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Gold standard treatment for a malunited collapsed calcaneal fracture is distraction subtalar joint arthrodesis with structural graft. Various grafts are have been reported in the literature with femoral head or iliac crest allograft being most common. The present case report demonstrates a case of a 64-year-old female who presented two years after attempted subtalar joint fusion. The patient had pain recalcitrant to conservative care with clear bony collapse on weight bearing radiography and complete non-union on computed tomography. A novel technique is presented wherein a dorsally based posterior calcaneal osteotomy is performed and the removed bone wedge placed into the subtalar fusion to serve as structural autograft. The patient remained non-weight-bearing for 8 weeks post-operatively. Computed tomography was obtained at 6 months after surgery noting greater than 40% osseous bridging. The patient had improvement in all symptomatology and had complete return to activity from her baseline before the index surgery. Technique is illustrated along with description of details.

Modern advancements in total ankle arthroplasty techniques and implants have increased their popularity as treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision. However, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38 %. Minor dehiscence occurred in 6.00 % of cases, while major wounds or infections occurred in 3.62 %. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03 % before 2013 to 4.75 % after 2013 (p = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (p > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing. Level of Clinical Evidence: 3

Chronic ankle instability is a pathology arising from one of the most common orthopedic injuries, lateral ankle sprains. The gold standard surgical procedure for lateral ankle instability is repair of the anterior talofibular and calcaneofibular ligaments with imbrication of the inferior extensor retinaculum. The senior author's indications for a modified Brostrom versus a modified Chrisman-Snook have evolved over the past decade. Indications for a modified Chrisman-Snook include: revision reconstruction, generalized laxity, collagen vascular disease, BMI greater than 35, and significant hindfoot varus or midfoot cavus. The primary aim of this report is to provide a narrative review of the Chrisman-Snook procedure and overview of our modified technique.

A non-salvageable talus, often secondary to avascular necrosis, is a difficult pathology to treat. A standard technique for talar defects includes tibiotalocalcaneal fusion with plating or a hindfoot intramedullary nail. The 21st century has brought about the increasing use of total talus replacements as an alternative procedure for severe osteonecrosis of the talus. As total talus replacement becomes more popular, the need for revision options will increase. The present study's evaluates the viability of revision TTR with a talar component constrained into the navicular and calcaneus. Three consecutive patients undergoing revision total ankle total talus replacement were retrospectively reviewed. Two males ages 62 and 57 and a female aged 55 failed conservative therapy at 41, 34, and 29 months after index total talus replacement. Single Photon Emission Computed Tomography (SPECT) was obtained to confirm uptake in the talonavicular and subtalar joint implant interfaces. At 26, 20, and 14 months postoperatively all patients on computed tomography possessed at least 30 % osseous bridging at hindfoot joints. No patient has had a reoperation, and one complication of medial gutter pain was observed. All patients with revision total talus replacement to a combined constrained implant returned to function and avoided tibiotalocalcaneal fusion or below knee amputation. There is a clear need to standardize reporting and establish the safety and efficacy of TTR. Furthermore, more comparative studies between total talus replacement and tibiotalocalcaneal arthrodesis are needed.

Osteoarthritis of the tibiotalar joint is a debilitating condition and often post-traumatic in nature and can contain deformity. Historically, significant coronal plane deformities were considered contraindications for total ankle arthroplasty. To preserve long term success and balance the loading of any ankle arthroplasty one must focus on correcting any aberrations in alignment of the foot, ankle, or leg. Varus deformity at the tibiotalar level is common but there is no standard treatment for its correction prior to prosthesis implantation. A retrospective review was undertaken to quantify deformity correction and viability of a medial malleolar lengthening technique with intercalary allograft. Ten patients met inclusion and exclusion criteria. Transverse opening osteotomy with bone allograft osteotomy was made just distal to the medial malleolar shoulder in a staged fashion or simultaneously with total ankle arthroplasty. A mean age of 60.3 years and mean body mass index of 26.3 (kg*m2) was observed. Seventy percent (7/10) of osteotomies progressed to union (7/10) at an average follow up of 24.7 months. All nonunions (3/3) were asymptomatic. Pre-operative average tibiotalar angle was 70.9 degrees, and post-operative was 87.9 (p < 0.001). All but 2 patients had ancillary procedures in addition to malleolar osteotomy and ankle arthroplasty. While promising, patients may need to be counseled that asymptomatic pseudoarthrosis is common (30 %). Further research is needed regarding management of coronal plane deformities of the ankle.

Background: Ankle sprains are one of the most common injuries amongst the general population and affect all spectrums of activity levels. While the anterior talofibular and calcaneal fibular ligaments are most prevalently injured during sprains there are instances when chronic lateral ankle instability leads to rotational ankle instability and attenuate the deltoid ligament. The few literature that exists concerning lateral and medial ankle ligament reconstruction focus on an arthroscopic approach. Aim: The goal of this current work is to describe a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. Surgical Technique: A singular semitendinosus allograft is utilized to reconstruct the anterior deltoid, anterior talofibular and calcaneofibular ligaments. Canals are reamed for anchoring of the allograft through the medial malleolus, anterior talar body, distal fibula, and midline calcaneus. The anterior talar body, distal fibula and midline calcaneus are reamed fully to allow for pull through technique of the allograft. The medial malleolus and talar neck are anchored first, followed by the anterior fibula, and lastly the lateral calcaneus. All anchoring is performed with the ankle in a neutral position. Conclusion: This work successfully describes a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. This technique affords the surgeon greater control over the final product and allows for a repair in a neutral position. The semitendinosus allograft also allows for a more anatomic repair with less incidence of stiffening at the ankle joint. The authors’ have noted good results and return to full activity for the patients that have undergone this procedure.

Varus and valgus ankle deformities were once considered contraindications for TAA, and were primarily treated by tibiotalar fusions. As the total ankle implant generations matured in conjunction with evolving surgeon techniques the indications for total ankle arthroplasty grew. Currently, ankle deformities may receive arthroplasty if the deformity is corrected either at the time of implantation or beforehand. There exists a lack of consensus in the literature regarding the most appropriate timeframe for these procedures to be performed, and oftentimes these protocols are unique to each individual surgeon. In this text the authors present a protocol that has been developed and employed to overwhelmingly positive results. This was developed with the goal of returning to early ambulation and reducing the amount of surgical trauma of any one given procedure. These tenants allow for the optimization of the arthroplasty procedure's function as well as respecting the healing timeframe necessary in reconstructive surgery. It is the author's hope that this protocol may serve as a steppingstone for other surgeons to develop their criteria and timeframe to suit their comfort level.

Avascular necrosis of the talus can oftentimes result in severe painful deformity due to the eventual collapse of the body. This condition historically has had limited options for joint sparing procedures. Total talus replacements are a relatively new implant type with limited data available in the literature concerning the most recent, third generation model. The non-constrained version of these implants contains the largest breadth of published literature and have performed well in mid-term length studies. This current case report presents a revision total talus replacement with a constrained implant. The patient of interest initially developed talus AVN four years after talus open reduction internal fixation resulting from a bicycle versus motor vehicle accident. Throughout the patient's course and numerous surgeries, progressive cavovarus deformity was a common theme that may have originated from the one week delay between the date of injury to the index procedure. Eventually the decision was made to prevent any further progression of this deformity through a constrained total talus replacement with fixation into the subtalar and talonavicular joints. This procedure occurred 3 years after the initial total talus replacement and was only performed after all conservative cares had been entirely exhausted. The surgical course of this case is followed in detail and describes a successful revision total talus replacement with a constrained implant. It is the authors’ conclusion that this option is appropriate to preserve ankle range of motion and delay tibiotalocalcaneal fusion.