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Purpose of the Study: Osteoarthritis (OA) of the joints of the hand is one of the most common musculoskeletal disorders in the elderly population. It is a complex, degenerative disease affecting all components of the joint. Surgical treatment is indicated when conservative therapy fails. The ultimate solution is arthrodesis of the distal interphalangeal (DIP) joint. Various methods of arthrodesis have been described, ranging from the use of K-wires or compression screw to different types of intra-articular (intramedullary) implants. The aim of this study is to evaluate the surgical outcomes of arthrodesis of the distal interphalangeal (DIP) joint of the fingers using intramedullary implants., Material and Methods: Since 2011, arthrodesis of the distal interphalangeal joint using an intramedullary implant has been performed at our department 97 times in total, in 59 patients. 9 patients (15 cases of arthrodesis) were excluded from the study group due to their failure to complete the questionnaire, 1 female patient died. In the final group, 82 cases of arthrodesis in 49 patients (47 women, 2 men) were evaluated. In 72% of cases, the surgery was performed on the dominant hand. The mean age at the time of surgery was 58 years (median 59 years). The patients were indicated for surgery after the failure of all conservative treatment options. In addition to radiographs, also the hand function and pain were assessed based on the preand postoperative DASH score questionnaires., Results: The surgical outcomes for all implants are satisfactory. In all 82 patients, the surgical wounds healed per primam. In one case, implant extraction was performed due to infection. Another complication was an unhealed fusion and formation of a non-union with minimum pathological mobility (the patient is satisfied with the outcome). In three patients, a fracture at the base of the distal phalanx was observed on postoperative radiographs, which fully healed within 3 months after surgery. The mean DASH score decreased from 41.95 preoperatively to 14.93 postoperatively. The mean time to healing of the arthrodesis observed on radiographs was 9.1 weeks., Discussion: Currently, there are many different types of arthrodesis of the distal interphalangeal joint of the hand. Each method has its pros and cons. Arthrodesis using an intramedullary implant has the advantages of the older methods while minimizing postoperative complications. Our results are comparable to those reported in the foreign literature., Conclusions: Based on the evaluated outcomes, arthrodesis of the distal interphalangeal joint using an intramedullary implant can be considered valid. It definitely deserves to be included in the portfolio of surgical treatment of osteoarthritis of the DIP joints of the hand. According to our observation, the differences between various types of implants are minimal and their outcomes are comparable to those reported in foreign publications. The pain relief, restored finger function and fusion rate are comparable to, if not better than, those achieved by the older surgical methods. The advantage of this method is mainly easier implantation, fewer complications, and the possibility of implantation without the use of an X-ray image intensifier, which ultimately reduces the cost of surgery. The main disadvantage is the higher purchase price of the implant., Key Words: osteoarthritis, distal interphalangeal joint, arthrodesis.

PURPOSE OF THE STUDY The authors focused on the topic of tibiotalocalcaneal arthrodesis. It is a surgical procedure used to manage severe comprehensive ankle and hindfoot pathology. The scope of surgery and the negative impact on the walking stereotype are offset by preserving a weight-bearing and pain-free limb. The purpose of the study was to evaluate the group of patients who had undergone surgery at the First Department of Orthopaedic Surgery, St. Anne s University Hospital Brno and to identify the most suitable fixation for arthrodesis. It also aimed to compare the outcomes achieved by the authors with those reported by other departments. MATERIAL AND METHODS The group included patients operated on at the authors department between 2011 and 2021. The surgery was indicated in patients with severe concomitant arthritis of the upper and lower ankle, complex hindfoot instability, Charcot arthropathy. Contraindications included acute infection, decompensated diabetes and heavy smoking. The study compares fixation using a lateral plate, a retrograde nail and a retrograde nail with fibula acting as biological plate. The patients were scored preoperatively and postoperatively using the AOFAS Ankle-Hindfoot Score. Statistical analysis of the results was also carried out. RESULTS The group included 23 patients, of whom a lateral plate was opted for in 7 patients, a retrograde nail in 8 patients and a retrograde nail with fibula used as a biological plate in 8 patients. The patients of the group were followed up for the period ranging from 0.5 to 9 years after surgery. Serious complications were observed by the authors in 6 patients of the group. The failure of osteosynthesis material was reported in 2 cases with lateral plating fixation. A stress fracture above the apex of the nail developed in 2 cases. A serious infection was observed by the authors in 1 patient. The method associated with the lowest incidence of complications was the fixation with a retrograde nail and fibula used as a biological plate. DISCUSSION The forms of fixation for tibiotalocalcaneal arthrodesis have recently advanced considerably, the methods of fixation for arthrodesis in particular. The modern implants enable to compress the individual structures, to provide stable fixation and potentially to avoid long-term plaster cast fixation. Nonetheless, these surgical procedures are associated with a high complication rate. Currently, there is no consensus in international studies on the optimal fixation for arthrodesis. Numerous papers describe complications including postoperative infections, failure of osteosynthesis material and fractures close to osteosynthesis material. The number and the type of complications observed by the authors in their group of patients were similar to those reported by other authors. CONCLUSIONS Tibiotalocalcaneal arthrodesis is a surgical procedure reserved exclusively for patients indicated based on strict criteria and should be performed by an experienced team able to cope with potential complications. In the followed-up group of patients, the optimal method of fixation for arthrodesis appeared to be the fixation with a retrograde nail and fibula used as a biological plate. Key words: tibiotalocalcaneal arthrodesis, retrograde nail, lateral ankle plate, ankle instability, ankle arthrosis, biological plate.

PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.

PURPOSE OF THE STUDY The authors in their paper evaluate a group of patients who underwent arthrodesis of the first metatarsophalangeal joint using a locking plate. MATERIAL AND METHODS In the period 2010-2015, we performed surgery in 51 patients (56 forefeet), of which in 5 cases bilaterally and in 46 cases unilaterally, in 38 women and 13 men. The mean age was 57.8 years, the mean follow-up was 3.1 years. The indications for surgery were hallux rigidus in 23 patients, hallux valgus in 15 patients, hallux varus in 3 patients, and hallux erectus in 2 patients. In 4 patients the surgery was performed for valgus deformity associated with rheumatoid arthritis, 9 patients were indicated for a failure of the prior surgical intervention. In all 56 forefeet, the anatomic, low-profile titanium plate Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7 was used. RESULTS According to Gainor s score the surgical outcomes were assessed as excellent in 46 patients who underwent surgery (90%), good in 4 patients (8%), fair in 1 patient (2%), and poor in 0 patient (0%). In 53 forefeet, the control radiographs showed solid bone union. In 2 patients and 3 forefeet, non-union of the arthrodesis occurred. In 2 forefeet, revision arthrodesis was performed, after which solid bone union followed. Malpositioned union was reported in 5 forefeet, of which in 4 cases into valgosity and in 1 case into dorsiflexion. DISCUSSION Numerous fixation materials can be used for arthrodesis of the first metatarsophalangeal joint. The use of the least stable Kirschner wires (cerclage) is being abandoned and substituted with a more stable fixation by screws, memory staples and locking plates. The achievement of excellent results requires proper positioning of the arthrodesis. Impingement syndrome between the big toe and the second toe can result in painful callosities formation, too large dorsiflexion can lead to a hallux hammertoe, with reduced big toe support function, to metatarsalgia. CONCLUSIONS The arthrodesis is indicated in patients with Grade III and IV hallux rigidus, with severe hallux valgus, hallux varus, and in patients in whom the previous surgeries failed. We tend to prefer stable arthrodesis. Fixation by anatomic LCP plate facilitates early rehabilitation, loading and early return to work and sports activities. Key words: arthrodesis, metatarsophalangeal joint, hallux rigidus, hallux valgus.

Purpose of the Study: The aim of the study was to compare results of the Burton-Pellegrini trapeziectomy with ligamentoplasty using the flexor carpi radialis tendon with those of trapeziometacarpal joint replacement in the treatment of advanced rhizarthrosis., Material and Methods: A group of 17 patients, 15 men and two women, underwent trapeziectomy with ligamentoplaty; in 12 of them, the dominant hand was involved. The trapeziometacarpal joint prosthesis Beznoska was implanted in 11 patients (10 men and one woman) with seven dominant and four non-dominant hands. All patients pre-operatively experienced pain during thumb movement and hand grip. They were examined before surgery and at 3, 6 and 12 months after it; the values obtained before and at 1 year after surgery were compared. The methods of evaluation included pain intensity assessed using the visual analogue scale (VAS), the Kapandji thumb opposition test and the disabilities of the arm, shoulder and hand (DASH) score (total DASH score and its thumb-targeted module)., Results: In the group treated by the Burton-Pellegrini procedure, the average pre- and post-operative Kapandji scores were 6.4 and 8.9, respectively. The average VAS scores were 5/10 pre-operatively and 1/10 post-operatively. The average values for the total pre- and post-operative DASH scores were 58 and 19 points, respectively. The DASH score in a thumb-targeted module assessing basal joint-loading in the thumb was 63 points before and 21 points after surgery. In the patients with total joint replacement, the average pre- and post-operative values were as follows: Kapandji score, 7.4 and 9.8; VAS score, 5/10 and 1/10; total DASH score, 56 and 7 points; thumb module DASH score, 60 and 11 points. Two serious complications were recorded, an infection in resection interposition arthroplasty and a trauma associated with total joint replacement loosening. Four patients showed transient paresthesia., Discussion: Several methods for surgical treatment of rhizarthrosis are available today. Arthrodesis is still a widely used procedure although it inhibits thumb movements. Resection arthroplasty provides sufficient pain-free thumb motion, but radial shortening and a loss of grip strength are its disadvantages. Resection interposition arthroplasty results in sufficient painless motion. Tendon interposition provides enough stability for the thumb and for sufficient grip and pinch strength. The disadvantages of this method include a potential for failure of the suspensory tendon during over exercising or a weakened attachment of the autologous tendon to the bone and thus a risk of rupture. Total joint replacement respects the thumb anatomy, preserves the articular capsule and fibrous structures during conservative resection of joint surfaces and keeps the biomechanics of the basal joint of the thumb. It combines advantages of the other surgery procedures, by allowing for a painless range of motion in the joint and vital pinching and gripping abilities, while avoiding their disadvantages such as movement restriction and loss of grip strength. However, the technique may still bear any of the risks associated with foreign material implantation (dislocation, replacement failure, infection, etc.)., Conclusions: The two techniques present valuable contributions to the treatment of advanced rhizarthrosis. In our patients, better outcomes are shown in trapeziometacarpal joint replacement though, in comparison with resection interposition arthroplasty, the indication criteria for this surgery are limited by factors such as the height of the trapezium bone and bone quality necessary for good osseointegration.

Unlabelled: PURPOSE OF THE STUDY The aim of the study was to evaluate, on the basis of radiographic findings and AOFAS scores, the results of the Grice extra-articular subtalar arthrodesis for treatment of planovalgus foot deformity in cerebral palsy patients. MATERIAL AND METHODS A total of 38 patients (50 feet) with cerebral palsy indicated to the Grice procedure for planovalgus foot deformity between 2006 and 2010 were assessed. The group comprised 18 girls and 20 boys, of whom 10 had spastic quadriparesis (four undergoing bilateral surgery), three had triparesis, four had hemiparesis and 21 had diparesis (treated on both sides in eight). The average age at surgery was 12 years (range, 7 years and 2 months to 17 years and 8 months). All patients were evaluated based on the AOFAS scoring system and radiographic findings before and after surgery. RESULTS The average follow-up was 4.5 years. The average AOFAS score increased from 54.9 points pre-operatively to 76.6 points post-operatively. The pre- and post-operative average values for the talocalcaneal angle were 49.8° and 25°, respectively; for the calcaneal inclination angle they were 8.6° and 13.4°, respectively. DISCUSSION The Grice procedure has long been considered a primary surgical treatment for planovalgus foot deformity in patients with cerebral palsy. Recently, calcaneal osteotomy has been used more frequently, but with no evidence of provably better results. CONSLUSIONS The mid-term results of the Grice extra-articular arthrodesis in our group of cerebral palsy children were very good in terms of both radiographic and AOFAS score evaluation; the latter includes objective assessment as well as the patient's subjective evaluation., Key Words: Grice procedure, extra-articular subtalar arthrodesis, cerebral palsy, planovalgus foot deformity.

Purpose of the Study: The aim of the study was to clinically and radiographically evaluate the results of a two-stage surgical technique used in our department to treat congenital vertical talus., Material and Methods: In the years 1990-2010 we treated eight patients (nine feet). We used a two-stage surgical technique, with lengthening of the dorsiflexor muscles of the leg and the tibialis anterior muscle at the first stage. This was followed by cast fixation with the ankle in plantar flexion for 6 weeks. At the second stage, through a Cincinnati approach, the talonavicular and calcaneocuboid joints were reduced and the Achilles tendon and peroneal tendons were elongated. Two patients underwent the Grice extra-articular subtalar arthrodesis at the third stage. The post-operative outcomes were assessed based on radiographic findings of dorsoplantar views of the talocalcaneal angle (TC AP) and talar axis-first metatarsal base angle (TAMBA AP), lateral views of the weight-bearing talocalcaneal angle (TC LAT), talar axis-first metatarsal base angle (TAMBA LAT) and talotibial angle (TT). In all patients but one who was lost to follow-up, the radiographic and objective findings were evaluated with the 10-point scale described by Adelaar et al., Results: The average follow-up was 8 years and 9 months. All radiographic findings showed improvement in all angles measured. The pre-operative values decreased in TC AP from 64.2° to 27.6°; in TC LAT from 48.8° to 30.4°; in TT from 158° to 109.3°; in TAMBA AP from 54.7° to 17.4°; in TAMBA LAT from 57.3° to 5.7°. The Adelaar scoring system was employed in seven patients of whom three had excellent, three good and one fair results. Two patients required additional surgery due to recurrence of the deformity, Discussion: Studies in recent years have shown a gradual diversion from extensive surgical procedures and a trend toward techniques like manipulation, serial casting application and minimal surgical intervention with talonavicular reduction and fixation. The Dobbs technique has so far shown good results but no long-term results have yet been available and therefore the number of recurrent cases is not known., Conclusions: The two-stage surgical technique used in our department proved to be very successful in a long-term follow-up, but the group of patients was too small to provide conclusive evidence. However, benefits of this technique are clearly apparent from the post-operative radiographic and objective findings assessed as very good.

Purpose of the Study: Arthrodesis of the trapeziometacarpal joint is the method of choice in the treatment of degenerative arthritis of this joint. This procedure was indicated most frequently in middle-age patients doing hard manual labor. Methods for achieving a solid fusion of the trapeziometacarpal joint are known and often reported in the literature. Frequently, they are associated with some failure rate, particularly as concerns bone union. Our study presents a simple and effective method verified in cadaver specimens and then currently used at our department., Material and Methods: The procedure for arthrodesis of the trapeziometacarpal joint was verified fist in fixed wrist and hand specimens at the Institute of Anatomy, 1 st Faculty of Medicine, Charles University in Prague. If the original shape of the basal thumb joint between the trapezium and the metacarpal is maintained, it allows for correct reduction and subsequent arthrodesis in a required position. In patients, surgical treatment included the use of implants, two DePuy shape-memory staples, which facilitate sufficient fragment compression and provide stable fixation. The staples were inserted in pre-drilled and gauged tunnels in the body of the trapezium and in the proximal metaphysis of the fist metacarpal., Results: Between 2011 and 2014, the procedure was used in 14 patients diagnosed with primary arthritis of the trapeziometacarpal joint. The group comprised nine women and five men, the average age was 52 years and the range was 44 to 69 years. Surgery was most frequently carried out on the dominant upper extremity (85%); there was no bilateral surgery. The average follow-up was 18.3 months (range, 5 to 39 months). Solid fusion was recorded at 7 weeks after surgery in all patients except for the one still treated at the time of this paper submission. All patients were free of pain, ten reported satisfaction with grip strength and hand function, the rest would have preferred improvement in fine motor skills of the thumb. All of them found the cosmetic appearance of the hand satisfactory.., Discussion: The methods generally used for trapeziometacarpal joint arthrodesis are reported to carry some risk of pseudarthrosis development. A lot of modifications have been described, from conventional procedures using AO lag screws or Kirschner wires to up-to-date plate systems involving angle-stable fixation. Total fusion of the trapeziometacarpal joint is disputable in patients with rheumatoid arthritis from the technical point of view as well as the relevance of indication criteria. Some authors consider this procedure a contraindication for patients with rheumatoid arthritis. The use of joint replacement in treating trapeziometacarpal joint arthritis is another complex issue., Conclusions: An arthrodesis of the trapeziometacarpal joint based on careful assessment of indication criteria proved to be a simple, effective and low-cost method of stable osteosynthesis that provided good conditions for solid fusion of the trapezium with the base of the fist metacarpal. It allowed for sufficient abduction and opposition of the thumb, thus permitting satisfactory hand grip strength and full involvement in everyday life activities and occupations. It provided stability of the thumb, its painless movement and good cosmetic looks.

Purpose of the Study: The aim of this study is to compare functional and X-ray results before and after four-corner arthrodesis using an angular stable dorsal circular plate in patients with post-traumatic degenerative changes of the wrist., Methods: Nine consecutive patients with scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) of the wrist, stage III, underwent scaphoid excision and four-corner fusion using angular stable plate fixation. The wrists were immobilised using a split for two weeks and then a removable wrist brace with assisted physiotherapy for four weeks. Minimal followup was 18 months. Clinical assessment before and after surgery included the wrist range of motion (ROM), grip strength, presence of pain, disabilities of the arm, shoulder and hand (DASH) scores, and radiographic findings of the carpal height and ulnar translation ratios. Differences were statistically tested. In addition, patients' satisfaction with functional outcomes was evaluated., Results: In the post-operative period the patients experienced less pain during daily activities and had a better carpal height ratio than before surgery; these differences were statistically significant. In the other criteria, although showing better post-operative results, improvement was not statistically significant. Eight patients were satisfied with the final outcome. One patient required limited denervation of the wrist for pain relief. There was no non-union. DISCUSSION The functional outcomes (ROM, grip strength) in our patients at follow-up were fully comparable with the previously published studies. Although, by most postoperative treatment protocols, physical therapy is started at four to eight weeks of rigid fixation of the wrist, no non-union was found in our group of patients who had a shorter period of post-operative fixation., Conclusions: Four-corner arthrodesis of the wrist using angular stable dorsal circular plate fixation provides pain relief with acceptable preservation of the range of motion and no consolidation problems. Long-term follow-up and a larger group of patients would be necessary to confirm these hopeful results.

Introduction: Chronic osteomyelitis is a serious chronic condition that frequently results in permanent after-effects. Treatment is complex, lengthy and costly., Material and Methods: Between the beginning of 2003 and the end of 2010, 438 operations of the proximal humerus were performed at our department using either angle-stable osteosynthesis or hemiarthroplasty. In four cases out of this group of patients, deep tissue infection affecting the bone developed. These four patients were treated with arthrodesis of the shoulder joint using an external fixation device. Arthrodesis was also the treatment method in a patient who previously received conservative treatment but developed chronic osteomyelitis., Results: Healing of the infectious focus along with the formation of stable, painless shoulder was achieved in all five patients, with the arthrodesis offering full support for the limbs periphery., Conclusion: The above method represents an alternative to reverse arthroplasty of the shoulder joint usually performed after infection is cured. While function of the limb usually worsens after arthrodesis, the risk of recurring inflammation is substantially lower.

Purpose of the Study: When the talus and the talocalcaneal joint are both affected, their fusion is the method of treatment. Ankle arthrodesis is carried out using various osteosynthetic materials such as external fixators, screws and plates. One of the options is retrograde nailing. Tibio-talo-calcaneal arthrodesis is frequently indicated in patients with rheumatoid arthritis (RA) in whom both the talus and the subtalar joint are often affected., Material and Methods: A retrograde nail for tibio-talo-calcaneal arthrodesis was developed at our department in cooperation with MEDIN Company. This is a titanium double-curved nail, with the distal part bent at 8 degrees ventrally and 10 degrees laterally. It is inserted from the transfibular approach., Results: Sixty-two patients, 35 women and 27 men, were treated at our department from 2005. Since one patient had bilateral surgery, 63 ankles were included. The indications for arthrodesis involved rheumatoid arthritis in 42, post-traumatic arthritis in 10, failed ankle arthrodesis in two and failed total ankle arthroplasty in five ankles; tibial stress fractures close above the ankle in two RA patients, one patient with dermatomyositis and one with lupus erythematodes. The average age at the time of surgery was 64.2 years (range, 30 to 80). The average follow-up was 4.5 years (range, 1 to 9 years), Satisfaction with the treatment outcome and willingness to undergo surgery on the other side were reported by 82% of the patients. The AOFAS score improved from 35 to 74 points. Three (4.8%) patients complained of painful feet due to the fact that exact correction of the calcaneus was not achieved and the heel after arthrodesis remained in a slightly varus position. Of them, two had a failed total ankle arthroplasty. Post-operative complications included early infection managed by antibiotic treatment and early surgical revision with irrigation.in two (3.2%) RA patients, who were undergoing biological therapy. Late infection developed at 2 to 3 years after surgery in three (4.3%) patients (two had RA). The infection was managed by revision surgery with nail removal and irrigation. All patients healed well. Necrosis of the talus and development of a pseudoarthrosis were recorded in four (6.4%) patients, who subsequently underwent nail removal and repeat fusion using an external fixator., Discussion: Retrograde nailing for tibio-talo-calcaneal arthrodesis is used by many authors. Its complication rate is comparable with the other methods of arthrodesis., Conclusions: The use of tibio-talo-calcaneal arthrodesis aims at a painless and stable joint. Arthrodesis of the talus and the subtalar joint using a retrograde nail is an effective surgical treatment of the joints affected. It is especially recommended for RA patients who have severe deviations. Retrograde nailing provides a stable osteosynthesis which does not require plaster cast immobilisation. The double-curved nail allows for its insertion in the solid part of the calcaneus and helps avoiding injury to the neurovascular bundle.

Purpose of the Study: To present the results of surgical treatment of carpometacarpal joint arthritis of the thumb, using cannulated screw fixation which is stable and, after bony union, allows the patient to do also harder manual work, Material: In the years 2000 to 2005, this method was used for 20 operations in 18 patients (16 women and two men); one man and one woman had bilateral surgery. The right hand was operated on in seven cases and the left one in 13 cases. The average age of the patients was 61 years., Methods: The procedure was performed from the dorsoradial approach, access to the joint was gained between the extensor pollicis brevis and abductor pollicis longus tendons, and care was taken to protect the superficial branch of the radial nerve. The articular surface of the trapezium bone and the first metacarpal base including osteophytes were resected and arthrodesis was carried out by means of a 4.5 mm cannulated screw. The final position of the thumb axis was at 40 degrees to 45 degrees palmar abduction, 20 degrees to 25 degrees extension and 10 degrees to 15 degrees pronation. A plaster hand splint was applied for 6 to 8 weeks post- operatively. The patients were capable of full use of the hand at 3 months after surgery., Results: Evaluation included a pain scale of 1 to 5 grades, range of motion, reduction of muscle strength and fine motor function. All operative wounds healed by first intention, no infection or neurological complications were recorded. Primary union was achieved in 18 cases, two developed pseudoarthrosis. The patients reported improvement on the pain scale by 2 grades on average. However, in thumb opposition tasks, the range between the tip of the thumb and the fifth metacarpophalangeal joint decreased on average by 20 mm. Fourteen patients reported deterioration of fine motor function. All patients were satisfied with improved muscle strength enabling them to do more demanding physical work., Discussion: The results of carpometacarpal joint arthrodesis by means of a cannulated screw are comparable with those of arthrodesis using other implants. The final thumb position is discussed as well as the use of suitable fixation material in order to prevent pseudoarthrosis. Issues such as the use of interpositioned tissue, shortening of the radial column and the resultant limited muscle strength in resection arthroplasty, and the choice of a most suitable implant and possibility of its failure in alloplasty are also discussed., Conclusions: Arthrodesis with cannulated screw fixation is best for treatment of the carpometacarpal joint of the thumb with stage III rhizarthritis (Eaton classification). It results in an axis-stable thumb that is pain free and capable of physical activity and firm grip.

Purpose of the Study: To evaluate our experience with the use of a retrograde nail locked in the sagittal plane for tibiotalocalcaneal arthrodesis indicated in severe post-traumatic arthritis of the ankle., Material: Twenty patients, 16 men and four women at an average age of 58.7 years (range, 23 to 72) were evaluated. All patients had severe post-traumatic changes in the talocrural and talocalcaneal joints. Five patients also had an equinus deformity. In two patients arthrodesis followed the treatment of purulent arthritis of the talocrural joint. A local fasciocutaneous flap was used for soft tissue reconstruction in three patients. All patients were operated on using the standard surgical technique. METHODS With the patient in a supine position, reamed by hand with the use of a driving rod, a straight retrograde AAN Orthofix nail was inserted through the heel bone and talus into the distal tibia and locked in these bones in the sagittal plane., Results: No complications such as injury to the neurovascular plexus or pseudoarthrosis were recorded. Four patients showed a reaction to the proximal locking screw on the proximal tibial surface, which was treated by earlier screw removal under topical anaesthesia. Due to infectious complications, the nail had to be removed prematurely in one patient. The average Foot Function Index was 12 points (range, 10 to 15) and the average ankle-hindfoot score was 67.6 points (range, 59 to 84). Thirteen patients (65 %) were not limited in their daily activities or recreational sports, six (30 %) experienced pain in sports but not daily activities and one patient (5 %) reported pain even when walking. All fusions healed in the correct position within 18 weeks., Discussion: Tibiotalocalcaneal arthrodesis is not a frequent surgical procedure in either trauma surgery or orthopaedics. For this complicated procedure, rather than intramedullary nails, internal fixation with screws or plates or external fixation are preferred. The high rate of bony healing can be explained by maintenance of exact nail locking in the sagittal plane. The antero- posterior approach provides a more secure locking in the bone and assists in neutralizing sagittal forces at the site of arthrodesis. The use of reamed interlocking nails can therefore be accepted not only for treatment of long-bone fractures, but also for treating pseudoarthrosis and in complicated or failed arthrodesis., Conclusions: Patients' satisfaction is the primary goal we strive to achieve in severe post-traumatic conditions of the talus and foot. Repeat surgery, spongioplasty, external fixation revision for pin-tract infection, persistent pain, activity restriction and poor clinical results reduce patients' satisfaction. In our group, the rate of healed arthrodesis was high and the number of complications was low, therefore our patients' satisfaction was high.

Purpose of the Study: Arthrodesis of the carpometacarpal (CMC) joint of the thumb is an option for treatment of degenerative and post-traumatic conditions affecting the CMC thumb joint. This procedure is indicated most frequently in patients with primary or secondary stage III rhizarthritis (by the Eaton classification of basal joint arthritis) of idiopathic, rheumatic or post-traumatic etiology. Patients with multidirectional CMC instability, usually traumatic in origin, undergo this surgery only occasionally. In our institution, the treatment is based on the Carroll technique., Material and Methods: Between 1990 and 2005 a total of 14 arthrodeses of the CMC joint of the thumb were performed in 12 patients. The Carroll technique used in all cases involved a conical shaping of the first metacarpal base and a corresponding shaping of the trapezium articular surface, their subsequent set-up and fixation with Kirschner's wires. The patients were assessed for the presence of pain, changes in mobility and muscle strength before and after surgery. The comprehensive evaluation of the whole group was carried out by means of the Cooney score., Results: Arthrodesis resulted in complete union of the CMC joint of the thumb in all cases. The patients were followed up for 5 years on average. The initial painful hand grip subsided in most of them. The initial restriction of motion remained, but was painless in almost all cases. However, broad grip strength improved on average by 35 %. The comprehensive Cooney score showed 64 % of excellent and very good results., Discussion: All characteristics of the patient group and the results achieved by this technique, including the Cooney score evaluation, are discussed. It is concluded that this technique is indicated particularly in middle-aged male patients with stage III rhizarthritis (Eaton classification) who do hard manual work, and in whom rhizarthritis of the other thumb joints can be excluded. Also, unstable CMC joints are indicated for this treatment. The resulting position of arthrodesis and methods of joint fixation are discussed. Different methods of osteosynthesis and their advantages are described. From a comparison with the relevant literature results it appears that the absence of postoperative pseudoarthrosis, a marked reduction of grip pain, improvement of grip strength and the values of Cooney score are encouraging results of arthrodesis for the CMC thumb joint performed by the Carroll method., Conclusions: It is concluded that the Carroll arthrodesis is an effective technique which, if correctly indicated, alleviates pain, restores the axis of the thumb and, consequently, its stability necessary for thumb function in achieving a hand grip.

Purpose of the Study: The indications for arthrodesis of interphalangeal joints include pain, instability, deformity or irreparable damage to the relevant flexor or extensor tendon. The general principle of arthrodesis is to resect the affected joint ends in the flexion desired so that a highest possible surface of contact may be provided. Subsequently, retention by means of internal or external fixation is performed. The aim of this study is to evaluate our method of interphalangeal joint arthrodesis, using an external frame fixator, to present the results and to point out the advantages of this method, thus showing its applicability for relevant surgical indication., Material: Arthrodesis by external fixation was carried out in 37 patients. The group included 21 men and 16 women at an average age of 49.6 years (range, 30 to 67 years). The method was used in the patients who differed in the etiology of lesions of interphalangeal joints. Twenty-two patients had previously experienced purulent arthritis, six had post-traumatic arthritis and joint instability, five had rheumatoid arthritis, two had primary arthritis and two had an inveterate rupture of the extensor aponeurosis., Methods: We used a simple frame fixator whose stability was based on two to four Kirschner's wires inserted and maintained in clamps on rods, 4 cm or 7.5 cm long, each having a double anti-clockwise thread that facilitates compression, distraction and correction in one plane. The surgical procedure was carried out under axillary block with the use of a tourniquet. It involved making an S-shaped incision dorsally, severing the extensor apparatus, resecting articular surfaces in the desired flexion position, inserting parallel wires and fixing them in clamps on rods, achieving compression, checking the position of articular surfaces and suturing. Included in the group assessment were the gender and age of the patients, etiology of articular disease, number of the digits and joints affected, limb laterality, wound healing, stability of fixation, maintenance of a correct arthrodesis position and signs of healing on X-ray images. Time required for bony union and the shortening of the digit due to surgery were also included in the evaluation., Results: The 35 followed-up patients showed healing of the wound and arthrodesis, with firm bony union being achieved at an average of 6.7 weeks. In one patient after removal of the fixator, septic pseudoarthrosis developed at the site of the resected distal interphalangeal joint. Another patient developed ischemia of the distal phalanx of the thumb treated, which required release and subsequent removal of the external fixator, with vasodilatation therapy. After a prolonged topical therapy, painless fibrous ankylosis developed in that interphalangeal joint and the thumb was salvaged., Discussion: The aim of arthrodesis is to achieve firm and painless bony union in a correct functional position at a reasonable time. Arthrodesis in our patients healed at an average time of 6.7 weeks. The high effectivity of the compression technique in achieving firm bony fusion is the factor emphasized in the literature, particularly in situations where there is a reduced contact surface, poor coverage by soft tissue, infection or the presence of a systemic disease, such as rheumatoid arthritis or diabetes mellitus. This all is in agreement with the results of this study., Conclusions: This study shows advantages of the compression technique of arthrodesis by means of external frame fixation based on insertion of wires beyond the site of inflammation. Compression and stability result in rapid osseous union, immobilization in plaster cast is not necessary, free joints of the hand can be exercised, the fixator is removed in an outpatient department and the minimal presence of metal material does not interfere with good healing of soft tissues. Therefore this method has all merits to be used for surgery in a terrain affected by rheumatic, inflammatory or potentially inflammatory lesions.

Purpose of the Study: Total arthrodesis of the carpal joint is a complex operative procedure that results in the restoration of joint stability in frontal and sagittal planes and improvement in function of the tendons of digits' extensors and flexors. We developed our own method based on the use of a special implant; in this study we report our long-term results., Material: Since 1992 we have carried out 54 total carpal arthrodeses, using our method, on 51 patients; three patients were treated bilaterally. Both wrists were treated in. This group comprised 34 women and 19 men, with the average age of 47.6 years. We used the modified method mainly in patients with stage IV rheumatic carpal destruction (Larsen classification) or in those with wrist destruction due to arthritis or psoriasis. In two patients, this method was indicated because of a non-reparable lesion of the nervus radialis. It was also used in two patients who had their wrist replacements removed due to failure., Methods: The procedure was carried out, with a tourniquet applied to the upper arm, from the dorsal approach to the carpal joint. After opening the capsule, using an oscillating saw, we resected the facies articularis radii, the carpal bones, which were freed from cartilage and turned into a cancellous in situ filling, and the distal ulna. This procedure prepared the operation field for the application of our plate. This L-shaped plate, only 2 mm thick, with its concave curve fitting the palm, allows for three-point fixation of the metacarpal region and also maintains slight compression., Results: In all the patients, we achieved osseous fusion detectable by radiography and clinical examination on average at 12 weeks postoperatively. The grasping function of the hand improved in all patients because the carpal axis was adjusted to a functionally convenient position. The resection of the distal ulna, which is a part of our method, removed pain caused by supination or pronation. The patients reported the absence of pain, instability and edema of the wrist., Discussion: The aim of any method for total wrist arthrodesis is the firm fixation of resection-treated articular surfaces of the radius, carpal bones and metacarpal bases for a period long enough to allow for their complete fusion. These techniques involve intraosseous procedures, the use of plates, osteorrhaphy and external fixation. Most of these methods use massive corticocancellous grafts collected from the hipbone crest. The critical point of all methods is fixation of the metacarpal region., Conclusions: The method described here is based on an original implant in the form of an L-shaped plate that permits sufficient fixation without using grafts taken from the pelvis. In patients with rheumatic arthritis, if needed, it facilitates peritenosynovectomy or reconstruction of spontaneous tendon ruptures in one operation. It does not require long-term immobilization in plaster cast and permits early rehabilitation of finger joints.

Introduction: Indication for arthrodesis of the knee joint is nowadays most frequently failure of a total endoprosthesis, usually septic. A less frequent indication is purulent gonitis, frequently after corticoid administration, the condition after a complicated intraarticular fracture with subsequent arthritis or oncological disease of the bones in the area of the knee joint., Material and Methods: In the course of 2000 to 2002 at the authors' department 15 arthrodeses were implanted. In three cases the indication for arthrodesis was purulent gonitis, in three cases the condition after an open articular injury associated with infectious complications and in the remaining nine cases failure of an endoprosthesis of the knee, incl. seven caused by infection. The patients were three men and 12 women, mean age 64 years (30-75 years). For stabilization of the arthrodesis 9x external fixation was used, 5x plates and 1x intramedullary osteosynthesis., Results: In all cases consolidation of the arthrodesis was achieved. In one case the external fixation had to be replaced by a system of two fixation devices and in one case correction of the axial position of the extremity was made. The presence of external fixation was perceived negatively in particular by female patients., Discussion: Plate osteosynthesis and the use of external fixation devices are relatively quick, cheap and considerate methods of arthrodesis. External fixation must be used in acute virulent infections while plate osteosynthesis can be indicated in its absence. The characteristic of intramedullary fixation is similar, however special nails used for arthrodesis of the knee are several times more expensive than the previous types of stabilization. The advantage is the possibility to use a massive bone graft to fill the defect.

The authors give an account of Grice's operation, i.e. extraarticular, talocalcaneal arthrodesis as one of the basic operations in infantile cerebral palsy in children and adolescents which can be used in the spastic as well as paretic form of the disease. It is valuable as after reposition it stabilizes the position of tarsal bone sub talo. The 65 operations by Grice's method in infantile cerebral palsy with very favourable results (failure or partial failure in five operations, i.e. 9.2%) and the authors' experience with this operations also in other neurogenic disorders indicates that the operation is justified in children and adolescents. It may be performed also in adults. According to the authors' experience this operation does not lead during subsequent development to deformities of the sole and does not merely substitute the well known triple arthrodesis sub talo. Its application is much wider. It can be combined with other surgical procedures on soft parts as well as bones, in particular with Young's operation and with temporary fixation of tarsal bones with Kirschner wires after reposition.

The authors emphasize the importance of a stable pain-free carpus for the function of fingers. Reflections on their own type of osteosynthesis are based on anatomical and biomechanical findings. They emphasize the functional concept of the central pillar of the wrist where maximum flexion and extension takes place. In this very line formed by the distal portion of the radius, os lunatum, os capitatum and the base of the third metacarpal bone they apply the splint. The splint is as compared with classical AO splints low (only 2.8 mm), L-shaped and in its cross section slightly convex dorsally. It follows thus the natural arching of the carpal and metacarpal bone and does not increase the tension of soft structures and the overlying skin. By the localization of oval openings it makes slight self-compression possible and ensures adequate, three-point fixation of the metacarpal region. The oval opening in the short branch of the splint serves location of the centre of the transverse section of the second metacarpal bone and ensures correct placement of the screw. It makes plastic operation of extensors possible which in rheumatic synovialis and destruction of the carpal bone are frequently impaired. The authors present the results of 21 operations. Adequate healing of bone was achieved in all patients, on average after 3.5 months. In all the height of the carpal index (CHI) was increased and the hand grip improved. In nine patients they found rupture of the extensors and repaired it. In all instances they performed synovectomy and resection of the head of the ulna. Two patients have bilateral arthrodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

In the years 1965-1985 212 patients were treated at the I. Orthopaedic Clinic in Brno by means of the resection sub talo. 100 patients with 105 operations were checked up on average 13 years after operation. The average age in the time of operation was 27. Indicated for operation were in 54 cases patients with neurologic deformity of the foot, in 51 cases patients with a local deformity. Reported were 65 good, 25 fair and 15 poor results. Residual deformity occurred in 12 patients and severe instability of the leg also in 12 cases. Eight patients suffered from moderate arthrosis of the joint ankle, three patients had severe arthrosis. Pseudoarthrosis in the area of resection was found in 5 cases. Prior to operation it is inevitable to examine the stability of the talus and anterior subluxation of the ankle joint. In cases of the instability of the talus ankle arthrodesis is indicated. The authors put emphasis on the release of soft tissues prior to or during the operation. The work proves longterm usefulness of the resection sub talo.