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Mulligan RP, Adams SB, Easley ME, DeOrio JK, Nunley JA. Comparison of Posterior Approach With Intramedullary Nailing Versus Lateral Transfibular Approach With Fixed-Angle Plating for Tibiotalocalcaneal Arthrodesis. Foot Ankle Int 2017; 38:1343-1351. [PMID: 28952355 DOI: 10.1177/1071100717731728] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A variety of operative approaches and fixation techniques have been described for tibiotalocalcaneal (TTC) arthrodesis. The intramedullary (IM) nail and lateral, fixed-angle plating are commonly used because of ease of use and favorable biomechanical properties. A lateral, transfibular (LTF) approach allows for direct access to the tibiotalar and subtalar joints, but the posterior, Achilles tendon-splitting (PATS) approach offers a robust soft tissue envelope. The purpose of this study was to compare the results of TTC arthrodesis with either a PATS approach with IM nailing or LTF approach with fixed-angle plating. METHODS A retrospective review was performed on all patients who underwent simultaneous TTC arthrodesis with minimum 1 year clinical and radiographic follow up. Patients were excluded if they underwent TTC arthrodesis through an approach other than PATS or LTF, and received fixation without an IM nail or fixed-angle plate. Primary outcomes examined were union rate, revisions, and complications. Thirty-eight patients underwent TTC arthrodesis with a PATS approach and IM nailing, and 28 with a LTF approach and lateral plating. RESULTS The overall union rate was 71%; 76% (29 of 38 patients) for the PATS/IM nail group, and 64% (18 of 28) for LTF/plating group ( P = .41). Symptomatic nonunion requiring revision arthrodesis occurred in 16% (6 of 38) of the PATS/IM nail group versus 7% (2 of 28) in the LTF/lateral plating group ( P = .45). There were no significant differences in individual tibiotalar or subtalar union rates, superficial wound problems, infection, symptomatic hardware, stress fractures, or nerve irritations. CONCLUSION Union, revision, and complication rates were similar for TTC arthrodesis performed with a PATS approach and IM nail compared with an LTF approach and fixed-angle plate in a complex patient population. Both techniques were adequate, especially when prior incisions, preexisting hardware, or deformity preclude options. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ryan P Mulligan
- 1 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel B Adams
- 1 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mark E Easley
- 1 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - James K DeOrio
- 1 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- 1 Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Abstract
UNLABELLED Tibiotalocalcaneal arthrodesis with an intramedullary nail is a procedure reserved for patients who have conditions affecting the ankle joint and subtalar joint. The most common complications include nonunion, malunion, delayed union, infection, periprosthetic fracture, hardware failure, lateral plantar nerve injury, and wound healing. Significant bone void may result if the hardware requires removal secondary to one of these complications. The purpose of this article is to report on 2 cases of infected intramedullary nails, which were revised with fibular inlay strut grafts. Both cases were augmented with either internal or external fixation. LEVELS OF EVIDENCE Therapeutic, Level IV: Case report.
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Affiliation(s)
- Spencer J Monaco
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (SJM).,Washington Hospital, Washington, Pennsylvania (NL).,Trinity Clinic, Tyler, Texas (BC)
| | - Nick Lowery
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (SJM).,Washington Hospital, Washington, Pennsylvania (NL).,Trinity Clinic, Tyler, Texas (BC)
| | - Brandon Crim
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (SJM).,Washington Hospital, Washington, Pennsylvania (NL).,Trinity Clinic, Tyler, Texas (BC)
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Özer D, Bayhan Aİ, Keskin A, Sarı S, Kaygusuz MA. Tibiotalocalcaneal arthrodesis by using proximal humeral locking plate. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:389-92. [PMID: 27519965 PMCID: PMC6197364 DOI: 10.1016/j.aott.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/26/2015] [Accepted: 01/16/2016] [Indexed: 11/22/2022]
Abstract
Objectives The aim of this study was to evaluate the short-term clinical and radiological results of tibiotalocalcaneal arthrodesis (TTCA) with proximal humeral locking plate. Material and methods Eight patients (7 female, 1 male; average age 53 years (range: 24–67)) who underwent TTCA with proximal humeral locking plate between 2009 and 2011, were retrospectively evaluated with AOFAS hindfoot scale and Maryland foot score system. The mean follow up was 32.6 months (range: 23–54). Results Complete fusion was achieved in 7 patients. Soft tissue infection was observed in 2 patients and reflex sympathetic dystrophy in 3 patients. All patients recovered with medical treatment. At the final follow-up, mean AOFAS Hindfoot score was 60 (range: 41–81) and Maryland Foot Score was 67.8 (range: 41–85). The satisfactory rates of AOFAS and MFS were found as 12.5% (1/8) and 50% (4/8), respectively. One patient had an incomplete union with 5 degrees of heel varus deformity and 5 degrees of equinus deformity was observed in another. There were no implant failure or deformation of the plate during the follow-up period. Conclusion Our study suggests that proximal humeral plate may be an alternative for fixation in tibiotalocalcaneal fusion surgery.
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Peterson KS, Chapman WD, Hyer CF, Berlet GC. Short-Term Radiographic Results and Technique of Tibiotalocalcaneal Arthrodesis With a Posterior Anatomic Locking Plate. J Foot Ankle Surg 2016; 55:906-9. [PMID: 27106523 DOI: 10.1053/j.jfas.2016.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Indexed: 02/03/2023]
Abstract
Tibiotalocalcaneal arthrodesis is a salvage procedure for severe hindfoot/ankle deformities, arthritis, avascular necrosis of the talus, failed total ankle replacement, and Charcot neuroarthropathy. The methods for fixation include anterior and lateral plates, screws, retrograde intramedullary nails, and external fixation. The purpose of the present report was to describe the short-term radiographic outcomes and technique using a posterior approach with an anatomic-specific locking plate for tibiotalocalcaneal arthrodesis. Nine patients underwent tibiotalocalcaneal arthrodesis using a posterior locking plate. The medical records and radiographs were retrospectively reviewed for patient demographics, fusion rate, complications, and patient satisfaction. The mean patient age was 57.89 ± 10.8 years, and the follow-up period was 11.11 ± 4.74 months for the patients undergoing posterior tibiotalocalcaneal arthrodesis. The mean time to weightbearing in a shoe with a brace was 16.68 weeks. The ankle and subtalar joints had healed within a mean duration of 13.61 ± 2.96 weeks. Two patients (22%) developed nonunion, 1 at both the ankle and subtalar joint and 1 at the ankle only. The present report demonstrates an alternative posterior approach to joint preparation and fixation. Direct visualization of both joints and soft tissue coverage provide a viable option for posterior fusion in patients with compromised anterior and/or lateral skin envelopes.
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Affiliation(s)
| | - W Drew Chapman
- Attending Physician, Harvard Foot and Ankle, Hollywood, FL
| | | | - Gregory C Berlet
- Attending Physician, Orthopedic Foot and Ankle Center, Westerville, OH.
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Kheir E, Borse V, Bryant H, Farndon M. The use of the 4.5 mm 90° titanium cannulated LC-angled blade plate in tibiotalocalcaneal and complex ankle arthrodesis. Foot Ankle Surg 2015; 21:240-4. [PMID: 26564724 DOI: 10.1016/j.fas.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/23/2014] [Accepted: 12/23/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibiotalocalcaneal arthrodesis is used to manage end stage arthritis, often associated with severe bone loss. The goal is to relieve pain through a stable, well-aligned hindfoot and ankle. We describe our initial results and outcome of ankle and tibiotalocalcaneal arthrodesis using a 90° blade plate. METHODS We retrospectively reviewed the records of patients managed at our institution between 2010 and 2014. Twenty cases were identified who had either talocrural (n = 9) or TTC fusion (n = 11) with 1 patient having both ankle and then TTC fusion in separate sittings. RESULTS Fusion occurred in 18 of the 20 cases (90%) with correction of angular deformity and restoration of hindfoot alignment. None of the 18 patients developed complications and all discharged to follow-up when independently mobile and satisfied with the outcome. CONCLUSIONS This study demonstrated that using a 90° blade plate for ankle or TTC arthrodesis in a diverse group of complex primary and revision indications associated with severe deformity and bone loss resulted in a high rate of bony union and stable deformity correction.
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Affiliation(s)
- Ehab Kheir
- Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate HG2 7SX, United Kingdom.
| | - Vishal Borse
- Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate HG2 7SX, United Kingdom
| | - Helen Bryant
- Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate HG2 7SX, United Kingdom
| | - Mark Farndon
- Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate HG2 7SX, United Kingdom
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Caixeta TB, Júnior MOC, de Castro RV, Martins JS, Costa EN, Albieri AD, de Moraes FB. Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing: 29 patients' clinical and functional evaluation. Rev Bras Ortop 2014; 49:56-61. [PMID: 26229773 PMCID: PMC4511752 DOI: 10.1016/j.rboe.2013.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/13/2013] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate clinically and functionally the pos-operative results of patients submitted to tibiotalocalcaneal arthrodesis for the treatment of traumatic arthropathy and neuropathy. Methods Retrospective study of 29 patients undergoing ankle arthrodesis with intramedullary retrograde nail. All patients were evaluated for fusion time, AOFAS and VAS scores, satisfaction, and complications of surgery. The mean follow-up was 36 months (range 6–60 months). Results The union rate was 82%, and the consolidation occurred on average at 16 weeks (10–24 weeks). The pos-operative AOFAS score improved in 65.5% (average of 57.7 on neurological cases and 75.7 on cases pos-traumatic) and VAS score improved 94.1% (average of 2.3 on neurological cases and 4,2 on post-traumatic cases), and 86% of patients were satisfied with the procedure performed. Complications occurred in 11 patients (38%), including pseudoarthrosis (17.24%), infection (17.24%), material failure (13.8%) and fracture (13.8%). Conclusion Tibiotalocalcaneal arthrodesis with retrograde intramedullary nail proved to be a good option for saving the ankle joint, with improvement of clinical and functional scores (AOFAS = 65.5% and VAS = 94.1%).
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Affiliation(s)
- Thiago Barbosa Caixeta
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Régis Vieira de Castro
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Jefferson Soares Martins
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Edegmar Nunes Costa
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Alexandre Daher Albieri
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | - Frederico Barra de Moraes
- Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, GO, Brazil
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Artrodese tibiotalocalcaneana com haste intramedular retrógrada: avaliação clínica e funcional de 29 pacientes. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rigby RB, Cottom JM. Lateral simultaneous reaming technique with femoral head allograft implantation for tibiocalcaneal arthrodesis: a case report. Foot Ankle Spec 2013; 6:45-9. [PMID: 23074292 DOI: 10.1177/1938640012463055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Femoral head allograft is an accepted alternative for significant bone loss in severe hindfoot reconstruction. This is primarily because the size and shape of the graft provides not only structural support but additionally prevents significant loss of limb length. We present a case using a technique from a directly lateral approach and simultaneous preparation of the tibia and calcaneus for tibiocalcaneal arthrodesis. Acetabular resurfacing reamers were used to prepare the joint for grafting as well as sculpt the graft itself for near press fit between the tibia and calcaneus. Fixation with a lateral locking plate avoids the unnecessary decompression reaming of the graft core itself, ultimately sparing the valuable poles of the graft for increased likelihood of incorporation.
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Affiliation(s)
- Ryan B Rigby
- Sarasota Orthopedic Associates, Sarasota, Florida 34239, USA.
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DeHeer PA, Catoire SM, Taulman J, Borer B. Ankle arthrodesis: a literature review. Clin Podiatr Med Surg 2012; 29:509-27. [PMID: 23044060 DOI: 10.1016/j.cpm.2012.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ankle joint arthrodesis should be considered the gold standard procedure for end-stage ankle arthritis in the appropriate patient. Incisional approach and fixation technique should be based on the patient and specific needs. Arthrodesis can be achieved with adequate resection of cartilage, good compression across the fusion site, stable fixation, proper postoperative protocol, and patient compliance. It is important to remember that positioning of the ankle joint is a keystone in ankle arthrodesis. There are complications that can arise from the ankle fusion, including the need for further surgical intervention owing to arthritis in the subtalar and midtarsal joints.
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TIBIOTALOCALCANEAL ARTHRODESIS WITH LATERAL COMPRESSION PLATE: ARTRODESE TIBIO-TALO-CALCANEANA COM PLACA DE COMPRESSÁO LATERAL. Rev Bras Ortop 2012; 47:467-73. [PMID: 27047852 PMCID: PMC4799458 DOI: 10.1016/s2255-4971(15)30130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the short-term clinical and radiographic results from a TTC fusion procedure using a lateral locking plate specifically designed for this purpose. METHODS All the fourteen patients were evaluated using a variety of methods, including a visual analogue scale (VAS), the AOFAS hindfoot score and a subjective satisfaction scale. The average follow-up was 10 months. RESULTS The average AOFAS score improved from 41 points preoperatively to 63 points postoperatively. The VAS pain score decreased from 7 to 3 points. Four patients reported excellent results, eight good, one fair and one poor. CONCLUSION Our study provides support for using a specially designed plate for TTC fusion in hindfoot salvage surgery. RESUMO Objetivo: O propósito deste estudo é avaliar os resultados clínicos e radiológicos a curto prazo do procedimento de fusão tíbio-talo-calcaneana (TTC) com o uso de uma placa lateral bloqueada específicamente concebida para este fim. Métodos: Todos os 14 pacientes foram avaliados usando uma variedade de métodos, incluindo a escala analógico visual da dor (EAV), escore da AOFAS para o retropé e escala subjetiva de satisfação. O acompanhamento médio foi de 10 meses. Resultados: O escore AOFAS médio melhorou de 41 pontos no período pré-operatório para 63 pontos no período pós-operatório. O escore da dor (EAV) caiu de 7 para 3 pontos. Quatro pacientesforam classificados como excelentes resultados, oito bons, um moderado e um ruim. Conclusão: Nosso estudo dá suporte ao uso da placa especialmente desenhada para a fusão tibio-talo-calcaneana (TTC) nas cirurgias de salvamento do retropé.
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DiDomenico LA, Wargo-Dorsey M. Tibiotalocalcaneal arthrodesis using a femoral locking plate. J Foot Ankle Surg 2011; 51:128-32. [PMID: 21945399 DOI: 10.1053/j.jfas.2011.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Indexed: 02/03/2023]
Abstract
The goal of a tibiotalocalcaneal arthrodesis is to create a pain-free, stable hindfoot and ankle. Although a reserved procedure, it is useful when simultaneous ankle and subtalar joint pathology exists. Numerous complications have been reported after tibiotalocalcaneal arthrodesis, most importantly nonunion. Locking plates have proved to be a more stable construct than alternative forms of arthrodesis. In the inverted positions, the hybrid plating of the femoral locking plate structurally aligns with the anatomy of the hindfoot. This provides an anatomically sound construct, while allowing for both locking and lag screw insertion. We describe a new technique using a 4.5-mm condylar plate for tibiotalocalcaneal arthrodesis.
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Didomenico LA, Sann P. Posterior approach using anterior ankle arthrodesis locking plate for tibiotalocalcaneal arthrodesis. J Foot Ankle Surg 2011; 50:626-9. [PMID: 21737315 DOI: 10.1053/j.jfas.2011.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/05/2011] [Indexed: 02/03/2023]
Abstract
Tibiotalocalcaneal arthrodesis is a successful treatment for patients with severe pain and functional disability in the ankle and subtalar joint. Patients with post-traumatic ankle and subtalar joint arthritis, and/or Charcot deformity, often present with compromised skin and soft tissue structures. In the present report, we describe a technique using an anterior ankle arthrodesis locking plate placed posteriorly to obtain hindfoot and ankle fusion. This technique, which uses the well vascularized, thick, posterior soft tissue envelope, provides very good exposure of the articular surfaces for resection and tibiotalocalcaneal fusion. The technique provides a valuable option for patients with compromised skin and soft tissue structures over aspects of the ankle that make other approaches risky and complicated.
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