OKOJ, Volume 9, No. 9

Tibiotalocalcaneal Fusion: Indications and Techniques

Tibiotalocalcaneal fusion is indicated for patients in whom conservative bracing for conditions involving the ankle and subtalar joint has failed. The most common indications for tibiotalocalcaneal fusion are posttraumatic arthritis, in some cases with osteonecrosis of the talus; Charcot arthropathy of the ankle or hindfoot; and failed total ankle replacement. Use of an intramedullary rod in such cases provides strong internal biomechanical fixation with a load-sharing device. This paper describes the surgical technique for tibiotalocalcaneal fusion and discusses a number of factors relevant to this procedure. Most recent studies report success rates of approximately 90% with the use of tibiotalocalcaneal fusion for this complex group of patients.

    • Keywords:
    • tibiotalocalcaneal arthrodesis

    • TTC arthrodesis

    • tibiotalocalcaneal fusion

    • TTC fusion

    • intramedullary nail fixation

    • Charcot ankle fusion

    • Charcot neuroarthropathy

    • osteonecrosis of the talus

    • avascular necrosis of the talus

    • AVN of the talus

    • Subspecialty:
    • Foot and Ankle

HOT TOPIC: Intramedullary Nail Options for Tibiotalocalcaneal Fusion

Tibiotalocalcaneal (TTC) arthrodesis is a salvage procedure for pain and hindfoot deformity related to tibiotalar and subtalar joint disease, failed total ankle replacement, osteonecrosis of the talus, and Charcot neuroarthropathy. A variety of fixation options for TTC arthrodesis are currently available, including locking plates and screws, fixed-angle devices such as blade plates, external fixation devices, and retrograde intramedullary nails. With the evolution of retrograde intramedullary nails designed specifically for TTC arthrodesis, retrograde intramedullary nailing has emerged as a reproducible and reliable means of treating significant hindfoot deformities. This article reviews the surgical technique, nail design considerations, complications, and outcomes related to TTC fusion using a retrograde intramedullary nail.

    • Keywords:
    • tibiotalocalcaneal arthrodesis

    • tibiotalocalcaneal fusion

    • TTC arthrodesis

    • TTC fusion

    • retrograde tibiotalocalcaneal arthrodesis

    • retrograde TTC fusion

    • retrograde intramedullary nailing

    • retrograde intramedullary nail arthrodesis

    • hindfoot arthrodesis

    • hindfoot fusion

    • Subspecialty:
    • Foot and Ankle

Lateral Elbow Tendinopathy

Lateral elbow tendinopathy is a common tendinopathy with a characteristic patient presentation but a poorly understood pathophysiology and treatment rationale. Many nonsurgical and surgical modalities have been described for the treatment of lateral elbow tendinopathy, but recent evidence suggests that this is a self-limited disease that should initially be treated supportively. For patients who fail nonsurgical treatment, percutaneous, open, and arthroscopic surgeries have been described. Despite the evidence for eventual resolution, the functional impairment of patients with lateral elbow tendinopathy can be substantial, and an understanding of the options for treatment is critical for patient care and education.

    • Keywords:
    • lateral epicondylitis

    • tennis elbow

    • epicondylitis lateralis humeri

    • lateral elbow pain

    • lateral epicondylosis

    • tendinosis of the extensor carpi radialis brevis

    • diagnosis

    • management

    • nonsurgical treatment

    • surgical treatment

    • Subspecialty:
    • Hand and Wrist

Cervical Spine Abnormalities in Children

The early recognition and management of congenital cervical spine disorders is important in preventing the neurologic compromise that can occur as a result of instability or stenosis. Understanding of the anatomy and development of the pediatric cervical spine is imperative for the evaluation of these conditions. In this article we review the developmental anatomy and radiographic assessment of the immature cervical spine. Common upper cervical spine anomalies including basilar invagination, occipitalization of the atlas, dysmorphic atlas, odontoid anomalies, spinal stenosis, and segmental instability are reviewed. We also outline specific congenital syndromes that commonly involve the cervical spine, such as Klippel-Feil syndrome, Down syndrome, and skeletal dysplasias. The clinical presentation of these conditions and their management, including newer techniques of surgical fixation, are discussed.

    • Keywords:
    • cervical spine

    • cervical spine abnormalities

    • atlanto-occipital fusion

    • basilar invagination

    • odontoid anomalies

    • atlas-dens interval

    • congenital aplasia of the atlas

    • congenital hypoplasia of the atlas

    • torticollis

    • Down syndrome

    • atlantoaxial rotatory displacement

    • Klippel-Feil syndrome

    • skeletal dysplasia

    • Subspecialty:
    • Pediatric Orthopaedics