INTRODUCTION:Lisfranc joint injuries are common and often underdiagnosed. They occur during trauma of various mechanisms, high or low energy. Their management is difficult because of the wide spectrum of lesions and the management of associated lesions, particularly in the emergency stage. Their surgical treatment remains controversial. Therefore, the objective of this study was to evaluate and compare the management of Lisfranc injuries and to study their clinical, functional and radiologic evolution. We also wanted to assess the consequences of these lesions on the patient's quality of life. MATERIAL AND METHODS:This was a retrospective multicenter study of 141 patients over 16 years at the time of the trauma. The patients included had presented a Lisfranc injury from January 2010 to June 2018. The epidemiological characteristics, the type of osteosynthesis, and the immediate and radiographic results at the last follow-up were collected. Functional assessment was analyzed by telephone review using the SF12, FAAM and AOFAS scores. RESULTS:An associated M2 base fracture was found in almost 50 % of cases. A closed reduction and fixation was made in 25 % of cases. There was 69 % pins fixation. The reduction was not anatomical in 1/3 of the cases and was more difficult to achieve with an associated fracture. The FAAM score was statistically superior in the patients with internal fixation by screws compared to the treatment by pins. We found 18 % early complications. At least 1 year after the injury, C2M2 osteoarthritis was found in 45 % of patients. DISCUSSION:Contrary to what is recommended in the literature, this study reported a high rate of osteosynthesis by pins whereas screws and plates were more recommended. Open reduction was also recommended and was the strategy of choice in this study. An M2 fracture was often associated with Lisfranc dislocations. The quality of reduction was essential and was better with open reduction and screw fixation.

Introduction: Talar fracture is rare. Treatment is surgical for neck and/or body fractures with displacement. The aims of the present study were to collect epidemiological data on talar fractures, and to assess the impact of trauma via various functional scores and radiographic impact in the medium term. Hypothesis: Displaced talar fracture shows negative medium-term functional and radiological/clinical impact. Material and methods: A multicenter retrospective study was performed with a minimum follow-up of 12 months post-trauma. Inclusion criteria included radiographic assessment at a minimum 12 months post-trauma and data on 3 functional scores: SF12, AOFAS and FAAM. 225 patients were initially included, 81 of whom had follow-up with functional and radiological/clinical assessment. Results: Fracture reduction was anatomic in 61% of cases when CT was performed; reduction quality was independent of approach (p > 0.05). 45% of patients showed subtalar osteoarthritis at a mean 2 years, significantly related to reduction defect (p < 0.05). Mean AOFAS score was acceptable, at 74/100. Factors for functional prognosis comprised: reduction quality, hindfoot alignment, subtalar osteoarthritis, and talar osteonecrosis with dome collapse. Discussion: Talar fracture led to late complications with socioeconomic impact. Subtalar osteoarthritis affects almost half of patients within some months of trauma. Optimal reduction is the key to fair progression. Postoperative CT assessment now seems mandatory. Level of evidence: IV; multicenter retrospective study. (c) 2021 Elsevier Masson SAS. All rights reserved.

Background: Isolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism. Methods: Case/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure. Results: Maximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group. Conclusions: IGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Les fractures du talus sont rares. Les fractures du col et/ou du corps déplacées sont traitées chirurgicalement. Cette étude avait pour objectifs : recueillir des données épidémiologiques des fractures du talus et évaluer par différents scores fonctionnels le retentissement à distance du traumatisme et les conséquences radiographiques à moyen terme. Les fractures déplacées du talus ont des conséquences fonctionnelles et radio-cliniques à moyen terme défavorables. Une étude multicentrique auprès de plusieurs centres a été réalisée. Le recul minimum était de 12 mois par rapport au traumatisme. Un bilan radiographique datant de plus de 12 mois par rapport au traumatisme et le recueil de 3 scores fonctionnels (SF12, AOFAS, FAAM) étaient obligatoires. Deux cent vingt-cinq patients ont été inclus, mais 81 ont pu être revus à distance pour l’évaluation fonctionnelle et radio-clinique. La qualité de la réduction de la fracture était considérée comme anatomique dans 61 % des cas sur l’évaluation tomodensitométrique postopératoire lorsqu’elle était réalisée. La qualité de la réduction ne dépendait pas de la voie d’abord chirurgicale (p > 0,05). L’arthrose sous-talienne concernait 45 % des patients de la série au recul moyen de 2 ans. Une réduction imparfaite était liée à la survenue d’arthrose sous-talienne de manière significative (p < 0,05). Le score AOFAS moyen était de 74/100, considéré comme acceptable. Les facteurs de mauvais pronostic fonctionnel étaient : la qualité de la réduction, l’axe de l’arrière pied, la survenue d’arthrose sous-talienne et la présence d’une ostéonécrose talienne avec effondrement du dôme. Les fractures du talus sont sources de complications tardives, entraînant un impact socioéconomique défavorable pour les patients. L’arthrose sous-talienne atteint près de la moitié des patients quelques mois après le traumatisme. Une réduction optimale semble être le gage d’une évolution favorable. L’évaluation postopératoire par un scanner paraît dorénavant nécessaire. IV ; étude rétrospective multicentrique.

Tibial eminence fractures can occur in adults and are equivalent to an acute ACL rupture. The purpose of this retrospective study was to compare the therapeutic outcomes of ARIF versus ORIF in tibial eminence fractures. Our hypothesis was that ARIF does not offer better results. A retrospective national multicentric study was conducted in five university hospitals between 2010 and 2015. A total of 65 consecutive patients were included. 33 patients were treated with ARIF and 32 with ORIF. Clinical functional outcomes were assessed using the Lysholm score and IKDC score. Radiographic findings were recorded, and a statistical analysis carried out. IKDC score at the mean last follow-up of 68.8 ± 11.8 months was significantly higher in the ORIF group with a mean difference of 20.2 points ± 8.9 (p = 0.028). There were early osteoarthritis findings in 12 patients (18.4%). At last follow-up, 7 patients (10.7%) presented complications. In this retrospective multicentric study, better functional outcomes were observed in the ORIF group. This difference needs to be carefully interpreted as many confounding factors exist. In terms of complications, the results for both ORIF and ARIF are similar at midterm follow-up. ORIF should remain gold standard for tibial eminence fracture treatment. III.

La dysplasie épiphysaire hémimélique (DEH) est une maladie rare d’étiologie inconnue consistant en une croissance ostéocartilagineuse anormale de l’épiphyse, généralement hémimélique avec des résultats histologiques similaires à ceux d’un ostéochondrome bénin. Dans cette description de cas, nous avons décrit les résultats du traitement chirurgical de deux cas consécutifs de localisation intra-articulaire de cheville de DEH. Les patients étaient âgés de trois et six ans. Ils mettent en évidence la DEH dans le diagnostic différentiel de la déformation douloureuse de la cheville de l’enfant. Le but de cette étude est de familiariser les cliniciens avec cette entité rare.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The article is a duplicate of a paper that has already been published in Foot Ankle Int. 2015 Oct;36(10):1229-34. doi: 10.1177/1071100715587232. One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper is not under consideration for publication elsewhere. Therefore, in order to comply with accepted standards of scientific publishing, as well as journal policies, the article is retracted. RETRACTED: Posterior Arthroscopic Tibiotalar Arthrodesis: Anatomic Feasibility StudyThe Journal of Foot and Ankle SurgeryVol. 56Issue 4PreviewThis article has been retracted: please see Elsevier Policy on Article Withdrawal ( http://www.elsevier.com/locate/withdrawalpolicy ). This article has been retracted at the request of the Editor-in-Chief. The article is a duplicate of a paper that has already been published in Foot Ankle Int. 2015 Oct;36(10):1229-34. https://doi.org/10.1177/1071100715587232 . One of the conditions of submission of a paper for publication is that authors declare explicitly that the paper is not under consideration for publication elsewhere. Full-Text PDF

OBJECTIVE: Spinal diseases often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled pilot study assessed the Vicon system for detecting sagittal spinopelvic imbalance, to determine the correlations between optoelectronic and radiographic parameters.METHODS: Reversible anterior sagittal imbalance was induced in 24 healthy men using a thoracolumbar corset. Radiographic, optoelectronic, and comparative analyses were conducted.RESULTS: Corset wearing induced significant variations in radiographic parameters indicative of imbalance; the mean C7- tilt and d/D ratio increased by 15(circle) +/- 7.4(circle) and 359%, respectively, whereas the mean spinosacral angle decreased by 16.8(circle) +/- 8(circle) (all P < 0.001). The Vicon system detected the imbalance; the mean spinal angle increased by 15.4(circle) +/- 5.6(circle) (P < 0.01), the mean floor projection of the C7S1 vector (C7'S1') increased by 126.3 +/- 51.9 mm (P < 0.001), and the mean C7- T1'- S1 angle decreased by 9.8(circle) +/- 3(circle) (P < 0.001). Variations in C7'S1' were significantly correlated with d/D ratio (p = 0.58; P < 0.05) and C7- tilt (p - 0.636; P < 0.05) variations.CONCLUSIONS: Corset wearing induced radiographically confirmed anterior sagittal imbalance detected using the Vicon system. Optoelectronic C70S10 correlated with radiographic C7- tilt and d/D ratio.

Introduction : Les hallux valgus des sujets jeunes sont souvent associes a des phenomenes douloureux marques en regard du bunion, alors que la deformation clinique reste parfois modeste. La presence d’un tissu « meniscal » d’interposition riche en fibres nerveuses pourrait expliquer ces phenomenes douloureux. Le but de notre etude anatomopathologique etait de comparer la structure histologique de ce tissu meniscal des hallux valgus operes dans les formes congenitales (distal metatarsal articular angle > 10°) ou degeneratives (distal metatarsal articular angle : Une analyse histologique du menisque de l’hallux etait realisee sur une serie continue de 30 patients operes pour un hallux valgus congenital (15 cas) ou degeneratif (15 cas). Il etait realise une arthrotomie mediale horizontale, une resection du bunion et du menisque situe a sa face mediale, une osteotomie de type chevron du premier metatarsien et une autre de type Akin sur P1 fixees par vis. L’analyse histologique evaluait la presence de fibres nerveuses, de fibrocartilage, d’inflammation, de synovite et de mucine. Chacun de ces criteres etait classe en trois stades (tissu absent, tissu present en faible quantite, tissu present en grande quantite). Resultats : Il existait une repartition bimodale de la population, avec un âge statistiquement plus jeune pour les formes congenitales. Tous les sujets etaient de sexe feminin. La presence de fibres nerveuses et de synovite etait correlee au jeune âge et a la forme congenitale de l’hallux. La mucine etait correlee aux sujets plus âges et a la forme degenerative de l’hallux. Discussion : Il existe un tissu d’interposition a la face mediale du bunion, decrit comme un menisque par certains auteurs. Sa structure histologique reste cependant tres differente du menisque du genou. La presence importante de fibres nerveuses dans les formes congenitales pourrait expliquer les crises douloureuses frequentes des sujets jeunes, alors que la deformation locale de l’hallux valgus reste modeste. Il nous est par contre impossible de conclure sur une eventuelle modification de la structure de ce tissu « meniscal » avec l’âge.

Open reduction and internal fixation of complex proximal humeral fracture represents a surgical challenge. The main objective of this procedure is to anatomically reduce the tuberosities. We propose a standardized and reproducible technique that we apply to all complex displaced 3- and 4-part fractures of patients under 50 years. We use an antero-lateral trans-deltoid approach; the humeral head and the tuberosities are reduced under fluoroscopic control. The tuberosities are stabilized with an inter-tuberosity osteosuture, and we then introduce a thin and straight intra-medullary nail (Telegraph IV FH Orthopedics) at the hinge point of the humeral head. The osteosynthesis of the tuberosities is completed by 3- or 4-self-stable divergent screws in the nail. A dynamic distal locking stabilizes the humeral shaft in rotation and facilitates consolidation thanks to micro movements. The removal of the nail with an arthroscopic shoulder arthrolysis in case of stiffness is possible secondarily.

Background: Operative indications for an anterior arthroscopic tibiotalar arthrodesis are well defined. A posterior approach with the patient in a prone position may be indicated when the anterior approach is precluded by the soft tissue condition or for a 1-step procedure associated with posterior approach subtalar fusion. Methods: An anatomic study assessed the feasibility of posterior arthroscopic tibiotalar fusion and sought to determine arthroscopy entry points, mortise cartilage freshening quality, and the risk of osseous, tendinous, vascular, and neural complications. Twenty-two zones of the fibular tibiotalar mortise were mapped from 10 specimens. Medial and lateral para-Achilles arthroscopic portals were used with a 4 mm 30-degree arthroscope. Chondral resection was performed with a motorized burr, curette, and osteotome. Results: The entire plafond of the tibia could be debrided in all cases, whereas the talar dome was debrided in its entirety in 20% of cases; in 80%, only the posterior two-thirds could be treated with the anterior portion approaching the neck of the talus being poorly accessible. More than 50% of the area of the malleolar grooves was debrided. There was 1 medial malleolar fracture and 1 peroneal artery lesion. Conclusion: The technique was shown to be feasible if there was no frontal hindfoot deformity or tibiotalar equinus preventing satisfactory resection of the posterior and anterior talar cartilage. Clinical Relevance: This study demonstrated that a posterior approach arthroscopic ankle fusion would lead to adequate joint preparation. This procedure reduces the risk of nerve damage.

La brièveté des gastrocnémiens est fréquente. Elle est associée à de nombreuses pathologies du pied et de la cheville. La physiopathologie de cette association n’est pas clairement établie. Nous avons réalisé une revue de la littérature afin d’apprécier les connaissances scientifiques actuelles sur l’impact d’une brièveté des gastrocnémiens sur la marche. Nous espérions ainsi affiner la compréhension de cette association entre brièveté des gastrocnémiens et pathologies du pied et de la cheville.

The use of fluoroscopy is necessary during proximal femoral fracture (PFF) osteosynthesis. The frequency of these procedures justifies a description of radiation exposure and comparisons between different techniques and between the different surgical team members.

Anterior arthroscopic tibiotalar arthrodesis has been well codified. A posterior approach with the patient in prone position is indicated when the anterior approach is precluded by soft tissue issues or for a 1-step procedure associated with posterior subtalar fusion. In an anatomic study, we assessed the feasibility of posterior arthroscopic tibiotalar fusion and sought to determine the arthroscopy entry points, mortise cartilage freshening quality, and risk of osseous, tendinous, vascular, and neural complications. We mapped 22 zones of the fibular tibiotalar mortise from 10 specimens. Medial and lateral pars-Achilles arthroscopic approaches were used, with a 4-mm arthroscope at 30. For chondral resection, we used a motorized burr, curette, and osteotome. The entire plafond of the tibial mortise could be freshened in all cases, but the talar dome could be freshened in its entirety in only 20% of cases. In 80%, only the posterior two thirds could be treated, because the anterior portion descending to the neck of the talus was poorly accessible. More than 50% of the area of the malleolar grooves was freshened. One medial malleolar fracture and one posterior fibular artery lesion developed. Thus, the technique was shown to be feaSible, if no frontal hindfoot deformity or tibiotalar equinus is present, which would prevent satisfactory resection of the posterior and anterior talar cartilage. The procedure allows for single-step associated subtalar fusion, requiring 2 complementary arthroscopic approaches, 1 cm distally. (C) 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.

L’examen clinique de l’épaule douloureuse post-traumatique est souvent difficile, et l’orientation diagnostique est plus volontiers guidée vers la pathologie tendineuse, plus fréquente que la souffrance nerveuse périphérique. Cependant, la souffrance du nerf supraclaviculaire risque d’être négligée, faute de la rechercher, et les demandes d’imagerie et les propositions thérapeutiques peuvent être erronées, voire même contestables. Nous avons souhaité reprendre notre expérience clinique dans ce domaine de la souffrance chronique d’un nerf sensitif. Cette étude rétrospective sur dix ans non exhaustive a réuni 25 dossiers de patients pour lesquels le diagnostic de souffrance chronique du nerf supraclaviculaire a été posé. Vingt dossiers de procédures d’expertises en contentieux ou en sapiteur pour des compagnies d’assurances, et 5 dossiers de consultation spécialisée en chirurgie de l’épaule ont été analysés. Les 25 dossiers concernaient 9 hommes et 16 femmes, actifs, qui avaient été victimes d’un accident par abaissement brutal de l’épaule ou par choc direct sur l’épaule dans la moitié des cas par ceinture de sécurité. Le délai entre l’accident et la mise en évidence clinique de la souffrance du nerf supraclaviculaire était en moyenne de 21 mois (6 mois à 7 ans). Le signe de Tinel positif sur un, deux ou trois rameaux du nerf supraclaviculaire, affirmait le diagnostic, confirmé par le territoire d’hypoesthésie sous-claviculaire et/ou sous-acromial. Les parcours des patients étaient assez semblables en termes d’imagerie et de thérapeutique : 1 à 5 échographies d’épaule, 1 à 5 arthrotomodensitométries ou IRM de coiffe, 6 à 150 séances de kinésithérapie, 1 à 3 arthroscopies pour acromioplastie et/ou ténotomie bicipitale. L’efficacité totale de l’infiltration anesthésique-test sur les zones gâchettes lorsqu’elle a pu être réalisée en complément des procédures expertales ou systématiquement en consultation : a confirmé le diagnostic, a procuré un soulagement complet immédiat des douleurs d’épaule, et a permis l’examen réel de l’épaule. Le décollement sous-cutané par l’injection des zones de fibrose péri-nerveuses sur la clavicule et/ou sur l’acromion a permis en règle le soulagement à terme des patients. La mise en balance du délai d’évolution, du nombre d’examens d’imagerie, du nombre de séances de kinésithérapie, du nombre d’interventions non justifiées, versus l’efficacité d’une goutte de Lidocaïne, mérite de ne pas oublier cette explication nerveuse d’une épaule douloureuse post-traumatique.

Resume Introduction La reconstruction du ligament croise anterieur (RLCA) en ambulatoire est une procedure qui se developpe en France, sous l’impulsion de mesures economiques. La douleur reste la premiere cause d’echec pouvant necessiter une hospitalisation. L’objectif de cette etude etait de definir les meilleures modalites anesthesiques et analgesiques pour ce type de prise en charge. Materiel et methode Une etude prospective multicentrique comparative a ete menee entre janvier 2014 et avril 2015. Les criteres d’inclusion etaient les RLCA chez des patients âges de plus de 15 ans en ambulatoire. Les modalites anesthesiques analysees etaient l’anesthesie generale, la rachi-anesthesie et le quadribloc. Les techniques analgesiques etudiees etaient les blocs nerveux en injection unique ou a diffusion lente par catheter, les infiltrations d’anesthesiques locaux periarticulaires et intra-articulaires, les anti-inflammatoires non steroidiens (AINS) et les corticoides intraveineux. Le critere de jugement principal etait la douleur selon l’echelle de visualisation analogique (EVA). Les criteres secondaires etaient les echecs d’ambulatoire, la consommation d’opioide et les complications selon les differentes techniques anesthesiques et des modalites analgesiques. Resultats Six cent quatre-vingt patients ont ete inclus dans cette etude, ce qui correspondait a 63 % des RLCA. Il s’agissait de 69 % d’hommes et 31 % de femmes, avec un âge moyen de 30 ans. Vingt-trois patients (3,4 %) n’ont pas pu sortir le jour de l’intervention (echec d’ambulatoire). Aucune correlation n’a ete retrouvee selon la technique d’anesthesie utilisee. Le traitement par AINS etait un facteur protecteur d’echec d’ambulatoire ( p = 0,009) et la consommation d’opioide un facteur de risque ( p Discussion Tout type d’anesthesie est compatible avec la RLCA en ambulatoire. A la lumiere de cette etude, aucun gold standard analgesique ne peut etre defini. Cependant, nous recommandons une analgesie multimodale associant infiltration d’anesthesiant local periarticulaire ou bloc nerveux one-shot sensitif de type saphene, un traitement par AINS et glucocorticoide, et la cryotherapie. Niveau de preuve Niveau II, etude prospective comparative non randomisee.

Introduction: More and more anterior cruciate ligament (ACL) reconstructions are being performed as outpatient surgery in France, because of economic considerations. Postoperative pain is the most common reason for delayed discharge that could require hospitalization, and the main reason for unanticipated hospital admission. The purpose of this study was to define the best anesthesia and analgesia methods for ACL reconstruction.Materials and methods: This was a prospective, multicenter, comparative study performed between January 2014 and April 2015. Inclusion criteria were ACL reconstruction in patients above 15 years of age performed as an outpatient surgical procedure. The anesthesia techniques analyzed were general anesthesia, spinal anesthesia and quadruple nerve blockade. The analgesic methods studied were single-shot nerve blocks, continuous nerve blocks, peri-articular and intra-articular local infiltration analgesia (LIA), non-steroidal anti-inflammatory agents (NSAIDs) and intravenous corticosteroids. The main outcome criterion was pain on a visual analog scale (VAS). The secondary outcome criteria were delayed discharge of a patient who had undergone outpatient surgery, consumption of opioids and complications for the various anesthesia techniques and analgesia methods.Results: In all, 680 patients were included in this study, which was 63% of the ACL reconstruction procedures performed during this period. The study population was 69% male and 31% female, with an average age of 30 years. Twenty-three patients (3.4%) could not be discharged on the day of surgery. No correlation was found with the anesthesia technique used. NSAID treatment was protective relative to delayed discharge (P=0.009), while opioid consumption was a risk factor (P<0.01). There were no differences in the pain levels related to the type of anesthesia. Peri-articular LIA of the hamstring tendon harvest site was effective. Intra-articular LIA did not provide better analgesia. Continuous nerve block had complication rates above 13%.Discussion: All types of anesthesia were compatible with outpatient ACL reconstruction. No gold standard analgesia method can be defined based on this study's findings. However, we recommend multimodal analgesia associating peri-articular LIA or one-shot sensory saphenous nerve block, NSAIDs and corticosteroid treatment, and cryotherapy. (C) 2016 Elsevier Masson SAS. All rights reserved.

Platelet rich plasma (PRP) has been used for around ten years in degenerative and traumatic diseases of the locomotor apparatus by sports physicians, rheumatologists, radiologists and orthopaedic surgeons. Indications are currently increasing, unfortunately, however, there is a lack of evidence regarding the efficacy of PRP in these new indications. The aim of this article is to carry out a review of the literature, in order to state the level of evidence for the efficacy of PRP in five major diseases.

Arthroscopy has become indispensable for performing tibiotalar and subtalar arthrodesis. Now in 2015, it is the gold-standard surgical technique, and open surgery is reserved only for cases in which arthroscopy is contraindicated: material ablation after consolidation failure, osteophytes precluding a work chamber, excentric talus, severe malunion, bone defect requiring grafting, associated midfoot deformity, etc. The first reports of arthroscopic tibiotalar and subtalar arthrodesis date from the early 1990s. Consolidation rates were comparable to open surgery, but with significantly fewer postoperative complications: infection, skin necrosis, etc. Arthroscopy was for many years reserved to moderate deformity, with frontal or sagittal deviation less than 10°. The recent literature, however, seems to extend indications, the only restriction being the surgeon's experience. Tibiotalar arthrodesis on a posterior arthroscopic approach remains little used. And yet the posterior work chamber is much larger, and initial series showed consolidation rates similar to those of an anterior approach. The surgical technique for posterior tibiotalar arthrodesis was described by Van Dijk et al., initially using a posterior para-Achilles approach. This may be hampered by posterior osteophytes or ankylosis of the subtalar joint line (revision of non-consolidated arthrodesis, sequelae of calcaneal thalamus fracture) and is now used only by foot and ankle specialists. Posterior double tibiotalar-subtalar arthrodesis, described by Devos Bevernage et al., is facilitated by transplantar calcaneo-talo-tibial intramedullary nailing.