Introduction: The aim of ankle fusion is to create a stable and pain‑, free hind foot. A decrease in bone density secondary to postoperative immobilization is well established. It is commonly accepted that bone density is restored toward normal values when normal weight bearing is permitted. To the current authors’,knowledge, this restoration of bone density has not been definitively established via clinical studies. Subjects and Methods: Patients who underwent an isolated ankle fusion between January 1998 and March 2015, to address advanced degenerative or posttraumatic osteoarthrosis or rheumatoid arthritis were included. Clinical and radiological examination, Foot Function Index (FFI), and American Orthopedic Foot and Ankle Society‑, Score (AOFAS) scoring systems were utilized. Pain intensity was calculated using the Visual analogue scale (VAS). We use semiquantitative ultrasound osteodensitometry to measure bone density. Results: Bone density was determined in 60 patients, at an average follow‑, up of 9 years following ankle fusion. The mean T‑, score for bone density of the calcaneus was significantly lower in the treated foot compared to the contralateral side (−, 1. 4 vs. −, 0. 4,P = 0. 001). With the numbers available, a reduction in bone density was found without a significant difference in the AOFAS score (P = 0. 875), FFI (P = 0. 655), VAS (P = 0. 804), and body mass index (P = 0. 272). Seven (12%) developed a nonunion. Conclusions: These results demonstrate that a reduction in bone density as a consequence of immobilization while bone union was achieved did not completely return to baseline values even at 10 years postoperative. This persistent reduction in bone density does not correlate in a statistically significant way with higher pain scores, inferior AOFAS scores or nonunion rates. Postoperative partial weight bearing should be instigated as soon as possible to minimize bone loss.

The leg is a complex district with functions of weightbearing support, stability, and motility. The management of extensive and complex defects is more challenging and often results in leg amputation or shortening. Leg amputation is a severe mutilation that alters the patient’s work and social life by limiting ambulation and self-sufficiency. During a 3 years period we treated four patients with leg injury consisting of tibial defect who underwent one-stage surgery for soft tissue and bone reconstruction.The follow-up period was from 31 to 36 months. Time to bony union ranged from 4 to 7 months. Time to full weight bearing was from 5 to 9 months after operation. All of the transferred tissue showed hypertrophy after weight bearing.Nonunion & abscess occurred in one case. Arterial thrombosis & valgus deformity were other postoperation complications. The limb was shorter by an average of 0.5 cm in three cases, longer by 1.1 cm in one case, and in the last case, it was not measurable.Other disabling complications were not seen. We believe that this forgotten method can be a valuable alternative to other techniques such as free fibula flap in certain cases that the surgeon can reconstruct bone & soft tissue defects in one stage.

Objectives: While operative fixation is the current recommendation for treating significantly displaced tibial plateau fractures (DTPFs) in elderly patients, our research suggests that non-operative management may also be a viable option as the primary treatment for these individuals. Our study aimed to evaluate the clinical outcomes of patients with complex DTPFs who received non-operative management as their primary management. Methods: Our study involved a retrospective analysis of non-operatively treated DTPFs during the period of 2019 to 2020. We included all patients for the evaluation of fracture healing and range of motion (ROM). Additionally, we conducted functional outcome assessments on all patients, utilizing the Oxford Knee Score (OKS) both before their injury and at the 10-month mark after their injury. Results: The study included 10 patients, comprising two males and eight females, with a mean age of 62. 9 years (range: 46-74). Among them, four patients had Schatzker Type III DTPFs, two had Type V, and four had Type VI. Non-operative management was administered using hinged-knee braces, and patients progressed to weightbearing gradually, with a minimum follow-up period of 10 months. The average time to bone union was 4. 3 months (range: 2-7). The mean Oxford Knee Score (OKS) after the injury was 38. 8 (range: 23-45), with an average reduction of 16. 9% (p = 0. 003). The average fracture depression was 11. 41 mm (range: 4. 2-29), and the average fracture split was 14. 03 mm (range: 5. 5-44). Conclusion: Based on our study, it appears that elderly patients with significantly displaced tibial plateau fractures (DTPFs) can be treated non-operatively as their primary management, despite the current consensus suggesting otherwise.

Background: Ankle fractures represent one of the most common orthopedic injuries in the lower extremity. Weightbearing and rehabilitation protocols after surgical treatment of ankle fracture have recently evolved from traditional methods to full Weight-bearing protocols. However, more evidence is needed on unprotected immediate Weight-bearing along with a standardized rehabilitation program. The purpose of this study was to evaluate effects of unprotected immediate Weight-bearing as tolerated and an eight-week prescheduled supervised rehabilitation program on the midterm clinical and functional outcomes of surgically treated ankle fractures, and to compare functional results with the unaffected side. Methods: Eighty patients (24F and 56M) who underwent rigid fixation of bimalleolar ankle fractures were included (mean age 41. 57± 13. 22 years). Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. The fractures were classified using Lauge-Hansen classification system. Ankle ROMs, Pain Disability Index (PDI), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form36 scores were evaluated. Patients were allowed unprotected Weight-bearing on the immediate postoperative period and a standardized supervised prescheduled rehabilitation program was undertaken following surgery. Results: The mean follow-up period was 30. 32± 6. 91 months. Based on Lauge-Hansen classification, supinationexternal rotation injuries were found in 32(40%) patients, supination adduction injuries in 14(17. 4%) patients, pronationexternal rotation injuries in 28(35%) patients, and pronation-abduction fractures in 6(7. 6%) patients. The solid union was achieved in all patients at the final follow-up. The mean PDI score was 12. 78± 14. 78, and the AOFAS score was 80. 93± 17. 24. Although patients’ health-related quality of life was at a good level, the injured-side ankle ROM was lower than the healthy side (P≤ 0. 05). Conclusion: Satisfactory clinical and functional outcome can be achieved at mid-term with unprotected Weight-bearing as tolerated and pre-scheduled supervised eight-week rehabilitation program following rigid internal fixation of ankle fractures. However, this protocol is not studied in patients with associated comorbidities.