title: Open triple fusion versus TNC arthrodesis in the treatment of Mueller-Weiss disease.
abstract: BACKGROUND
  Mueller-Weiss disease is a rarely diagnosed deformity where the navicular bone undergoes spontaneous osteonecrosis in adults. Until now, there is no widely accepted operative treatment for this unusual disease. We aimed to compare clinical and radiological outcomes between the open triple fusion and talonavicular-cuneiform arthrodesis for Mueller-Weiss disease of stage 4.
  
  
  METHODS
  During the period from February 2012 to June 2016, 10 patients (11 feet) suffering from Mueller-Weiss disease of stage 4 were treated by the same senior surgeon. Among them, 5 patients (5 feet) were treated with open triple fusion and 5 patients (6 feet) were treated with talonavicular-cuneiform arthrodesis. Clinical outcomes were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Radiological results were assessed based on the X-ray and CT. Postoperative complications were also recorded.
  
  
  RESULTS
  There were no significant differences in AOFAS score between the two groups (p = 0.1 > 0.05). For the open triple fusion, the average AOFAS ankle-hindfoot score improved from 30.2 ± 3.27 preoperatively to 79 ± 3.81 at the last follow-up (p = 0.008). And for the talonavicular-cuneiform (TNC) arthrodesis, the average AOFAS ankle-hindfoot score improved from 33.2 ± 5.63 preoperatively to 86.2 ± 3.49 at the last follow-up (p = 0.007).
  
  
  CONCLUSIONS
  Both triple fusion and TNC arthrodesis are reasonable methods for the treatment of Mueller-Weiss disease if properly used. It is crucial to use radiological assessment to evaluate the involved joints preoperatively and then chose the appropriate method to treat different patients.
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China. 18351037117@163.com.
authors.forename: Hongtao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
authors.forename: Junkun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
authors.forename: Yusen
authors.initials: Y
authors.lastname: Qiao
authors.affiliation: Orthopedic Institute, Soochow University, 708 Renmin Rd, Suzhou, Jiangsu, 215007, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Gao
authors.affiliation: Department of Mathematics, University of Waterloo, Waterloo, N2L 3G1, Canada.
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005530:Foot Deformities / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D013628:Talus / Q000601:surgery; D013639:Tarsal Bones / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arthrodesis; Mueller-Weiss disease; Navicular; Triple fusion