Late complications of fractures of the calcaneus.

We retrospectively reviewed the results of the operative treatment of forty-three fractures of the calcaneus in forty-two patients (thirty-six men and six women). The operations had been performed a mean of twenty-six months (range, six to seventy-two months) after the injury. An in situ subtalar arthrodesis had been performed in fifteen patients; a subtalar distraction bone-block arthrodesis, in fourteen; a triple arthrodesis, in five; a lateral calcaneal ostectomy, in seven; a transection and proximal transposition of the sural nerve, in seven; and a release of the tibial nerve, in five. The patients were examined at a mean of thirty-two months (range, twenty-six to fifty-two months) after the operation. The difference between the preoperative and postoperative rating scores was used to measure any improvement in function. Pain was partially relieved in thirty-eight (90 per cent) of the patients, function improved in thirty-five (83 per cent), and thirty-two (76 per cent) of the patients returned to work or to a pre-injury level of activity at a mean of eight months (range, four to sixteen months) after the operation. There was a trend (p = 0.07) that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. The most successful results were in the patients who had had a subtalar arthrodesis.

Ankle arthrodesis. A comparison of an arthroscopic and an open method of treatment.

An arthroscopic technique and an open technique with malleolar ostectomy for ankle arthrodesis is described and compared. Internal fixation with compression across the tibiotalar joint was utilized for both methods using either 6.5-mm or 7.0-mm cannulated screws. The indications, advantages, results, and complications of these two fusion techniques in 33 patients are reported. Arthroscopic arthrodesis was performed in 17 patients, using open arthrotomy and malleolar ostectomy in 16. The mean time to arthrodesis for patients having the procedure arthroscopically was 8.7 weeks (range, six to 14 weeks), compared to 14.5 weeks in the open arthrotomy group (range, eight to 26 weeks; p less than 0.004). Despite differences in patient selection for each of the two groups, it was concluded that disabling ankle arthritis for certain patients may be more appropriately managed with arthroscopic arthrodesis than by arthrotomy and malleolar ostectomy, utilizing similar methods of internal fixation.

Complications associated with limb salvage for extremity sarcomas and their management.

A retrospective clinical review of 100 consecutive patients with extremity sarcomas managed by limb salvage operations was performed to evaluate local tumor control and morbidity. The mean follow-up period was 45.1 months. Overall survival was 86%. There were local recurrences in 3% of patients, and 26 complications in 22 patients. Wound necrosis was the most frequent complication. Failure of allogeneic bone graft operations occurred in 25 patients. Most of the complications were salvageable without loss of limb. Limb salvage is an acceptable surgical treatment of extremity sarcomas based on adequate local control and minimal morbidity.

The use of large allografts for tumor reconstruction and salvage of the failed total hip arthroplasty.

Large bone defects have become a more common orthopedic problem in recent year. This is due to the increased enthusiasm for limb salvage surgery as a technique to manage patients with primary bone tumors and for patients who have had multiple joint arthroplasties with subsequent bone loss. One technique that has proven successful for this difficult problem is the use of fresh frozen allografts to reconstruct these skeletal defects. From January 1981 until January 1987, 60 large fragment fresh frozen allografts were used for skeletal reconstruction. These grafts were divided into three basic groups: intercalary, 15; osteoarticular, 16; and allograft-prosthetic composite, 29. The diagnoses included 43 bone tumors, 16 failed total hip arthroplasties, and one traumatic bone loss. The average patient age was 39.7 years and had an average follow-up period of 24 months. The average length of allograft was 12.4 cm. Using the Enneking Functional Evaluation System, the final functional analysis revealed excellent or good results in 86% of the patients and fair or poor results in 14% of the patients. Roentgenological union at the allograft-host bone junction was achieved in 90% of the patients in a mean time of 5.8 months after surgery. An additional three patients obtained union after autogeneic bone grafting. At the time of follow-up evaluation, 92.3% of the patients were free of tumor; they had no local recurrences. The use of fresh frozen allografts represents an acceptable alternative for the reconstruction of large skeletal defects. One can expect good or excellent function for the majority of patients. The best functional results were obtained with the intercalary allografts and the allograft-prosthetic composites.