Use of a Proximal Humeral Locking Plate for Complex Ankle and Hindfoot Fusion

The Outcomes of Isolated Tibiocalcaneal Arthrodesis: A Systematic Review

Background

Tibiocalcaneal arthrodesis (TCA) can be achieved by internal fixation (intramedullary nail or plate), external fixation, or a combination. Evidence for the optimal approach is limited. This systematic review examines the outcomes of these different approaches to guide surgical management.

Methods

A MEDLINE and Oxford SOLO search was performed using "tibiocalcaneal," "ankle," "fusion OR arthrodesis." The primary outcome was union. Secondary outcomes included rates of postoperative complications, weightbearing status, rates of revision surgery, and PROMs. We included any studies with follow-up greater than 6 months that contained our primary outcome and at least 1 secondary outcome.

Results

The initial search yielded 164 articles, of which 9 studies totaling 53 cases met the criteria. The majority of articles were excluded because they were nonsurgical studies, or were not about isolated TCA but were for tibiotalocalcaneal arthrodesis, more complex reconstructions (eg, Charcot), case reports, and/or did not include the predetermined outcome measures.TCA union rate was 86.2% following external fixation, 82.4% for intramedullary nail fixation, and 83.3% for plate fixation. One patient underwent a hybrid of external and internal fixation, and the outcome was nonunion. The rate of complications following TCA was 69.8%.

Conclusion

There is limited evidence on the best operative approach for isolated tibiocalcaneal arthrodesis. Both external and internal fixation methods had comparable union rates. External fixation had frequent complications and a more challenging postoperative protocol. Novel techniques such as 3D-printed cages and talus replacement may become a promising alternative but require further investigation.

The effect of early weight-bearing on bone fusion after triple arthrodesis

Triple arthrodesis is an effective method for treating stiff horseshoe feet and severe osteoarthritis. However, it is still a challenge to improve postoperative bone fusion by changing early weight-bearing. This study improved the classical bone remodeling algorithm, established a mathematical relationship between density change rate and mechanical stimulation, and combined it with finite element theory. The proposed algorithm can not only predict the effect of early weight-bearing on triple arthrodesis but also visually demonstrate the change of bone mineral density with time. The analysis results indicated that 2.5% of the initial load was a potential factor leading to bone nonunion, and 50% of the initial load would result in bone resorption. Meanwhile, it was found that 25% of the external load was more conducive to postoperative rehabilitation. The study results have theoretical significance for enhancing the effect of postoperative bone fusion and formulating a more scientific rehabilitation program, thereby supporting patients' postoperative rehabilitation exercise.

Plate Fixation in Midfoot and Ankle Charcot Neuroarthropathy

Surgical reconstruction of Charcot arthropathy in the foot and ankle is extremely difficult. The fundamentals of reconstruction are necessary to provide adequate outcome. Removing and resecting the diseased bone is needed along with good anatomic alignment and rigid fixation. This reconstructive surgery is not only difficult from medical management point of view but also involves patient compliance and good technical components of the surgery from the surgeon. The surgeon must have skills with internal and external fixation, a good understanding of lower extremity vascular disease, and a good understanding of infectious disease and plastic surgical techniques of the lower extremity.

An Alternative Fixation Option for Subtrochanteric Femur Fractures in Children: Adult Proximal Humerus Plate

BACKGROUND

Subtrochanteric femur fractures are unstable injuries due to strong muscle forces on the proximal femur. The ideal fixation device is controversial in the treatment of subtrochanteric femur fractures in children. The aim of this study is to evaluate the clinical and radiological outcomes of subtrochanteric femur fractures in children treated with an adult proximal humerus plate.

METHODS

A total of 9 patients [mean age at surgery, 8.3 years (range: 7 to 12); mean follow-up period, 28.1 months (range: 12 to 56)] who underwent surgery due to a subtrochanteric femur fracture and treated with an adult proximal humerus between January 2017 and December 2021 were retrospectively evaluated. Four of the patients had a pathological fracture associated with a benign bone tumor while 5 patients had a nonpathological fracture. The clinical and radiological outcomes were assessed using the Flynn scoring system at the latest follow-up. Time to union and complications were recorded.

RESULTS

All patients demonstrated a solid fusion of the fracture site and were able to bear full weight at the latest follow-up. The mean time to union was 8.2 weeks (range: 6 to 10). Based on the Flynn scoring system at the latest follow-up, seven patients had excellent clinical outcomes and two patients had satisfactory outcomes. Two patients had limb length discrepancy, and one patient had coxa valga and a limb length discrepancy of 16 mm. There were no patients with nonunion, infection, implant failure, osteonecrosis of the femoral head, and heterotopic bone formation.

CONCLUSION

This study suggests that the adult proximal humerus plate may be an effective alternative fixation option in the treatment of subtrochanteric femur fractures in children, including pathological fractures.

LEVEL OF EVIDENCE

Level IV, Case series.

Expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities: A technical note

Pre-contoured anatomical locking plates were designed to address the clinical need of fixing small epiphyseal segments with a larger number of screws. Those plates match the contour and shape of a variety of bones allowing for optimal buttress properties. The aim of this manuscript is to highlight the benefits of applying proximal humerus locking plates in the fixation of lower extremity bones. Although designed for the proximal humerus, the low-profile plate shape and anatomic contour also provides versatile use in certain areas of the lower extremity. This technical narrative highlights the versatile and reliable use of this plate for other anatomical areas than the one to which it has been originally conceived.

Anterior minimally invasive plating osteosynthesis using reversed proximal humeral internal locking system plate for distal humeral shaft fractures

OBJECTIVE

To describe the surgical application of anterior minimally invasive plating osteosynthesis (MIPO) using reversed proximal humerus internal locking system (PHILOS) plate for multifragmentary distal humeral shaft fractures.

METHODS

Twelve patients with distal humeral shaft fractures (type 12B, n = 6 and type 12C, n = 6) were operated on by anterior MIPO and reversed PHILOS plate fixation. The amount of intact bone in the distal fragment was measured by fracture-to-coronoid distance (FCD). Data of the postoperative alignment, complications, union time, and clinical outcomes were collected.

RESULTS

The mean time for fractures to unite in all patients was 14.8 weeks (range 12-22). There was no perioperative complication. The mean FCD was 4.8 cm (range 2.1-8.1). The mean coronal angulation was 3.4° (range 0-9), and the mean sagittal angulation was 1° (range 0-5). All patients had excellent UCLA shoulder score and MEP score results, and the mean range of elbow motion was 140° (range 130-145).

CONCLUSION

Anterior MIPO using reversed PHILOS plate is safe and effective for multifragmentary fractures of the distal humeral shaft even in a fracture with a length of intact bone above the coronoid fossa of only 2 cm.

Modified use of proximal humeral interlocking plate (PHILOS) in lateral malleolus fracture, functional and radiological outcome in series of 13 cases

BACKGROUND

Lateral malleolus fracture can occur alone or is associated with the fracture of the medial malleolus leading to ankle instability. Treatment is aimed to achieve anatomical reduction and ensure stability. Compared to non-locking plate locking plate provide stable construct and compromise bone vascularity less. However, there is increase wound complication with locking plates than non-locking plates. PHILOS plate combines the principles of fixation with a conventional plate with those of locking screws. The benefits of this implant are that it gives enhanced purchase in osteopenic bone. It is the first case series of studying the outcomes of modified use of PHILOS plate in lateral malleolus fracture.

MATERIALS AND METHOD

This is a non-commercialized retrospective case series which were done by a single surgeon at our university tertiary-care level-1 trauma hospital between May 2013 to August 2017. Cases of lateral malleolus fracture fixed with PHILOS included. Functional and radiological outcome were recorded from patients' files and radiographs.

RESULTS

Out of 13 patients 1 patient was lost to follow up. Mean time to union was 8.5 weeks. One patient developed superficial surgical site infection and implant was removed in 2 patients. Mean postoperative Olerud-Molander Ankle Score was 88.6 at last follow up.

CONCLUSION

Modified use of PHILOS is neither the only nor the best means of achieving union, but rather it can offer significant advantages over previously described techniques and is a reasonable option in case of lateral malleolus fracture.

Tibiotalocalcaneal (TTC) arthrodesis with reverse PHILOS plate and medial cannulated screws with lateral approach

BACKGROUND

Tibiotalocalcaneal arthrodesis is most common and effective surgical treatment for severe hindfoot pathology, but the fusion rate is often lower than the ordinary tibiotalar arthrodesis because of the more serious joint disease associated with obvious deformity and osteoporosis. Recent literature describe tibiotalocalcaneal arthrodesis with reverse PHILOS plate with good clinical outcome result, though some patients non-union, due to eccentric force of the plate may be hidden. The purpose of this study was to evaluate clinical outcome of the lateral approach for tibiotalocalcaneal (TTC) arthrodesis with reverse PHILOS Plate and medial cannulated screw.

METHODS

Between Jun, 2013 to April, 2015 12 patient with hindfoot pathology had TTC arthrodesis with a reverse PHILOS plate with medial cannulated screw through a lateral approach with resection of the distal fibula and bone graft. Perioperatively observe for wound and neurovascular status. Patients were follow-up from post-operative 1, 3, 6 and12 months, to observation of wound healing, ankle pain, subtalar Joint Fusion, internal fixation and ankle function. Ankle function were scored according to the American Orthopaedic Foot and Ankle Society(AOFAS) Ankle-Hindfoot Scale system.

RESULTS

Twelve ankle fusion all patient follow-up, with mean time to surgery 18.6 months (12-36 month). No cases infection and issue necrosis; one patient complaint of lateral foot numbness we observe and follow-up was spontaneously recovery after 3 months. After 3 months of operation, no obvious pain of ankle joint and internal fixations loose were found. Almost fusion and good axial alignment of TTC joint also were found by X-ray and CT examination. After final fellow-up of each case, no case complain of pain of ankle joint, good fusion and axial alignment of TTC joint were also all found through Terminology. The mean American Orthopaedic Foot and Ankle society (AOFAS) score average was 77.5.

CONCLUSION

TTC arthrodesis with reverse PHILOS Plate and medial cannulated screw have advantages of clear incision, effective bone orthopaedic and graft fully secure, stable internal fixation, high fusion rate and less complications, can effectively correct deformities, alleviate hindfoot pain and improve function, and is an effective method of treatment of after severe hindfoot disease.

TRIAL REGISTRATION

This trial is registered on ClinicalTrials.gov with reference number: ID: NCT02977910 . Registered 26 Nov 2016, retrospectively registered.