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Kim SW, Choi SM, Kim MB, Cho BK. The Effects of Tibialis Anterior Tenotomy on Wound Complications and Functional Outcomes After Anterior Fusion Plating for Severe Ankle Arthritis. J Foot Ankle Surg 2023; 62:237-243. [PMID: 35906152 DOI: 10.1053/j.jfas.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 02/03/2023]
Abstract
Nonunion is known to be a relatively common complication following ankle arthrodesis. Various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior (TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 2 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, 38 patients who underwent arthrodesis without TA tenotomy were analyzed. Functional outcomes were evaluated with Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure. Wound complication rate, time to fusion, fusion rate, time to pain relief were evaluated. Mean Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure scores significantly improved to 32.6 and 69.4 points at final follow-up, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in functional outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed a significantly lower wound complication rate (4.3%) than control group (23.7%) (p < .001). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Ankle arthrodesis using anterior fusion plate in conjunction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with excellent fusion rate and less wound complication rate. Although there were no specific functional deficits related to absence of TA tendon, further studies are needed to determine long-term effects of TA tenotomy in patients with a fused ankle.
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Affiliation(s)
- Seok-Won Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, Korea
| | - Seung-Myung Choi
- Department of Orthopaedic Surgery, Eulji University School of Medicine, Uijeongbu Hospital, Uijeongbu, Gyeonggi, Korea
| | - Min-Boo Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, Korea
| | - Byung-Ki Cho
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, Korea; Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
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Park JJ, Son WS, Woo IH, Park CH. Combined Transfibular and Anterior Approaches Increase Union Rate and Decrease Non-Weight-Bearing Periods in Ankle Arthrodesis: Combined Approaches in Ankle Arthrodesis. J Clin Med 2021; 10:jcm10245915. [PMID: 34945209 PMCID: PMC8706894 DOI: 10.3390/jcm10245915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 02/05/2023] Open
Abstract
The transfibular approach is a widely used method in ankle arthrodesis. However, it is difficult to correct coronal plane deformity. Moreover, it carries a risk of nonunion and requires long periods of non-weight-bearing because of its relatively weak stability. We hypothesized that the transfibular approach combined with the anterior approach in ankle arthrodesis wound yield a higher fusion rate and shorter non-weight-bearing period. This study was performed to evaluate the clinical and radiographic results and postoperative complications in ankle arthrodesis using combined transfibular and anterior approaches in end-stage ankle arthritis. Thirty-five patients (36 ankles) with end-stage ankle arthritis were consecutively treated using ankle arthrodesis by combined transfibular and anterior approaches. The subjects were 15 men and 20 women, with a mean age of 66.5 years (46-87). Clinical results were assessed using the visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) scores, and the ankle osteoarthritis scale (AOS) preoperatively and at the last follow-up. Radiographic results were assessed with various radiographic parameters on ankle weight-bearing radiographs and hindfoot alignment radiographs. All clinical scores significantly improved after surgery. Union was obtained in all cases without additional surgery. Talus center migration (p = 0.001), sagittal talar migration (p < 0.001), and hindfoot alignment angle (p = 0.001) significantly improved after surgery. One partial skin necrosis, two screw penetrations of the talonavicular joint, and four anterior impingements because of the bulky anterior plate occurred after surgery. In conclusion, combined transfibular and anterior approaches could be a good method to increase the union rate and decrease the non-weight-bearing periods in ankle arthrodesis.
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Affiliation(s)
- Jeong-Jin Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea; (J.-J.P.); (I.-H.W.)
| | - Whee-Sung Son
- Department of Orthopaedic Surgery, Guro Hospital, Korea University Medical Center, Seoul 08308, Korea;
| | - In-Ha Woo
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea; (J.-J.P.); (I.-H.W.)
| | - Chul-Hyun Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu 38541, Korea
- Correspondence: ; Tel.: +82-53-620-3640
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Bai Z, Yang Y, Chen S, Dong Y, Cao X, Qin W, Sun W. Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24998. [PMID: 33725876 PMCID: PMC7969227 DOI: 10.1097/md.0000000000024998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion. OBJECTIVE To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis. METHODS We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software. RESULTS A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = -2.31, 95% CI:-4.63, -2.21), intraoperative blood loss (MD = -43.37, 95%CI: -48.49, -38.25), hospital stay (MD = -1.80, 95%CI: -2.28, -1.33), and visual analog scale score (MD = -1.75, 95%CI: -2.04, -1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001). CONCLUSION Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application. PROSPERO REGISTRATION NUMBER CRD42020195727.
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Abstract
Ankle arthritis occurs primarily because of trauma and has a huge impact on patient's quality of life. Ankle arthrodesis is indicated for patients with end-stage ankle arthritis who fail conservative management. High rates of fusion can be achieved through an anterior approach. This video demonstrates an ankle arthrodesis using an anterior approach to the ankle in a patient with posttraumatic ankle arthritis.
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Abstract
Ankle arthritis is a major source of morbidity impacting a younger working age population than hip and knee arthritis. Unlike the hip and knee, more than 70% of ankle arthritis cases are post-traumatic, with the remainder being inflammatory or primary arthritis. Nonoperative treatment begins with lifestyle and shoe-wear modifications and progresses to bracing, physical therapy, anti-inflammatory medications, and intra-articular injections. Ankle arthrodesis and total ankle arthroplasty are the 2 main surgical options for end-stage ankle arthritis, with debridement, realignment osteotomy, and distraction arthroplasty being appropriate for limited indications.
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Affiliation(s)
- Vu Le
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Peter Salat
- Department of Radiology, University of Calgary, Alberta, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, Carney D, Hogan MV. Management of Posttraumatic Ankle Arthritis: Literature Review. Curr Rev Musculoskelet Med 2018; 11:546-557. [PMID: 30327933 PMCID: PMC6220012 DOI: 10.1007/s12178-018-9525-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. RECENT FINDINGS Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
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Affiliation(s)
- Samuel O Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
| | - Malcolm Dombrowski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takashi Hirase
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge L Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mitchell Weaver
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Kline
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Smith K, Araoye I, Jones C, Shah A. Outcomes of Locking-Plate Fixation for Hindfoot Fusion Procedures in 15 Patients. J Foot Ankle Surg 2018; 56:1188-1193. [PMID: 29079235 DOI: 10.1053/j.jfas.2017.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Indexed: 02/03/2023]
Abstract
Tibiotalocalcaneal arthrodesis is a salvage procedure for various end-stage foot and ankle pathologic entities. Several factors are known to influence the union rate after these procedures, including construct rigidity. The data on locked plates as a fixation technique have been inconclusive, with variable union rates reported. One recent study suggested that locking plates can lead to high nonunion rates owing to excessive rigidity. The purpose of the present study was to retrospectively examine the outcomes of locking plate fixation. We retrospectively reviewed the cases of 15 patients (7 [46.7%] male, 8 [53.3%] female) who underwent tibiotalocalcaneal, tibiocalcaneal, or tibiotalar arthrodesis fixed with a locking plate from January 2013 to January 2014. The average age was 52.19 ± 5.8 years. The mean follow-up period was 17 ± 5.3 months. We examined the overall union rates and the effects of smoking, diabetes, and rheumatologic status on the union rate. Of the 15 cases, 11 (73.3%) did not achieve union. The mean time to failure was 10 ± 5.3 months. Age, gender, smoking, diabetes, use of augmentation screws outside the plate, and operating surgeon did not have an effect on the failure rate (p > .50). In addition, gender, smoking, and diabetes did not predict for nonunion. The high failure rate of rigid locking plate fixation reported might be attributable to the high incidence of smoking and diabetic comorbidities in our study. However, excessive construct rigidity might play an important role. Larger studies are needed to establish more reliable union rates with the use of locking plates in foot and ankle fusion.
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Affiliation(s)
- Kenneth Smith
- Orthopaedic Resident, Postgraduate Year-4, Orthopaedic Division, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Ibukunoluwa Araoye
- Orthopaedic Research Fellow, University of Alabama at Birmingham, Birmingham, AL
| | - Caleb Jones
- Medical Student, Year 3, University of Alabama at Birmingham, Birmingham, AL
| | - Ashish Shah
- Director, Foot and Ankle Fellowship, Orthopaedic Division, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Kusnezov N, Dunn JC, Koehler LR, Orr JD. Anatomically Contoured Anterior Plating for Isolated Tibiotalar Arthrodesis: A Systematic Review. Foot Ankle Spec 2017; 10:352-358. [PMID: 28345364 DOI: 10.1177/1938640017700974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We performed a systematic review of the published literature to characterize patient demographic, surgical techniques, and functional outcomes to elucidate the complication and revision rates following isolated tibiotalar arthrodesis with anatomically contoured anterior plating. METHODS A comprehensive literature search was performed. Inclusion criteria were peer-reviewed studies in English, after 1990, at least 10 patients, and reporting clinical outcomes following contoured anterior plating and with follow-up of at least 80% and 1 year. Primary outcomes were fusion rate, time to fusion, return to activities, satisfaction, and functional outcome scores. Complication rates, reoperation, and revision were also extracted. RESULTS Eight primary studies with 164 patients met the inclusion criteria. The average sample size was 21 ± 10.0 patients and average age was 49.2 years with 61.6% male. Posttraumatic arthritis (49.4%) was the most common operative indication, followed by primary osteoarthrosis (18.9%). The average follow-up was 21.1 months. At this time, 97.6% of patients went on to uneventful union at a weighted average time of 18.7 weeks postoperatively. AOFAS scores improved significantly ( P < .05). 25% complication rate was reported with wound complication (7.9%) and hardware irritation (6.7%) most common. Overall, 21.3% of patients underwent reoperation; 4 for revision arthrodesis following nonunion. CONCLUSION Isolated tibiotalar arthrodesis utilizing anatomically contoured anterior plating demonstrates excellent clinical and functional outcomes at short-term follow-up. Overall, 97.6% of patients went on to fusion and functional outcomes consistently improved following surgery. Furthermore, while one-quarter of patients experienced complications, wound complications were relatively uncommon and less than one-quarter of these required surgical intervention. LEVELS OF EVIDENCE Level IV: Systematic Review.
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Affiliation(s)
- Nicholas Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - John C Dunn
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Logan R Koehler
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
| | - Justin D Orr
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
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Mitchell PM, Douleh DG, Thomson AB. Comparison of Ankle Fusion Rates With and Without Anterior Plate Augmentation. Foot Ankle Int 2017; 38:419-423. [PMID: 27920332 DOI: 10.1177/1071100716681529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal fixation construct for tibiotalar arthrodesis continues to be debated. While biomechanical data and clinical series support anterior plate augmentation, comparative studies assessing its use are sparse. The purpose of this study was to compare the rates of successful tibiotalar arthrodesis with and without anterior plate augmentation of a compression screw construct. METHODS We studied 64 patients (65 ankles) undergoing tibiotalar arthrodesis done by a single surgeon over a 10-year period (2006-2016) with anterior plate augmentation beginning in 2010. Twenty-six ankles had a construct using compression screws only and 39 ankles had anterior plate augmentation of a compression screw construct. We reviewed clinical notes, operative reports, and postoperative radiographs to evaluate for union, incidence of revision, and postoperative complications. RESULTS The nonunion rate in the compression screw (CS) cohort was 15.4% and 7.7% in the anterior plate augmentation (AP) cohort ( P = .33). The revision rate was 7.7% in the CS group and 2.6% in the AP cohort ( P = .34). The use of autograft harvested through a separate incision was 19.2% and 17.9% in the CS and AP cohorts, respectively. There were 2 deep postoperative infections in the AP group and none in the patients with CS only ( P = .24). There were no superficial wound complications in either group. CONCLUSION Anterior plate augmentation was a viable fixation strategy in tibiotalar arthrodesis. In a trend toward an improved rate of fusion and decreased revision rate in the anterior plate augmentation cohort. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Phillip M Mitchell
- 1 Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA
| | - Diana G Douleh
- 1 Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA
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Abstract
End-stage arthritis of the tibiotalar joint is disabling and causes substantial functional impairment. Most often it is the residual effect of a previous traumatic injury. Nonsurgical treatment of end-stage arthritis of the ankle includes bracing, shoe-wear modifications, and selective joint injections. For patients who fail to respond to nonsurgical modalities, the two primary treatment options are arthroplasty and arthrodesis. Each has its proponents. Although no ideal treatment of ankle arthritis exists, high-quality studies can help guide treatment in patients of varying demographics. Inherent risks are linked with each treatment option, but those of greatest concern are early implant loosening that requires revision following arthroplasty and the acceleration of adjacent joint degeneration associated with arthrodesis.
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Kestner CJ, Glisson RR, DeOrio JK, Nunley JA. A biomechanical analysis of two anterior ankle arthrodesis systems. Foot Ankle Int 2013; 34:1006-11. [PMID: 23539168 DOI: 10.1177/1071100713484007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An increasingly popular ankle fusion method uses plates and screws positioned on the anterior aspect of the tibiotalar joint. This study compared the mechanical properties of 2 contemporary plate systems for ankle arthrodesis, one based on a single anterior plate and the other comprising paired anteromedial and anterolateral plates. METHODS Ten matched pairs of fresh-frozen cadaver ankle joints underwent arthrodesis with a single anatomically contoured anterior plate or 2 anatomic plates applied anteromedially and anterolaterally. Each arthrodesed specimen was subjected to controlled sagittal and coronal plane bending and internal and external rotation. Tibiotalar joint bending stiffness, bending angulation, torsional stiffness, and joint rotation were documented. RESULTS Bending stiffness of the 2-plate system was 1.5 to 5 times greater than that of the single-plate system in plantarflexion, dorsiflexion, eversion, and inversion (P = .005-.050). Angulation in each bending direction was several-fold greater than for the single plate (P = .005-.014) at the peak applied moment. Torsional stiffness of the 2-plate system nearly doubled that of the single plate in both rotation directions (P = .014, P = .005). Approximately half as much arthrodesis site rotation occurred with 2-plate fixation at the peak applied torque (P = .005, P = .007). CONCLUSION The tested 2-plate arthrodesis system has the potential to optimize arthrodesis site stiffness compared with fixation with a contemporary single plate. CLINICAL RELEVANCE Use of the stiffer 2-plate system could improve the clinical fusion rate, especially in patients with suboptimal bone quality.
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Berkowitz MJ, Sanders RW, Walling AK. Salvage arthrodesis after failed ankle replacement: surgical decision making. Foot Ankle Clin 2012; 17:725-40. [PMID: 23297436 DOI: 10.1016/j.fcl.2012.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fusion remains the primary technique to salvage the failed total ankle. Fusions present a daunting challenge because of the large bone defect left by the explanted arthroplasty components and the difficulty obtaining stable fixation. Limiting the fusion to the tibiotalar joint preserves the essential motion of the hindfoot. However, because of loss of talar bone stock, it is often necessary to include the subtalar joint in a tibiotalocalcaneal fusion. This article discusses how to determine whether an isolated ankle or ankle-hindfoot fusion is indicated and presents surgical techniques for filling the bone defect and achieving stable internal fixation.
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Affiliation(s)
- Mark J Berkowitz
- Orthopaedic and Rheumatologic Institute, Cleveland Clinic, A40, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Oboirien M. Ankle arthrodesis following trauma, a useful salvage procedure - a report on three cases. J Surg Tech Case Rep 2012; 3:102-5. [PMID: 22413056 PMCID: PMC3296432 DOI: 10.4103/2006-8808.92805] [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] [Indexed: 11/16/2022] Open
Abstract
Open musculoskeletal injuries remain a difficult problem to manage especially in resource-poor regions. They are complicated by prolonged morbidity and chronic osseous infections and sometimes gangrene. Our objective was to look at ankle arthrodesis as a primary and useful salvage procedure through simple technique for cases of severe open ankle injuries. Three patients with severe open ankle injuries between January 2007 and December 2009 were seen and had wound debridement done and compressive ankle arthrodesis with a Charnley's arthrodesis clamp. Tibiotalar and tibiocalcaneal arthrodesis was the procedure carried out. Patients were followed up for 3–12 months. Wound breakdown was seen in two cases and one later had skin grafting. All patients expressed satisfaction with the outcome of surgery. Ankle arthrodesis is a simple and useful salvage procedure for severe ankle disruption, guaranteeing patients satisfaction as against amputation.
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Affiliation(s)
- Muhammad Oboirien
- Department of Orthopaedics and Trauma, Trauma Centre, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Abstract
This article discusses the introductory physiology of bone healing with respect to arthrodesis. The joints of the foot and ankle can suffer many trials and tribulations in an otherwise normal life, and must adapt to instances such as fractures, dislocations, and congenital problems. When adaptation leads to a malformation in the unit structure, surgical intervention is required to restore the foot and ankle complex to a working device. Primary indications for regarding any joint fusion in the human body include deformity, instability, and pain. An overview of the indications for performing joint fusions at the foot and ankle is presented.
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