With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.

Radiologic and endoscopic examinations before LASGB revealed pathology needing therapy in 42% of the patients and provided important additional information influencing the operative procedure. At an average follow-up of 17 months, 24% of the 148 patients needed unplanned additional upper GI series.

The resection of os trigonum or posterior talar process for posterior ankle impingement is a technically easy and frequent operation. So far, the scientific literature has focused only on the surgical approach and perioperative problems. However, the author has encountered unfavorable followup results (professional athletes had to stop their career), which also other surgeons tell to have encountered. This study aims to describe for the first time this complication rate and possible reasons therefore. Methods: From 3/11 to 7/15 29 patients (17male, 12 female, 32+/-14 years) with 30 feet were operated (22 endoscopic, 8 open resections). Average followup was 27+/-13 months. All charts and pre-and postoperative radiographs were retrospectively evaluated. Patients were grouped into "no complications", "minor temporary (< 3 months)", "major follow up (end of athletic career)" complications. The following radiographic parameters were measured referenced on the intersection of the talar radius with the calcaneus (Fig. 1): (1) length of posterior talar process/ os trigonum, (2) length of the calcaneus below the posterior process/os trigonum, (3) length of the uncovered subtalar joint after resection. Results: The major complication rate was 13.3% (4 of 30 feet, 2 os trigonum, 2 posterior talar process): all 4 had symptomatic talar edema and 3 of 4 had symptomatic subtalar osteoarthritis. 1 minor complication (persistent pain for 3 months) was found. The length of the posterior talar process was preoperatively 9.37 +/-2.89mm (os trigonum 8.62+/-2.62mm) postoperatively 0.64+/-1.8mm. The length of the posterior calcaneus preoperatively was 8.35 +/-4.63mm, postoperatively 1.97 +/-3.0mm. The uncovered subtalar joint surface postoperatively was 1.77+/-2.92mm. All patients with major complications showed retrospectively what we call the "deadly configuration": the radius of the talus ends within the subtalar joint. Consequently the free subtalar joint surface was significantly larger (6.4mm +/-3.33) in feet with major complications than in feet without (1.06mm +/-2.15, P < 0.001). Feet without complications but with this deadly configuration (7/26) had a lower free subtalar surface (3.27mm +/-1.81, P=0.09) than feet with major complications. Conclusion: The resection of os trigonum or posterior talar process has a high complication rate of 13.3% with symptomatic talar edema and subtalar osteoarthritis at follow up which can be career-ending in professional athletes. The only risk factor found was what we call the "deadly configuration" characterized by the ending of the talar radius into the subtalar joint. In such cases, the resection has to be made sparingly preferably not anterior into the subtalar joint and patients have to be informed about this possible unfavorable course.

Calcaneal fractures are associated with a high rate of complications, such as subtalar osteoarthritis, hind foot varus malalignment, heel shortening and widening, ventral ankle impingement, and soft tissue complications. To achieve stable fixation and to reduce these complications, a special open reduction and internal fixation technique has been developed. The individual frame-like arrangement of 3 angular stable low-profile plates takes the calcaneal anatomy into account and allows stable fixation in the cortical and subchondral bone. Therefore, the purpose of this study is to describe this new technique in detail and report the preliminary results.

Introduction/Purpose: The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years.Methods: Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded. Results:The ten year survival rate was (def. 1) 94% (CI 82-98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28). Conclusion:The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis.