Treatment of malunion and nonunion at the site of an ankle fusion with the Ilizarov apparatus. J Bone Joint Surg Am
ABSTRACT Malunion and nonunion of an ankle fusion site are associated with pain, osteomyelitis, limb-length discrepancy, and deformity. The Ilizarov reconstruction has been used to treat these challenging problems.
We reviewed the results in twenty-one ankles that had undergone a revision of a failed fusion, with simultaneous treatment of coexisting pathologic conditions, with use of the Ilizarov technique. Eight patients had undergone ankle fusion only, eleven had undergone ankle and subtalar fusion, and two had undergone pantalar fusion. Eighteen patients with an average limb-length discrepancy of 4 cm underwent limb lengthening simultaneously with the revision surgery. The average patient age was forty years. Indications for treatment were malunion (eleven patients), aseptic nonunion (eight patients), and infected nonunion (two patients). Clinical, subjective, objective, gait, and radiographic analyses were performed after an average duration of follow-up of 83.4 months.
Solid union was achieved in all ankles. The functional result was excellent for fifteen patients, good for three, fair for two, and poor for one. The bone result was excellent for ten ankles, good for nine, fair for one, and poor for one. All eighteen patients who underwent gait analysis had a heel-to-toe progression gait, and twelve achieved normal walking velocity with their shoes on. A plantigrade foot was achieved in each case, and only two patients had >5 degrees of residual deformity. During the Ilizarov treatment, forty-one minor complications (treated conservatively) and twenty major complications (treated surgically) occurred. After removal of the circular frame, seven other complications, which required four additional operations, occurred.
In patients with a failed ankle fusion, infection, limb-length discrepancy, and foot deformity can be addressed simultaneously with use of the Ilizarov apparatus to achieve a solid union and a plantigrade foot, usually with a clinically satisfactory result.
- SourceAvailable from: Dror Paley
Article: Ankle arthrodesis.[Show abstract] [Hide abstract]
ABSTRACT: As a fused ankle provides a painless ankle joint with limited functional disability, ankle arthrodesis is still the treatment of choice for most disabling ankle arthritis. From January 1987 to December 1990, 45 cases of ankle arthrodesis were performed, including 27 male and 18 female patients, aged from 18 to 70 years with an average of 41.9 years. The causes leading to arthrodesis included 19 cases of post-traumatic arthritis, 3 rheumatoid arthritis, 7 osteoarthritis, 9 ankle infections (4 pyogenic and 5 tuberculosis), 4 ankle deformities, 2 avascular necrosis of the talus and 1 cases of Charcot joint. The methods included modified Blair's ankle arthrodesis (34 cases), compression arthrodesis (7 cases) either by Hoffman external fixation or triangular compression device, and intra articular arthrodesis by staple fixation (4 cases). The follow up period ranged from 17 Ms to 52 Ms with an average of 28.6 Ms. There were 2 cases who ultimately required amputation due to uncontrollable infection, and 2 cases of nonunion and one of them received refusion. There were 11 cases of delayed union (union time more than 6 Ms). The average union time was 5.6 Ms, ranging from 2 Ms to 10 Ms. Excluding the cases of amputation and nonunion, all patients had improvement in the ankle functional scale evaluation and 85.3% of the patients were satisfied with their present condition. The modified Blair's method of ankle arthrodesis has proven to be an effective method for treating ankle arthritis no matter what the cause. However, for cases of infection, compression arthrodesis with an external fixational device is superior.(ABSTRACT TRUNCATED AT 250 WORDS)The Kaohsiung Journal of Medical Sciences 10/1993; 9(9):524-31. · 0.61 Impact Factor
Conference Paper: Validation of thermoelectrics measurements. II[Show abstract] [Hide abstract]
ABSTRACT: This paper reports the joint effort of Marlow Industries (MI) and members of the Naval Research Laboratory (NRL) to test the usefulness of a carefully constructed conventional apparatus for measurement of the thermal conductivity of thermoelectrics. The design of the NRL apparatus takes into account the listed error sources, but is especially tailored to eliminate radiative exchange. This choice is driven by the fact that the instrument is most often used to measure the thermal conductivity of metals at high temperatures. We have found that as a consequence of using insulation to prevent radiation, the apparatus is not well suited for measurement of low thermal conductivity samples, such as standard thermoelectrics. The samples used as standard materials were taken from ingots grown at MI by a commercial method. The p-type ingot was grown from a melt of Sb<sub>150</sub>Bi<sub>50</sub>Te<sub>291</sub>Se<sub>9 </sub> plus a few percent of excess Te. The n-type ingot was grown from a doped melt of Bi<sub>20</sub>Te<sub>27</sub>Se<sub>3</sub>. With slight variations, these are the compositions used throughout the thermoelectrics industryThermoelectrics, 1996., Fifteenth International Conference on; 04/1996