Bipartite talus: a case series and algorithm for treatment.

BACKGROUND: Bipartite talus is a rare condition of uncertain aetiology, with various treatment options described. METHODS: We report five symptomatic bipartite talus cases in four male patients warranting surgical management. All patients were reviewed by an independent assessor. RESULTS: The youngest patient presented with bilateral lesions without sub-talar arthrosis. He was treated twice by internal fixation with bone grafting. The left side failed to unite. The second patient presented with isolated sub-talar osteoarthritis. He underwent fragment excision and sub-talar arthrodesis with bone graft. The third patient presented aged 55 with severe hind-foot osteoarthritis, and underwent tibio-talar-calcaneal fusion. The final patient was treated with fragment excision and sub-talar arthrodesis. All patients reported symptom improvement or resolution post-operatively. Four cases showed evidence of radiographic union. CONCLUSIONS: We suggest a treatment rationale of fragment fusion if large enough, or excision if not, with associated limited fusion if the adjacent joints are markedly degenerate.

Survivorship of the bio-action metatarsophalangeal joint arthroplasty for hallux rigidus: 5-year follow-up.

BACKGROUND: Metatarsophalangeal joint arthroplasty is an accepted treatment for hallux rigidus. There are few reports of the long-term results of this procedure. METHODS: A series of 15 consecutive bio-action first metatarsophalangeal total joint replacements were retrospectively reviewed after a minimum follow-up of 5 years. The patients were assessed using the American Orthopaedic Foot and Ankle Society Score. Patient satisfaction and standard radiographs were also examined. RESULTS: Subjectively, just over half the patients were satisfied with the results of the surgery. Objectively, however mechanical failure of the implant was universal, as determined radiographically. DISCUSSION: Despite some success in relieving symptoms in patients, we have abandoned this procedure because of the high and increasing rate of failure, as demonstrated both clinically and radiologically.

Polytrauma in patients of 65 and over. Injury patterns and outcome.

In a consecutive series of 416 patients with multiple injuries, 49 were aged 65 years or older (mean age 72.1). This group of "old" patients was compared with the remaining 367 "young" patients (mean age 31.3). In the old patients group, survivors and non-survivors were profiled. In general the injured old patient was a pedestrian hit by a car or a motorbike or someone who had simply fallen at home. Despite the fact that the mean Injury Severity Score (ISS) was significantly lower in the old patients' group (33.2 versus 42.1) (p less than 0.001), the mortality rate was significantly higher (18% versus 7.6%) (p less than 0.05). We found that in the elderly injured the ISS and preexisting diseases were not predictive of survival. However, brain injury with unconsciousness and the need for early intubation followed by long-term assisted ventilation were predictive of survival (p less than 0.001). Seventy-six per cent of the survivors were able to return home again within six months. As the final outcome in the elderly is no worse after polytrauma than after other important emergency procedures, an aggressive treatment including urgent operative fixation of major fractures is in our opinion justified.

The Ilizarov external fixator for treatment of deformities in Paget's disease.

Paget's disease of bone may cause progressive bowing of affected femurs and tibiae. Fractures or osteotomies in these patients technically are difficult to treat and may lead to delayed union or nonunion. The authors report their early results with the use of the Ilizarov external fixator to affix 3 corrective closing wedge osteotomies, 1 fracture, and 1 delayed union. Deformities were corrected fully during the surgery, with an option to correct remaining deformation progressively during the rest of treatment. Compression of the healing bone was applied to enhance osseous healing, when necessary. Three-dimensional control is possible, and the stability of the fixation is excellent in this structurally weak bone. Bony union was achieved without complications in all patients within 4 months.