Autogenous bone graft interpositional arthrodesis for the correction of flail toe. A retrospective analysis of 22 procedures.

Digital surgery is one of the most common types of surgery performed by foot and ankle surgeons. Flail toe is a complication that may occur after overaggressive resection arthroplasty of the proximal interphalangeal joint of the lesser toes. Correction of flail toe deformity has received little attention and has predominantly involved soft-tissue procedures. The authors' preferred technique for the surgical correction of flail toe is to place a unicortical autogenous bone graft (harvested from the ipsilateral calcaneus) within the revised proximal interphalangeal joint of the lesser toes to create a distraction arthrodesis. This technique allows restoration of digital length, stability, and purchase. A retrospective review of 22 such procedures in 13 patients is presented, along with a literature review of other procedures and a description of the authors' current surgical technique and postoperative management protocol. Overall success using the authors' procedure was 82%. Complications occurred in three patients, with one of the grafts showing complete resorption and two requiring additional surgical intervention owing to nonunion and malunion of toes.

Enhanced tenodesis for retrocalcaneal surgery.

Retrocalcaneal surgery is complex and difficult. Over the years, many different approaches to retrocalcaneal surgery have been described. Partial or total release of the tendo Achillis is often necessary, with reattachment being of paramount importance to allow for optimal function following surgery. Although numerous anchoring devices have been introduced for tendo Achillis reattachment, the authors have found the DePuy TiMAX Spider Plate (DePuy ACE, Warsaw, Indiana) to be superior. This article describes the Spider Plate and associated surgical technique, which have greatly enhanced the outcome of retrocalcaneal surgery.

Intraosseous lipoma of the calcaneus: a review and report of four cases.

Intraosseous lipomas have been reported as rare tumors in the lower extremity. They have been identified in the tibia, fibula, metatarsals, and calcaneus. They are frequently misdiagnosed as other tumors, especially unicameral bone cysts or aneutysmal bone cysts when found within the calcaneus. A detailed description of intraosseous calcaneal lipomas and their treatment is given. Surgical technique and four case reports are presented. One of the cases involved a pathologic calcaneal fracture, a finding to the authors' knowledge that has not been previously reported.