Results of arthrodesis in neuropathic feet.

We describe the results of arthrodesis for the treatment of recurrent acute neuropathic bone disease in 24 feet and of chronic disease with deformity in 91 feet, undertaken between January 1984 and December 2003. All were due to leprosy. Correction of the deformity was achieved in 80 of 106 feet (76%) and fusion in 97 of 110 feet (88%). In the 24 feet in which recurrent neuropathic bone disease was the reason for surgery, 17 (71%) obtained stability while in seven (29%) symptoms recurred postoperatively. Complications were experienced following 58 of the 110 operations (53%). In patients presenting primarily with deformity with a minimum follow-up of two years (79 feet), there was a reduced frequency of ulceration in 40 (51%). Normal footwear could be worn by 32 patients (40%) after surgery, while 40 (51%) required a moulded insole. Arthrodesis of the ankle in the neuropathic foot due to leprosy has a good overall rate of success although the rate of complications is high.

[Leprosy surgery in a bush hospital in Africa: experience in Madagascar]. / La chirurgie de la lèpre dans un hôpital de brousse en Afrique: expérience à Madagascar.

We report our experience of leprosy surgery in terms of feasibility and efficacy in a small hospital of bush in Madagascar during the period of September 1989 to January 1993. Operations of neurolysis, corrections of claw hands by the techniques of Lasso-Zancolli or Van Droogenbroeck, arthrodesis, resections and amputations have been performed. Our results suggest that at least a part of these surgical procedures may be performed by a non specialized medical team, taught on the premises. Thus, the cost of treatment will be low and accessible to more leprosy patients.

Long-term follow-up of joint stabilization procedures in the treatment of fixed deformities of feet in leprosy.

This retrospective study of 52 patients, who underwent joint stabilization procedures for static deformities of the feet in leprosy between 1971 and 1985, was undertaken to asses the long-term results of joint stabilization of feet for fixed deformities in leprosy. The main purpose of joint stabilization is to make the feet plantigrade for weight bearing and to make the wearing of footwear possible. Deformities corrected include varus, equinus and equinovarus. Chronic ulceration occurs repeatedly if these deformities are not corrected and leads to inevitable bone destruction and eventual amputation.

Correction of severe foot deformities.

An arthrodesis between tibia and calcaneus was performed after extirpation of the lateral malleolus and the talus in 65 patients with severe stiff paretic feet in equinovarus position, 44 nonleprosy and 21 with leprosy. Early mobilization with weightbearing was allowed after 1 week. Bony fusion was achieved in 95% in the nonleprosy group and 76% in the leprosy group. The final appearance and function was very satisfying with a good range of motion in the Chopart joint.

The results of arthrodesis of the ankle for leprotic neuroarthropathy.

Twenty-four patients who had arthrodesis of one or both ankles for leprotic neuroarthropathy were followed for an average of nine years and five months. At operation, after the removal of cartilage, joint debris, and sclerotic bone, the ankle joint was transfixed with a Küntscher intramedullary nail, and staples or Kirschner wires were used to control rotation. Fusion of bone was obtained in nineteen (73 per cent) of the twenty-six ankles. Failure to obtain fusion was due to postoperative infection in four patients, deficiency of the site of arthrodesis in one patient, and refracture through the site of fusion in two patients. When arthrodesis was successful, additional neuroarthropathic destruction of the mid-tarsal joint was halted, and the preoperative clinical symptoms of dull pain, local warmth, swelling, and instability were relieved.

Use of intramedullary polypropylene peg for joint stabilization in leprosy.

Joint arthrodesis is indicated when motion in a joint cannot be restored, and that joint requires stabilization in an optimal functional position. The Harrision Intramedullary peg has been used to advantage for this purpose in hand reconstruction in leprosy in a renal developing area. It is a method to be considered for selected cases requiring joint stabilization to improve total hand function.