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Lower Limb: P. F. Rosenfeld, S. A. Budgen, and T. S. Saxby Triple arthrodesis: is bone grafting necessary?: THE RESULTS IN 100 CONSECUTIVE CASES J Bone Joint Surg Br 2005; 87-B: 175-178 [Abstract] [Full text] [PDF]

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Letter from Kumar, Penematsa and Aravinth

Skand Kumar, S.R. Penematsa and T. Aravinth   (15 June 2005)

Triple Arthrodesis

Hazem Z Hassouna   (8 April 2005)

Letter from Kumar, Penematsa and Aravinth 15 June 2005
Skand Kumar, Orthopaedic Registrar Princess Royal Hospital, Haywards Heath, S.R. Penematsa and T. Aravinth Send letter to journal: Re: Letter from Kumar, Penematsa and Aravinth skandkumar{at}gmail.com Skand Kumar, et al.	Sir, We read this paper with interest. However, we feel that the fact that the senior author undertook all patient reviews could have led to bias as there was no independent observer. A validated outcome measure was not used and telephone interviews rather than clinical assessment were used for final assessment. The procedure was performed for a variety of conditions and no attempt was made to grade and segregate the deformity and diagnosis which would clearly influence the fusion. We note that some patients in the series had local bone grafting 'to fill any voids in the fusion surfaces'. Further details regarding bone grafting would be useful. We would also like to know if the smokers were excluded from the study. There were two patients with a previous ankle fusion who did not have bone grafting while undergoing triple arthrodesis. Although cases of nonunion were discussed, there is not sufficient evidence to claim a rate of nonunion of 100%. S KUMAR SR PENEMATSA T ARAVINTH Princess Royal Hospital, Haywards Heath, UK.
Triple Arthrodesis 8 April 2005
Hazem Z Hassouna, Orthopaedic Registrar Send letter to journal: Re: Triple Arthrodesis hhassouna{at}gmail.com Hazem Z Hassouna	Sir, I read this article with interest. However, there has been selective quoting of complications after bone grafting. The complication rate of bone grafts is usually lower than that which was mentioned in the study. A more accurate number, reflective of today's advanced surgical techniques shows that there is a complication rate of around 10%. Major complications include infection, prolonged wound drainage , large hematomas, re-operation and pain for longer than six months.1 The rating system of Angus and Cowell, although useful, has not been validated as an outcome measure scoring system. The 100% follow up rate is rather optimistic. The inclusion of different deformities as an indication for Triple Arthrodesis would weaken the purpose of the study. The need for bone grafting may be affected by the primary indication for the arthrodesis. H. Z. HASSOUNA 1. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989;3-3:192-5.