My own experience in Foot and Ankle Surgery

1. Dniepropetrovsk State medical academy Ukraine My own experience in Foot and Ankle Surgery MD Prof. Alexander Loskutov Dniepropetrovsk 2009

2. Osteosynthesis in multiple fractures of metatarsal bones, dislocations in Lisfrank’s joint • The problem of this pathology is: • multiple fracture; • combination of fracture and dislocation; • dislocation in Lisfrank’s joint; • high risk of ischemia, disorders of blood circulation and necrosis of foot tissues; the risk is significantly increases in case of opened reposition with osteosynthesis; • impossibility of firm fixation of bone fragments in cases of closed reposition and treatment with plaster bandage.

3. Our technology of transosseous osteosynthesis of foot fractures The original apparatus of external fixation The extension / flexion of foot

4. Multiple fracture of metatarsal bones The view of injured and intact foot X-ray at admission to the hospital X-ray after the operation The view of injured and intact foot at the end of treatment X-ray after the healing of fractures

5. Luxation in the Lisfrank’s joint X-ray at admission to the hospital X-ray after the operation X-ray after the healing of fractures The result of treatment and plantogram

6. Luxation in the Lisfrank’s joint X-ray at admission to the hospital X-ray after the operation X-ray, plantogram and functional result of treatment

7. The stable functional osteosynthesis of malleolar fractures The variants of plate for osteosynthesis of fractures of lateral malleolus

8. The stable functional osteosynthesis of malleolar fractures Type A fracture

9. The stable functional osteosynthesis of malleolar fractures Type B2 fracture

10. The stable functional osteosynthesis of malleolar fractures Type B3 fracture

11. The stable functional osteosynthesis of malleolar fractures Type B3 fracture

12. The stable functional osteosynthesis of malleolar fractures Type C1 fracture Minimal invasive closed osteosynthesis

13. The stable functional osteosynthesis of malleolar fractures Type C2 fracture

14. The stable functional osteosynthesis of malleolar fractures Type 43B2 fracture

15. The stable functional osteosynthesis of malleolar fractures Type C3 fracture

16. The stable functional osteosynthesis of malleolar fractures The proposed method of stable functional osteosynthesis of maleolar fractures was performed during 18 years in 1600 patients with type A fractures in 18% cases, type B – 52%, type C – 30%. The late osteoarthrosis was revealed only in 3.1% cases.

17. The inveterate ruptures of tibiofibular syndesmosis The 3-stage scheme of bone –grafting arthrodesis The bone-grafting stabilization removes the instability of joint and pain. The late osteoarthrosis of ankle joint was diagnosed after 10 years in 8.6% cases.

18. The bone-grafting syndesmodesis in case of instability of tibiofibular syndesmosis (patient S.) X-ray at admission to the hospital X-ray after the operation 11-years follow-up result

19. The reconstructive arthrodesis of foot joints in case of inveterate fractures of talar bone The scheme of operation

20. The result of treatment of inveterate fractures of talar bone (patient H.) X-ray follow-up result of operation X-ray at admission to the hospital Functional follow-up result

21. Total replacement of ankle joint Left and right version of implants, each has 3 sizes Tibial and talar components

22. The biomechanical grounding of construction of ankle joint endoprosthesis The studying of mechanical stiffness of articular endings of talar and tibial bones resulted to the following conclusion: in case of performing of ankle joint replacement the optimal level of resection of talar bone is in borders of 2.2±0.2 mm, as tibial bone 5.0 ±0.5 mm. The most significant resection does not give the stable fixation of ankle endoprosthesis.

23. Total replacement of ankle joint (patient L.) X-ray at admission to the hospital X-ray after the operation

24. Total replacement of ankle joint (patient L.) Follow-up X-ray and functional result, 10 years after operation

25. Thank You for attention. Welcome to Dniepropetrovsk!