion was achieved in 19 patients (86.4%) at 3-month follow-up. There were 2 cases of delayed union and one case of nonunion at 12-month follow-up. There was no other complication such as wound problem, persistent swelling of the ankle. Conclusion: Bony union may not be interfered even though patients were allowed to walk under cast within a few days after arthroscopic ankle arthrodesis.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.116-122
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• 2012

Purpose: Subtalar arthrodesis has been the gold standard for the painful subtalar joint disorders. Successful subtalar arthrodesis requires fusion of the 3 facet joints. The purpose of the study is to compare the clinical outcome of the posterior fixation (P2) and anterior-posterior (A1P1) fixation technique for subtalar arthrodesis which enhance anterior and middle facet fixation. Materials and Methods: The study is based on the 20 feet (19 patients) of the subtalar arthrodesis utilizing cannulated screws from September 2006 to September 2009 with at least 1-year follow-up. Two fixation techniques were utilized for the subtalar arthrodesis: 1) posterior fixation only (P2, 7 feet, 35%) and 2) anterior-posterior (A1P1) fixation method (13 feet, 65%). Visual Analog Scale Pain (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (maximum: 94 points), the time for returning to daily living and the patient satisfaction were also evaluated. Results: Average follow-up period were 13.2 months (12-3 mo). The AOFAS score improved from preoperative average 45 (0-68) to 81.6 (62-94), while VAS score was decreased from average 8.0 (3-10) to 1.8 (0-5) at final follow-up. Ninety-five percent of the patients were satisfied with surgery. All the patients returned to daily living at average 7.2 months (2-15 mo) post-surgery. Radiographically, 2 techniques both showed 100% fusion of the posterior compartment of the subtalar joint. Postoperative complications were 1 case of low grade infection and 1 case of sural nerve neuralgia. Conclusion: The subtalar arthrodesis using A1P1 fixation technique showed better fusion rate of the anterior compartment of the subtalar joint compared to P2 fixation technique although the 2 techniques both showed similar favorable clinical outcome. Therefore the A1P1 fixation technique is found to be a viable option to address chronic painful subtalar joint disorders to enhance the anterior compartment fixation.