Ankle arthrodesis:A systematic approach and review of the literature

Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis(ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus(0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches(open or arthroscopic) and differing fixation methods(internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons' skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.

Triple Arthrodesis with Internal and External Fixation: Technique Paper

Background: The triple arthrodesis was described early by Myerson in 1923 and has been the gold standard surgical procedure for various conditions with the goal to reduce pain, improve deformity and facilitate function. Methods: The procedure consists of fusion of the subtalar joint, talonavicular joint and calcaneocuboid joint [1]. The procedure is traditionally done with internal fixation, however, Marinet al. has shown it to be performed with external fixation [2]. Dr. Marin and the associates have developed an alternative technique to perform a triple arthrodesis using internal and external fixation. This paper describes a step-by-step technique to perform a triple arthrodesis with both internal and external fixation. It will demonstrate the use of the prefabricated arches on the footplate for more precise and accurate placement of transosseous wires using arch-wire technique [3]. Results/Conclusion: We believe this technique will not only help increase the ability to achieve fusion with a less chance of non-union, but may also decrease healing time, which may allow patients to be mobile from the first week post-operatively and may diminish the risks associated with being non-weightbearing.

Intraosseous device for arthrodesis in foot and ankle surgery: Review of the literature and biomechanical properties

BACKGROUND Arthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and stability.There have been numerous fixation devices described in literature for foot and ankle arthrodesis,each with their own benefits and drawbacks.AIM To review the use of intraosseous devices in foot and ankle surgery.METHODS There were 9 papers included in the review(6 clinical and 3 experimental studies)all evaluating arthrodesis in the foot and ankle using the IOFIX device(Extremity Medical™,Parsippany,NJ,United States).Outcome scores,union rates,as well as complications were analysed.RESULTS IOFIX appears to be safe and effective in achieving arthrodesis of the 1st metatarsophalangeal,and talonavicular joints with early rehabilitation.In comparison to plate/screw constructs there were fewer soft tissue complications and issues of metalwork prominence.Cadaveric and biomechanical studies on the use of intramedullary fixation for fusion of the tarsometatarsal and ankle joint showed decreased load to failure,cycles to failure and stiffness in comparison to traditional fusion methods using plates and screws,however IOFIX devices produced higher compressive forces at the joint.CONCLUSION We describe the reasons for which this biomechanical behavior of the intraosseous fixation may be favorable,until prospective and comparative studies with largersample size and longer follow-up confirm the effectiveness and limitations of the method.

Surgical Management of Lumbar and Thoracolumbar Spinal Fractures: Indications, Surgical Technique and Evaluation on a Series of 64 Patients Treated with Percutaneous Posterior Osteosynthesis Combined with Kyphoplasty or Anterior Arthrodesis

Introduction: Fractures of the lumbar spine and thoracolumbar junction are common in spinal trauma. The aim of this work is to analyze the nature of the indications, the morbidity as well as the results of these treatment regimens. Patients and Methods: A retrospective, single-center study, based on a review of 64 patients with lumbar spine and thoracolumbar junction fractures (T10-L2) without neurological disorders, was collected in the neurosurgery department of the North Hospital and University Hospital (CHU), Marseille over a period of 2 years from January 2015 to December 2016. Posterior percutaneous osteosynthesis were more or less associated with kyphoplasty preceded anterior arthrodesis. Clinical and radiological endpoints were collected at least 6 months later. Results: The mean follow-up was 9.5 months (6 - 24). The clinical evaluation found a mean VAS at last follow-up at 14/100 (0 - 30) and an average Oswestry score at the last follow-up at 88%. The initial average vertebral kyphosis went from 13° to 4° at the last follow-up with a correction loss of 1°, an absolute gain of 8°. No postoperative neurological complications were noted in our series. Conclusion: The implementation of a two-step therapeutic strategy with anterior reconstruction in Magerl’s lumbar spine or A3.3 thoracolumbar junction fractures allows effective and long-lasting correction of lumbar lordosis and thoracic kyphosis, and obtaining a balanced spine in the sagittal plane. Our functional results are close to normal, with low morbidity and a low complication rate.

Double Arthrodesis, Postero-Medial Release and Posterior Tibial Transfer in One Step in Paralytic Inveterate Equine Varus Foot

Introduction: Varus equine foot deformity is common in developing countries. The management of these deformities is surgical in adults. Several surgical techniques have been described with more or less satisfactory results. To our knowledge, no study has been performed on the simultaneous association of double arthrodesis, posteromedial release, and posterior tibial transfer in a single operation in inveterate paralytic varus equines feet. The purpose of this work was to evaluate the results obtained. Patients and Method: This was a retrospective descriptive study from January 01, 2018 to December 31, 2021. It concerned inveterate paralytic varus equines feet operated on by the simultaneous association in a single operative time of double arthrodesis of the foot, posteromedial release of the back foot and transfer of the posterior tibial muscle to the lateral cuneiform. We identified seven patients with a mean age of 22.1 years with extremes of 11 years and 36 years. There were three males and four females. The cause of the deformity was neurological in all cases. All patients had painful walking discomfort and shoeing difficulties. The average time to management was 13.3 years with extremes of 4 and 25 years. The chronology of the interventional steps was posteromedial release, arthrodesis, and transfer of the posterior tibial muscle to the lateral cuneiform. The average postoperative follow-up was 21.7 months with extremes of 6 and 48 months. The parameters studied were the duration of the procedure, complications related to the procedure, muscle strength at the last recoil, consolidation of the arthrodesis, residual pain, patient activity, gait perimeter, stepping, ankle mobility, residual deformity, footwear, protrusion of the transferred tendon, and the possibility of walking on the heel. Final results were graded according to the Angus and Cowell criteria. Results: No intraoperative complications were noted. An early superficial infection of the surgical site was noted. It was treated with local care and healed without sequel. Residual pain was present in one case. Tibiotalar osteoarthritis was observed in one case, which required a tibiotalar arthrodesis. At the last follow-up, consolidation of the arthrodesis was effective in all patients. The posterior tibial muscle was side 5 (n = 4) and 4 (n = 3). The patients’ activity was normal without assistance in all cases. The walking perimeter was greater than 1 km in six patients. Patient activity was normal without assistance in all cases. Stepping was absent in all patients. No difficulty with footwear was noted. According to the Angus and Cowell criteria, the result was good (n = 6), i.e. 85.7% and bad (n = 1), i.e. 14.3% of cases. Conclusion: This study suggests that double arthrodesis associated with posteromedial release and transfer of the posterior tibial in one step in inveterate paralytic varus equines feet, gives satisfactory results. It allows for easy shoeing and plantigrade walking without stepping. Complications are essentially represented by the absence of fusion of the arthrodesis and tibiotalar arthrosis.

Arthrodesis of the first metatarsophalangeal joint:The“when and how”

Arthrodesis of the first metatarsophalangeal(MTP)joint has been established as the“gold standard”for the treatment of several first ray disorders,due to its perceived efficacy and the consistently reported good results in the literature.Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis,rheumatoid arthritis with severe deformity,selected cases of severe hallux valgus(with or without signs of degenerative joint disease),as well as a salvage procedure after failed previous operation of the first ray.The goals of a successful 1st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear.Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation.As with any given surgical procedure,various complications may occur after arthrodesis of the 1st MTP joint,namely delayed union,nonunion,malunion,irritating hardware,etc.

Achieving high union rates after first metatarsophalangeal joint arthrodesis:Radiographic outcomes and technical pitfalls

BACKGROUND Fusion of the first metatarsophalangeal(MTP1)joint is a common surgery performed to correct hallux rigidus,hallux rigidus et valgus and other painful degenerative diseases of the MTP1.AIM To assess outcomes of our surgical technique including non-union rates,accuracy and aims of correction.METHODS Between September 2011 and November 2020 a total 72 of MTP1 fusions were performed using a low profile,pre-contoured dorsal locking plate and a plantar compression screw.Union and revision rates were analyzed with a minimum clinical and radiological follow up of at least 3 mo(range 3-18 mo).The following parameters were evaluated on pre-and postoperative conventional radiographs:Intermetatarsal angle,Hallux-valgus angle,dorsal extension of the proximal phalanx(P1)in relation to the floor and the angle between the Metatarsal 1 and the P1(MT1-P1 angle).Descriptive statistical analysis was performed.Pearson analysis was used to assess for correlations between radiographic parameters and achievement of fusion.RESULTS An overall union rate of 98.6%(71/72)was achieved.Two out of 72 patients did not primarily fuse with one patient suffering from a non-union,whilst the other demonstrating a radiological delayed union without clinical symptoms,with eventually complete fusion after 18 mo.There was no correlation between the measured radiographic parameters and the achievement of fusion.We believe the reason for the non-union was mainly attributed to the patient’s incompliance without wearing the therapeutic shoe leading to a fracture of the P1.Furthermore,we didn`t find any correlation between fusion and the degree of correction.CONCLUSION With our surgical technique,high union rates(98%)can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1.

距下关节融合钢板内固定治疗Sanders IV型跟骨骨折

目的:总结距下关节融合钢板内固定术对Sanders Ⅳ型跟骨骨折的手术经验.方法:对16例(17侧)Sanders Ⅳ型跟骨骨折在行切开复位的同时根据粉碎程度行距下关节融合跟骨钢板内固定,疗效采用AOFANS评分标准.结果:16例获得6～47个月随访(平均19.7个月),AOFANS评分平均为84.6分.结论:对于Sanders Ⅳ型跟骨骨折根据其粉碎程度可行距下关节融合跟骨钢板内固定术.

不同手术方法治疗Sanders Ⅳ型跟骨骨折的疗效

目的：比较切开复位钢板内固定（ORIF）和 ORIF加预防性距下关节融合术治疗 Sanders Ⅳ型跟骨骨折的临床疗效。方法54例 Sanders Ⅳ型跟骨骨折患者中，采用切开复位内固定24例（ORIF组），采用切开复位内固定加预防性距下关节融合术治疗30例（ORIF＋融合组）。观察手术后的Bohler’s角、Gissane’s角、跟骨宽度、跟骨轴长、跟骨丘部高度恢复及末次随访踝关节 Herr评分优良率。结果术后54例获24个月（6～48个月）随访。手术后Bohler’s角、Gissane’s 角、跟骨宽度、跟骨轴长、跟骨丘部高度的恢复，2组比较差异无统计学意义（P＞0．05）。末次随访踝关节 Herr评分优良率 ORIF组明显低于 ORIF＋融合组（62．5％比86．7％，P＜0．05）。结论切开复位内固定加预防性距下关节融合术治疗 Sanders Ⅳ型跟骨骨折疗效肯定，并发症较少，是治疗 Sanders Ⅳ型跟骨骨折的理想方法。

跟骨丘部重建加距下关节融合术治疗SandersⅢ型跟骨关节内陈旧性骨折

目的:观察跟骨丘部重建与距下关节融合术联合治疗严重的跟骨关节内陈旧性骨折的临床疗效,总结其手术适应证及注意要点。方法:2006年3月至2011年7月,采用跟骨丘部重建与距下关节融合术联合治疗SandersⅢ型跟骨关节内陈旧性骨折患者26例,男15例,女11例;年龄27～45岁,平均34岁;病程7～24个月,平均18个月。术前X线片及CT示Gissane角增大,B觟hler角减小,跟骨增宽向两侧膨出。术后复查时行影像学检查并对跟骨宽度、丘部高度、B觟hler角及Gissane角进行测量,并与术前比较。根据AOFAS踝后足评分标准对手术前后患足功能进行评分,比较改善程度。结果:24例患者获完整随访,随访时间5～26个月,平均19个月。X线片证实所有患者融合成功,未发生严重感染,其中1例患者术后出现皮缘坏死,行带腓肠神经营养血管岛状皮瓣转位修复术后皮瓣存活,伤口愈合良好。患者AOFAS踝后足评分由术前的(41.00±8.22)分提高到术后的(79.04±7.46)分;结果优3例,良15例,中6例。术后跟骨宽度、丘部高度、B觟hler角及Gissane角较术前有明显改善(P<0.01)。结论:重建跟骨丘部的距下关节融合术是治疗陈旧性跟骨骨折的一种有效方法,可矫正跟骨畸形、恢复足部外形并改善后足功能。

Current concepts on spinal arthrodesis in degenerative disorders of the lumbar spine

Back pain is a common chronic disorder that represents a large burden for the health care system. There is a broad spectrum of available treatment options for patients suffering from chronic lower back pain in the setting of degenerative disorders of the lumbar spine, including both conservative and operative approaches. Lumbar arthrodesis techniques can be divided into subcategories based on the part of the vertebral column that is addressed(anterior vs posterior). Furthermore, one has to differentiate between approaches aiming at a solid fusion in contrast to motion-sparing techniques with the proposed advantage of a reduced risk of developing adjacent disc disease. However, the field of application and long-term outcomes of these novel motion-preserving surgical techniques, including facet arthroplasty, nucleus replacement, and lumbar disc arthroplasty, need to be more precisely evaluated in long-term prospective studies. Innovative surgical treatment strategies involving minimally invasive techniques, such as lateral lumbar interbody fusion or transforaminal lumbar interbody fusion, as well as percutaneous implantation of transpedicular or trans-facet screws, have been established with the reported advantages of reduced tissue invasiveness, decreased collateral damage, reduced blood loss, and decreased risk of infection. The aim of this study was to review well-established procedures for lumbar spinal fusion with the main focus on current concepts on spinal arthrodesis and motion-sparing techniques in degenerative disorders of the lumbar spine.

Complex ankle arthrodesis: Review of the literature

Complex ankle arthrodesis is defined as an ankle fusion that is at high risk of delayed and nonunion secondary to patient comorbidities and/or local ankle/hindfoot factors. Risk factors that contribute to defining this group of patients can be divided into systemic factors and local factors pertaining to co-existing ankle or hindfoot pathology. Orthopaedic surgeons should be aware of these risk factors and their association with patients' outcomes after complex ankle fusions. Both external and internal fixations have demonstrated positive outcomes with regards to achieving stable fixation and minimizing infection. Recent innovations in the application of biophysical agents and devices have shown promising results as adjuncts for healing. Both osteoconductive and osteoinductive agents have been effectively utilized as biological adjuncts for bone healing with low complication rates. Devices such as pulsed electromagnetic field bone stimulators, internal direct current stimulators and low-intensity pulsed ultrasound bone stimulators have been associated with faster bone healing and improved outcomes scores when compared with controls. The aim of this review article is to present a comprehensive approach to the management of complex ankle fusions, including the use of biophysical adjuncts for healing and a proposed algorithm for their treatment.

Anterior ankle arthrodesis

Ankle arthrodesis is a common procedure that resolves many conditions of the foot and ankle; however, complications following this procedure are often reported and vary depending on the fixation technique. Various techniques have been described in the attempt to achieve ankle arthrodesis and there is much debate as to the efficiency of each one. This study aims to evaluate the efficiency of anterior plating in ankle arthrodesis using customised and Synthes Tomo Fix plates. We present the outcomes of 28 ankle arthrodeses between 2005 and 2012, specifically examining rate of union, patient-reported outcomes scores, and complications. All 28 patients achieved radiographic union at an average of 36 wk; the majority of patients(92.86%) at or before 16 wk, the exceptions being two patients with Charcot joints who were noted to have bony union at a three year review. Patient-reported outcomes scores significantly increased(P < 0.05). Complications included two delayed unions as previously mentioned, infection, and extended postoperative pain. With multiple points for fixation and coaxial screw entry points, the contoured customised plate offers added compression and provides a rigid fixation for arthrodesis stabilization.

Arthrodesis of the wrist in rheumatoid arthritis

In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.

International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100th birthday of G. A. Ilizarov)

The Ilizarov method is one of the current methods used in bone reconstruction.It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA.Its main merits are viable new bone formation through distraction osteogenesis,high union rates and functional use of the limb throughout the course of treatment.The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery.Since then,the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails.They gave rise to a relatively new orthopedic subspecialty termed“limb lengthening and reconstruction surgery”.Based on a comprehensive literature search,we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community.The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal’s rating.The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents.It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.

Arthroscopic vs open ankle arthrodesis:A prospective case series with seven years follow-up

BACKGROUND The osteoarthritis of the ankle,although less common than other joints,is associated with severe functional limitation.Surgical options are ankle arthroscopic debridement,osteotomies,ankle arthrodesis and ankle arthroplasty.Ankle arthroplasty is increasingly used thanks to the new implants design,but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure.AIM To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis.METHODS This study enrolled 23 patients,which underwent ankle arthrodesis.The patients were divided into 2 groups:group A(open procedure;n=11)and group B(arthroscopic procedure,n=12),the two groups were homogeneous with regard to age and body mass index(P=0.347).The American Orthopaedic Foot and Ankle score(AOFAS),Freiburg Ankle score(FAS)and visual analogue scale for pain intensity were evaluated preoperatively,at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B(P=0.364).RESULTS Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS(group A,62.2;group B,78.5;P<0.05)and the FAS(group A,61.1;group B,70.3;P=0.015)scores.Pain relief was achieved in both groups at six-month follow-up(group A,1.4;group B,0.9;P=0.162).Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up(P>0.05).Hospital stay was shorter in group B than in group A(P=0.001).More complications were reported in the open group than in the arthroscopic group(P=0.459).CONCLUSION The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up.Moreover,the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

Advanced concepts in knee arthrodesis

The aim is to describe advanced strategies that can beused to diagnose and treat complications after knee arthrodesis and to describe temporary knee arthrodesis to treat infected knee arthroplasty. Potential difficult complications include nonunited knee arthrodesis, limb length discrepancy after knee arthrodesis, and united but infected knee arthrodesis. If a nonunited knee arthrodesis shows evidence of implant loosening or failure, then bone grafting the nonunion site as well as exchange intramedullary nailing and/or supplemental plate fixation are recommended. If symptomatic limb length discrepancy cannot be satisfactorily treated with a shoe lift, then the patient should undergo tibial lengthening over nail with a monolateral fixator or exchange nailing with a femoral internal lengthening device. If a united knee arthrodesis is infected, the nail must be removed. Then the surgeon has the option of replacing it with a long, antibiotic cement-coated nail. The authors also describe temporary knee arthrodesis for infected knee arthroplasty in patients who have the potential to undergo insertion of a new implant. The procedure has two goals: eradication of infection and stabilization of the knee. A temporary knee fusion can be accomplished by inserting both an antibiotic cement-coated knee fusion nail and a static antibiotic cement-coated spacer. These advanced techniques can be helpful when treating difficult complications after knee arthrodesis and treating cases of infected knee arthroplasty.

Candidal periprosthetic joint infection after primary total knee arthroplasty combined with ipsilateral intertrochanteric fracture: A case report

BACKGROUND Candidal periprosthetic joint infection is a rare and difficult to diagnose complication of total knee arthroplasty.The treatment of such complications is inconclusive and may include prosthesis removal,debridement,arthrodesis,and extensive antifungal therapy to control the infection.CASE SUMMARY A 62-year-old male with a history of total knee arthroplasty(TKA)in his left knee presented with ipsilateral knee pain and a sinus discharge 20 mo after TKA.The patient was previously evaluated for left knee pain,swelling,and a transient fever one month postoperatively.Prothesis removal and insertion of a cement spacer were performed in a local hospital six months prior to the current presentation.Medical therapy included rifampicin and amphotericin which were administered for 4 wk following prosthesis removal.A second debridement was performed in our hospital and Candida parapsilosis was detected in the knee joint.Fourteen weeks following the latter debridement,the patient suffered a left intertrochanteric fracture and received closed reduction and internal fixation with proximal femoral nail anterotation.Two weeks after fracture surgery,a knee arthrodesis with autograft was performed using a double-plate fixation.The patient recovered adequately and was subsequently discharged.At the two-year follow-up,the patient has a stable gait with a pain-free,fused knee.CONCLUSION Fungal periprosthetic joint infection following TKA may be successfully and safely treated with prosthesis removal,exhaustive debridement,and arthrodesis after effective antifungal therapy.Ipsilateral intertrochanteric fractures of the affected knee can be safely fixated with internal fixation if the existing infection is clinically excluded and aided by the investigation of serum inflammatory markers.

A Look at Triple Arthrodesis Joint Fusion without Rigid Internal Fixation

Triple arthrodesis is an invasive procedure that involves denuding and fusion of three foot joints;Talocalcaneal (T-C), Talonavicular (T-N) and Calcaneocuboid (C-C). Traditionally, with external fixation triple arthrodesis has been per-formed without corresponding internal fixation. The purpose of this study is to take a scientific look at the compressive forces acting on the joint surfaces using the arch wire technique without the use of rigid internal fixation. Five fresh cadaveric lower-limb specimens were prepared for the triple arthodesis by anatomic dissection. External fixators were applied to the limbs and pressure sensors from the Tekscan 6900C were placed in the three foot joints where tension was applied. After several trials with different variables it was seen that the arched wire technique on the footplate alone does not allow constant compression at the three joints. However weightbearing increased compression across all three joints regardless of the arch wire compression. This study proves that weightbearing alone provides more compression at all 3 joints in a triple arthrodesis.

Ankle Arthrodesis Nail Combined with Locking Compression Plate to Stabilize Two-Level Pathologic Tibial Fractures

Treatment of fragility fractures of the distal tibia in the elderly is demanding because of osteopenic bone quality, the delicate soft tissue cuff and frequent critical circulation. We report the case of two-level tibial pseudarthroses in an 83- year-old woman caused by multiple myeloma successfully stabilized by a long ankle arthrodesis nail combined with locking compression plate osteosynthesis. This case is unique, as to our best knowledge, herein diaphyseal fractures were treated for the first time using a technique reported hitherto primarily for fragility ankle and pilon fractures.