Background Arthrodesis of the ankle joint using screws or external fixation is often a demanding procedure, notably in patients with rheumatoid arthritis. We investigated whether tibio-talocalcaneal arthrodesis with the use of an intramedullary nail is a safe and simple procedure.Patients and methods We retrospectively reviewed 25 ankles (25 patients) at median 3 (1-7) years after tibio-talocalcaneal arthrodesis because of rheumatoid arthritis. All had been operated on by retrograde insertion of a retrograde nail. 5 types of nail had been used. Complications, functional outcome scores, and patient satisfaction were determined and the radiographs evaluated for healing.Results All but 1 ankle had a radiographically healed arthrodesis. We recorded 3 deep infections, all healed-in 2 cases after extraction of the nail-and the arthrodesis healed in all 3 patients. The average functional scores at follow-up were high, considering that the patients suffered from rheumatoid arthritis. 23 patients were satisfied with the outcome. We found a correlation between the functional scores and the general activity of the disease expressed as a Health Assessment Questionnaire score.Interpretation In patients with rheumatoid arthritis, tibio-talocalcaneal arthrodesis with a retrograde intramedullary nail results in a high rate of healing, a high rate of patient satisfaction, and relatively few complications.

One hundred total ankle arthroplasties were performed in our department between 1974 and 1994, and of these, 21 have been reoperated on with arthrodesis due to septic or nonseptic failures after 6 months to 15 years (median 40 months). Immobilization using a Hoffman external fixator was the dominating method. The total ankles were of six different designs. Sixteen of the 21 patients suffered from rheumatoid arthritis. Four of the 21 ankles did not fuse whereas 17 did: 13 at the first attempt and 4 after repeat arthrodesis. At the time of the review, two patients had died. Of the remaining 15 patients whose ankles had fused, all but one were satisfied or somewhat satisfied with the result. Twelve of these 15 ankles rated excellent or good according to the Mazur and Kofoed scoring systems. We conclude that arthrodesis can be performed successfully after a failed ankle arthroplasty.

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We assessed the final outcome of curve progression in 90 consecutive school children with idiopathic scoliosis. 46 children treated 1971-76 were compared with 44 treated 1978-81, after the introduction of school screening in 1977. There was a decrease in demand for surgery from 45 percent before screening to 10 percent in the screening group. When differences in subsequent brace types were accounted for, the outcome remained better in cases detected during the screening period. The most probable explanation is the earlier onset of bracing in the screened group.