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Abaydi A, Radi J, Tbatou A, Lahrach K, Boutayb F. Tibio-Talo-Calcaneal Arthrodesis: Evaluation of the Effectiveness of a Specific Surgical Technique in 17 Cases. Cureus 2024; 16:e62014. [PMID: 38887747 PMCID: PMC11182152 DOI: 10.7759/cureus.62014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Ankle arthrodesis is a crucial surgical intervention for advanced hindfoot conditions, aiming to restore plantigrade walking and alleviate pain. This study evaluates the effectiveness of a specific surgical approach for tibiotalocalcaneal arthrodesis (TTCA), focusing on rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, and assesses the outcomes of this approach in terms of bone fusion and reduction of postoperative complications. MATERIALS AND METHODS This retrospective analysis includes 17 patients who underwent TTCA in a trauma-orthopedic department over seven years. Data were collected from medical records, the HOSIX software, and patient consultations. Preoperative assessments, surgical techniques, postoperative care, and follow-up evaluations were documented. RESULTS The mean age of patients was 42.4 years, with a male predominance. Surgical indications included post-traumatic arthropathy (53%), inflammatory arthropathy, ankle infectious pathologies, and Charcot foot and ankle prosthesis failures. All patients underwent standard preoperative evaluations and received corticocancellous grafts. An angled retrograde femoral nail in the sagittal plane was used for internal fixation. Postoperative immobilization lasted 6 to 8 weeks, with subsequent rehabilitation. The bone fusion rate was 100%, with a low complication rate (23.5%). DISCUSSION Our study showed a younger patient population with a male predominance, different from some previous studies. Surgical techniques, including the anterior approach combined with a lateral subtalar approach, were consistent with some studies but differed from others. Corticocancellous grafts and the angled retrograde femoral nail in the sagittal plane demonstrated favorable outcomes in terms of fusion. Complication rates were lower compared to some previous reports, highlighting potential improvements in postoperative management. CONCLUSION The surgical approach described for TTCA, emphasizing rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, led to satisfactory bone fusion and reduced postoperative complications. These results underscore the importance of this approach in achieving optimal functional outcomes in ankle arthrodesis.
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Affiliation(s)
- Anass Abaydi
- Orthodontics, University Hospital Center Hassan II, Fès, MAR
| | - Jihad Radi
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
| | - Amine Tbatou
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
| | - Kamal Lahrach
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
| | - Fawzi Boutayb
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
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Feeney KM, Murphy EP, Curran MG, Kearns SR. Outcomes following tibiotalocalcaneal arthrodesis using a solid posterior offset intramedullary nail in 44 patients with a minimum 30-month follow-up. Foot Ankle Surg 2024; 30:325-330. [PMID: 38309988 DOI: 10.1016/j.fas.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/03/2023] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Tibiotalocalcaneal arthrodesis is frequently performed by foot and ankle surgeons in the management of complex ankle and hindfoot pathology. In this study, the authors describe the clinical and radiological outcomes of tibiotalocalcaneal arthrodesis using a solid posterior offset hindfoot arthrodesis nail. METHODS Forty-four consecutive patients underwent tibiotalocalcaneal arthrodesis by a single surgeon operating in two centers. Clinical and radiological outcomes were assessed preoperatively and at 6-month, 12-month and final follow-up (mean 47 months). Clinical outcomes were assessed with VAS, AOFAS and MOXFQ scores. Serial radiographs were used to assess union at each follow-up visit. RESULTS Forty-four patients attended 12-month and final follow-up (mean 47 months). A total of 44 (100%) ankle joints and 44 (100%) subtalar joints were completely united at 12-month follow-up. The VAS score improved significantly from a mean of 6.5 preoperatively to a mean of 0.98 at final follow-up (P = <0.0001). AOFAS score improved significantly from a mean of 36.4 preoperatively to a mean of 73 at final follow-up (P = <0.0001). MOXFQ score improved significantly from a mean of 44.5 preoperatively to a mean of 12.7 at final follow-up (P = <0.0001). The mean change in frontal plane alignment was 5.7 degrees (P = 0.005). A total of 6 patients (13.6%) had an adverse event during the course of the study. CONCLUSIONS Tibiotalocalcaneal arthrodesis with a solid posterior offset hindfoot arthrodesis nail is a safe and effective surgical option for patients with severe ankle and hindfoot pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes.
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Affiliation(s)
- Kaylem M Feeney
- Department of Orthopaedics Bon Secours Hospital, Galway, Ireland.
| | - Evelyn P Murphy
- Department of Orthopaedics Galway University Hospitals, Galway, Ireland
| | - Michael G Curran
- Department of Orthopaedics Bon Secours Hospital, Galway, Ireland; Department of Orthopaedics Galway University Hospitals, Galway, Ireland
| | - Stephen R Kearns
- Department of Orthopaedics Bon Secours Hospital, Galway, Ireland; Department of Orthopaedics Galway University Hospitals, Galway, Ireland
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Manobianco A, Enketan O, Grass R. Tibiotalocalcaneal arthrodesis with an intramedullary nail: The functional and clinical outcome of a challenging patient group and its comparison to a below knee amputation. Foot Ankle Surg 2024; 30:268-272. [PMID: 38199925 DOI: 10.1016/j.fas.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure to fuse the ankle and subtalar joints to treat severe ankle and hindfoot disease. Patients often have multiple operations before a TTCA. A below knee amputation (BKA) has major physical and psychological impacts. Our aim is to investigate the outcomes of these treatments in salvage situations, with a focus on objective functional measurements and patient reported outcome measures (PROMs). METHODS 52 patients underwent TTCA with a retrograde intramedullary nail and contacted for clinical and functional assessments and compared to patients who underwent traumatic BKA. PROMS such as AOFAS score, SF-36 and foot function index (FFI), and objective functional outcome measures were used. RESULTS Of the 52 TTCA patients, 28 patients were recruited for follow-up. 35.7% of patients had postoperative complications. Mean postoperative AOFAS score was 63.9 ± 8.4 (range, 47-81), FFI 48.8 ± 15.8 (range, 22.2-75.2). 11 BKA patients (mean age 46.4 years) were included as control group. BKA patients scored higher than the TTCA patients on SF-36 physical functioning (p < 0.01) and SF-36 mental health (p < 0.05) subscales. The flat-surface functional tests (timed up and go test, 2-minute walk test, 10-meter walk test) showed significantly (p < 0.05) better outcomes for the BKA compared to TTCA. CONCLUSIONS A TTCA is a salvage procedure with high complication rates. Functional and psychometric results are reduced compared to the normal population. Patients after a BKA had significantly better scores on SF-36 functional and mental health subscales and better functional outcomes for flat ground activities compared to TTCA. Heterogeneity of the TTCA and BKA patient cohorts is a limitation of this study. With these results in mind, the outlook of a BKA is not necessarily a grim one. They may be used by surgeons to counsel patients preoperatively when managing complex ankle and hindfoot disease. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Alexander Manobianco
- Department of Orthopaedic Surgery, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2137, Australia
| | - Oliver Enketan
- Department of Orthopaedic Surgery, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2137, Australia; University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus Dresden, Fletscherstr. 74, 01307 Dresden, Germany.
| | - René Grass
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus Dresden, Fletscherstr. 74, 01307 Dresden, Germany
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Baker JD, Schroeder P, Kimbler T, Huh J. Reaming for Tibiotalocalcaneal Nailing Removes Only 10% of the Ankle and Subtalar Joints. J Orthop Trauma 2024; 38:210-214. [PMID: 38163916 DOI: 10.1097/bot.0000000000002754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Tibiotalocalcaneal (TTC) nailing in the setting of acute ankle trauma has become increasingly popular. No consensus exists as to whether formal joint preparation is necessary, although there is some concern that residual motion at unprepared joints may lead to implant loosening and/or breakage. The objective of this study was to quantify the proportion of tibiotalar and subtalar articular surface destruction that occurs during reaming for TTC nail fixation. METHODS Twelve cadaver lower extremities were procured. The specimens were pinned into neutral ankle and hindfoot alignment. A guidewire was inserted under fluoroscopy, followed by a 12-mm opening reamer. The specimens were then dissected, exposing the tibial plafond, talar dome, posterior facet of the talus, and posterior facet of the calcaneus. Images of each joint were obtained, and ImageJ software was used to calculate the total joint surface area and the area of articular destruction. RESULTS The mean proportion of articular cartilage destruction was 9.3%, 10.3%, 8.9%, and 10.3% for the tibial plafond, talar dome, posterior facets of the talus, and posterior facets of the calcaneus, respectively. No joint destruction was observed in the middle facets of the subtalar joint. CONCLUSIONS Reaming for TTC nail placement violates approximately 10% of each articular surface of the tibiotalar and subtalar joints. Retention of 90% of the articular surface may allow for residual motion at the joints and therefore potentially substantial stress on the implant. Formal joint preparation for the purposes of achieving fusion during TTC nail placement may be beneficial to prevent implant loosening or breakage.
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Affiliation(s)
- James D Baker
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX
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Moreira FD, Jambeiro JEDS, Cordeiro AT, Oliveira JA, Leão FF, Guedes A. Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases. Rev Bras Ortop 2024; 59:e143-e147. [PMID: 38524702 PMCID: PMC10957263 DOI: 10.1055/s-0041-1731356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/15/2021] [Indexed: 10/20/2022] Open
Abstract
Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6 th and 10 th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1 st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.
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Affiliation(s)
- Fernando Delmonte Moreira
- Grupo de Cirurgia do Pé e Tornozelo, Serviço de Ortopedia, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | | | - Antero Tavares Cordeiro
- Grupo de Cirurgia do Pé e Tornozelo, Serviço de Ortopedia, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - José Augusto Oliveira
- Grupo de Cirurgia do Pé e Tornozelo, Serviço de Ortopedia, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - Felipe Fernandes Leão
- Programa de Residência Médica em Ortopedia e Traumatologia, Serviço de Ortopedia, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
| | - Alex Guedes
- Grupo de Oncologia Ortopédica, Hospital Santa Izabel, Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil
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Trost M, Yarkin S, Knieps M, Frey S, Neiss WF, Eysel P, Gick S, Dargel J. Biomechanical comparison of different fixation methods in tibiotalocalcaneal arthrodesis: a cadaver study. J Orthop Surg Res 2023; 18:971. [PMID: 38105223 PMCID: PMC10726638 DOI: 10.1186/s13018-023-04444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques. METHODS Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion. RESULTS For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P < .01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P < .01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P = .10). CONCLUSIONS The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis.
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Affiliation(s)
- Matthias Trost
- Department of Orthopaedics and Traumatology, Saint Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Suzan Yarkin
- Department of Orthopaedics and Traumatology, Protestant Hospital Cologne Weyertal, Cologne, Germany
| | - Matthias Knieps
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
| | - Sönke Frey
- Department of Orthopaedics and Traumatology, Florence Nightingale Hospital, Düsseldorf, Germany
| | | | - Peer Eysel
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Sascha Gick
- Department of Traumatology, Orthopaedics and Hand Surgery, Saint Vinzenz Hospital, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedics, Saint Josefs Hospital, Wiesbaden, Germany
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He W, Zhou H, Li Z, Zhao Y, Xia J, Li Y, Chen C, Huang H, Zhang Y, Li B, Yang Y. Comparison of different fibula procedures in tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a mid-term retrospective study. BMC Musculoskelet Disord 2023; 24:882. [PMID: 37957652 PMCID: PMC10644431 DOI: 10.1186/s12891-023-07025-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Tibiotalocalcaneal (TTC) arthrodesis with a retrograde intramedullary nail for severe tibiotalar and talocalcaneal arthritis has a high fusion rate; however, no studies have focused on how to handle the fibula intraoperatively to achieve better results. This study aimed to compare the efficacies of various fibular procedures. METHODS We retrospectively reviewed the cases of severe tibiotalar and talocalcaneal arthritis in adults treated with TTC arthrodesis using a retrograde intramedullary nail between January 2012 and July 2017. The patients were divided into three groups according to different fibular procedures: Fibular osteotomy (FO), fibular strut (FS), and fibular preservation (FP). Functional outcomes and pain were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scales (VAS), respectively. The operation time, fusion time, radiographic evaluation, and complications were also recorded. RESULTS Fifty-eight patients with an average age of 53.2 (range, 32-69) years were enrolled in the final analysis. The numbers of patients enrolled in the three groups were 21, 19, and 18 in the FO, FS, and FP groups, respectively. The mean postoperative follow-up time was 66.0 (range, 60-78) months. All groups showed a high fusion rate (90.5% for FO, 94.7% for FS, and 94.4% for FP) and significant improvement in AOFAS ankle and hindfoot scores and VAS scores at the latest follow-up. There were no significant differences in these parameters among the three groups. The mean operation time of FS (131.3 ± 17.1 min) was longer than that of FO (119.3 ± 11.7 min) and FS (112.2 ± 12.6 min), but the fusion time was shorter (15.1 ± 2.8 weeks for FS, 17.2 ± 1.9 weeks for FO, and 16.8 ± 1.9 weeks for FP). Statistically significant differences were observed in these parameters. CONCLUSIONS TTC arthrodesis using a retrograde intramedullary nail is an effective procedure with a high rate of fusion to treat severe tibiotalar and talocalcaneal arthritis in adults; however, FSs can shorten fusion time when compared with FO and FP. LEVEL OF CLINICAL EVIDENCE Level 3.
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Affiliation(s)
- Wenbao He
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Haichao Zhou
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Zhendong Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Youguang Zhao
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Jiang Xia
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yongqi Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Cheng Chen
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Hui Huang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yi Zhang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Bing Li
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yunfeng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Dündar A, Ipek D. TIBIOCALCANEAL ARTHRODESIS: A COMPARISON OF ANTERIOR APPROACH AND TRANSFIBULAR APPROACH. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e267148. [PMID: 37876863 PMCID: PMC10592366 DOI: 10.1590/1413-785220233105e267148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/27/2023] [Indexed: 10/26/2023]
Abstract
Objective The aim of this study was to evaluate the clinical and radiologic results and complications of patients who underwent ankle arthrodesis performed by the transfibular approach and anterior approach in end-stage ankle osteoarthritis. Methods Between 2016 and 2022, 41 patients who satisfied the inclusion criteria for this retrospective comparative analysis were included. Of them, 19 patients are included in the anterior approach group and 22 patients are included in the transfibular approach group. The mean age of the participants is 58.9 years. Collected data included the BMI, American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale, visual analogue scale (VAS) score, diabetes, smoking, time to fusion, nonunion, union rate, preoperative and postoperative coronal tibiotalar angle and complications. Result The mean time to bone union was 14.3 weeks (range 11-17 weeks) in the anterior approach group, and 11.3 weeks in the transfibular approach group. Statistically significant difference was found between the two groups. Nonunion occurred in one case in the transfibular approach group and three cases in the anterior approach group. There was no significant difference in the nonunion rate between the both groups (p = 0.321). VAS score, and AOFAS score of the two groups were similar and no significant differences were found (p = 0.491, p = 0.448, p = 0.146, p = 0.073, p = 0.173, p = 0.506, respectively). Conclusions A stable and firm ankle arthrodesis and plantigrade foot can be achieved with both transfibular approach and anterior approach technique. Level of Evidence III, Retrospective Comparative Study.
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Affiliation(s)
- Abdulrahim Dündar
- Hitit University, Erol Olçok Training and Research Hospital, Department of Orthopedics' and Traumatology, Çorum, Turkey
| | - Deniz Ipek
- Hitit University, Erol Olçok Training and Research Hospital, Department of Orthopedics' and Traumatology, Çorum, Turkey
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Zielli SO, Mazzotti A, Artioli E, Arceri A, Bonelli S, Ruffilli A, Faldini C. Retrograde intramedullary nail entry point for tibio-talo-calcaneal arthrodesis: a review of anatomical studies. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3185-3195. [PMID: 36906879 DOI: 10.1007/s00590-023-03512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/26/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Tibio-talo-calcaneal arthrodesis (TTCA) is considered a safe and valuable option for end-stage tibiotalar and subtalar arthritis, and usually is performed with a retrograde intramedullary nail. Although the good results reported, potential complications may be related to retrograde nail entry point. Aim of this systematic review is to analyze in cadaveric studies the risk of iatrogenic injuries related to different entry points and different retrograde intramedullary nail design when performing TTCA. METHODS According to PRISMA, a systematic review of the literature was performed on PubMed, EMBASE and SCOPUS databases. A subgroup analysis comparing different entry point location (anatomical or fluoroscopic guided) and different nail design (straight vs. valgus curved nails) was performed. RESULTS Five studies were included, for a total of 40 specimens. Superiority of anatomical landmark-guided entry points was observed. Different nail designs did not seem to influence nor iatrogenic injuries neither hindfoot alignment. CONCLUSION Retrograde intramedullary nail entry point should be placed in the lateral half of the hindfoot in order to minimize the risk of iatrogenic injuries.
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Affiliation(s)
- Simone Ottavio Zielli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Antonio Mazzotti
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Simone Bonelli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
- Sidney Kimmel Medical College of Thomas Jefferson University (SKMC), Philadelphia, PA, USA
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Thamrongskulsiri N, Tangboonnitiwong N, Kuptniratsaikul V, Kuptniratsaikul S. Prebent Steinmann Pin to Remove the Broken Retrograde Intramedullary Nail After Tibiotalocalcaneal Arthrodesis. Arthrosc Tech 2023; 12:e873-e877. [PMID: 37424653 PMCID: PMC10323727 DOI: 10.1016/j.eats.2023.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
A retrograde intramedullary nail is an implant option for tibiotalocalcaneal arthrodesis because it provides mechanical strength and compression at the fusion site, while being less invasive to soft tissue. However, some fusion failures result in implant overloading, resulting in implant failure. The accumulated stress at the level of the subtalar joint will most likely cause implant breakage. It is challenging to remove the broken tibiotalocalcaneal nail's proximal part. Several surgical procedures for removing the broken tibiotalocalcaneal nail have been reported. In this article, we present a surgical technique for removing a broken tibiotalocalcaneal nail by punching out the proximal part of the broken nail using a prebent Steinmann pin. It has the advantage of being less invasive and not requiring any specific tools to punch out the nail.
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Affiliation(s)
| | - Napol Tangboonnitiwong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Vanasiri Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Somsak Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Wang C, Ma T, Li Z, Wang Q, Li Z, Zhang K, Huang Q. A modified hybrid transport technique combined with a retrograde tibiotalocalcaneal arthrodesis nail for the management of distal tibial periarticular osteomyelitis and associated defects. J Orthop Surg Res 2023; 18:259. [PMID: 36991442 DOI: 10.1186/s13018-023-03744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND This paper aimed to propose a modified technique of bone transport. An annular frame combined with a retrograde tibiotalocalcaneal arthrodesis nail was used in this novel technique for treating large distal tibial periarticular osteomyelitis and associated defects. METHODS Our team conducted a retrospective research. Forty-three patients with large distal tibial periarticular bone loss were involved in this study. Sixteen patients were treated using the modified hybrid transport technique (MHT group) while 27 were subjected to traditional bone transport (BT group). The mean bone loss was 7.8 ± 2.4 cm in the MHT group and 7.6 ± 2.6 cm in the BT group. The external fixation index, time in transport frame, self-rating anxiety scale, bone healing results and postoperative complications were recorded. RESULTS The mean time in frame for the MHT group was 3.6 ± 1.5 months, while that of the BT group was 10.3 ± 2.7 months (p < 0.05). The mean external fixation index of MHT group was 0.46 ± 0.08 months/cm versus 1.38 ± 0.24 months/cm of the BT group (p < 0.05). There was no statistical difference for the bone healing results between the MHT and BT groups (p = 0.856). The self-rating anxiety scale and total complication incidence of the MHT group were significantly lower than that of BT patients (p < 0.05). CONCLUSION Compared to the traditional BT technique, our modified hybrid transport technique showed better clinical outcomes for treating large distal tibial periarticular bone loss, including less time in transport frame, lower external fixation index and complication incidence. Therefore, this modified technique should be further promoted and developed.
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Affiliation(s)
- ChaoFeng Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Teng Ma
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Zhao Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Qian Wang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Zhong Li
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China
| | - Qiang Huang
- Department of Orthopedics, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, China.
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Dujela MD, Berlet GC, Houng BE, Hyer CF. Comparison of Dynamic Versus Static Locked Retrograde Tibiotalocalcaneal Arthrodesis With Intramedullary Nail Fixation: Evaluation of the RAIN Database. J Foot Ankle Surg 2023:S1067-2516(23)00032-7. [PMID: 36941141 DOI: 10.1053/j.jfas.2023.02.002] [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: 03/31/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 03/23/2023]
Abstract
Hindfoot osteoarthritis (OA) or deformity involving the ankle and subtalar joint is a disabling condition. Tibiotalocalcaneal (TTC) fusion is an effective salvage option in pathologies where total ankle replacement is contraindicated. The purpose of this study is to compare the union rate of the ankle joint in proximal static versus dynamically locked retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis. An institutional review board-approved comprehensive chart and radiographic review was performed. TTC arthrodesis performed in patients with OA, post-traumatic arthritis, or deformity corrected by retrograde nail were included. Patients with Charcot arthropathy, failed joint replacement, neuropathy, or avascular necrosis were excluded. The primary outcome was ankle joint union with secondary measure of mean time to fusion. A total of 60 patients met inclusion criteria with 30 in the static group (SG) and 30 in the dynamic group (DG). The average age of the static group (SG) and dynamic group (DG) was 56.9 and 54.1 years, respectively. Mean body mass index was 34.03 kg/m2 for SG and 33.43 kg/m2 for DG. The union rate of the ankle joint was slightly higher in the DG but not statistically significant [SG 83.3%, DG 86.6%, p > .05 (p = .83)]. Time to fusion (TTF) in SG was 111.6 days compared to 97.2 days in DG. Dynamically locked intramedullary nails allow continued compression across the arthrodesis site as fusions remodel. Time to union and union rate of the ankle joint was superior in the dynamic group but this was not statistically significant. In this cohort, union rates were excellent in both groups, and no statistically significant difference was seen in the number of nonunions.
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Affiliation(s)
- Michael D Dujela
- Fellowship-Trained Foot and Ankle Surgeon, Private Practice, Washington Orthopaedic Center, Washington, OH; Fellowship Director, Washington Orthopaedic Center Advanced Reconstructive Foot and Ankle Surgery Fellowship, Centralia, WA; Visiting Fellow, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Gregory C Berlet
- Attending Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Brian E Houng
- Fellow, Washington Orthopaedic Center Advanced Reconstructive Foot and Ankle Surgery, Centralia, WA
| | - Christopher F Hyer
- Attending Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH; Co-Fellowship Director, Orthopedic Foot and Ankle Center, Worthington, OH
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13
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Jennison T, Dalgleish J, Sharpe I, Davies M, Goldberg A. Total Talus Replacements. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221151068. [PMID: 36741680 PMCID: PMC9893085 DOI: 10.1177/24730114221151068] [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: 01/29/2023] Open
Abstract
Background Total talus replacements are a surgical treatment for talar avascular necrosis (AVN) replacing the entire talus. The potential for total talus replacements has increased with the advent of patient-specific implants using 3D printing based on computed tomographic scanning of the ipsilateral or contralateral talus. The primary aim of this review is to summarize the literature on total talus replacements, providing a historical survey, indications, controversies, complications, survival, and functional outcomes. Methods A systematic review was performed. Articles with survival of total talus replacements were included. Basic percentages and a critical review of the literature was performed. Results Nine articles with 115 patients were included. The mean age ranged from 27.6 to 72 years, but with 5 studies having a mean age of <50 years. Mean follow-up ranged from 12.8 to 152 months. The most common indication was avascular necrosis in 67 patients (58%). Five studies used customized implants and 4 studies used 3D printing. Four studies used ceramic prostheses, 3 cobalt chromium, 1 stainless steel, and 1 titanium with ceramic surface. Three studies involved a talus replacement in conjunction with an ankle replacement. Postoperative complications ranged from 0% to 33%. Of 24 functional outcomes scores, 66.7% demonstrated significant improvement. Conclusion Total talus replacements are a promising alternative to tibiotalocalcaneal fusion for patients with avascular necrosis of the talus; however, further studies are required to ensure reliable outcomes prior to widespread adoption of this technology. Level of Evidence Level IV, review of case series.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom,Toby Jennison, FRCS, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, PL6 8DH, United Kingdom.
| | - James Dalgleish
- Sheffield Teaching Hospitals NHS Foundation Trust, Broomhall, Sheffield, United Kingdom
| | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Mark Davies
- Sheffield Teaching Hospitals NHS Foundation Trust, Broomhall, Sheffield, United Kingdom
| | - Andrew Goldberg
- The Wellington Hospital, London, United Kingdom,Department of Surgery and Cancer, Imperial College London, London, United Kingdom,Department of Surgery, Royal Free Hospital, UCL, London, United Kingdom
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14
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Rosemberg DL, Macedo RS, Sposeto RB, Sakaki MH, Godoy-Santos AL, Fernandes TD. Tibiotalocalcaneal Arthrodesis: A Retrospective Comparison Between Nails and Lateral Locking Plate Complications. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231157719. [PMID: 36911423 PMCID: PMC9996735 DOI: 10.1177/24730114231157719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Background Tibiotalocalcaneal arthrodesis is a well-established procedure to treat some hindfoot diseases. Currently, the most used implants are retrograde intramedullary nails and locking plates combined with lag screws, but there are few articles comparing differences regarding the complications. Methods We have retrospectively analyzed the medical records and the radiographs of patients older than 18 years who underwent this procedure in our service between 2005 and 2019 through retrograde intramedullary nails or lateral locking plates and compression screws with at least 12 months of follow-up and with no history of osteomyelitis in these bones. Results We evaluated a total of 67 patients; of these, 48 received retrograde intramedullary nail implants and 19 received locking plates and compression screws. The overall mean age was 48 years; the median follow-up time was 64.3 months. The complication rate was 60.4% for the intramedullary nail procedure and 52.6% for the locking plate combined with compression screws procedure. Conclusion No significant differences were found in the complication rates between the 2 implants. Level of Evidence Level V, Case series.
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Affiliation(s)
- Dov Lagus Rosemberg
- Lab Prof Manilo Mario Marco Napoli, Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Rodrigo Sousa Macedo
- Lab Prof Manilo Mario Marco Napoli, Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Rafael Barban Sposeto
- Lab Prof Manilo Mario Marco Napoli, Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Marcos Hideyo Sakaki
- Lab Prof Manilo Mario Marco Napoli, Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Alexandre Leme Godoy-Santos
- Lab Prof Manilo Mario Marco Napoli, Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Tulio Diniz Fernandes
- Lab Prof Manilo Mario Marco Napoli, Department of Orthopedic Surgery, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Martínez-de-Albornoz P, Monteagudo M. Tibiotalocalcaneal Arthrodesis in Severe Hindfoot Deformities. Foot Ankle Clin 2022; 27:847-866. [PMID: 36368801 DOI: 10.1016/j.fcl.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe deformity. Many of these patients present with difficult previous sequelae that include nonunion, malunion, broken implants, vascular deficiencies, skin problems, or a combination of the previous. In that complex scenario, sometimes the only alternative treatment is a below-the-knee amputation. Image studies--weightbearing X-rays, tomography, and magnetic resonance - are fundamental to evaluate alignment and bone stock. When all conservative treatments fail to alleviate pain and dysfunction, the combination of osteotomies and arthrodesis is the procedure of choice. Surgical planning needs to be very detailed and thorough with a special focus on bone loss after debridement of non-healthy tissue and removal of metalwork. TTCA with grafting allows for the preservation of the limb in more than 80% of cases but at the expense of many complications with nonunion rates of approximately 20% of cases. There is controversy about the use of a retrograde nail versus specific TTCA plate and screws but results from biomechanical studies do not show a clear superiority of one specific construct. Amputation rates are close to 5% of cases after repeated failed surgeries. Bulk allografts increase the rate of nonunions but apparently do not have an influence on postoperative infections. Valgus positioning of the ankle/hindfoot is paramount to allow for maximal sagittal plane compensation from the midtarsal joints. Most patients are satisfied with the results of these salvage operations. The studies presented in this article have a considerable wide array of different scenarios that obviously bias some of the results, complications, and outcomes but together they present a persuasive pattern toward considering TTC with grafting and nail or plate fixation as a good salvage procedure that may help the patients to maintain their foot and ankle with a better alignment, function, and pain relief.
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Affiliation(s)
- Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud, Madrid, Spain; Faculty Medicine UEM, Madrid, Spain.
| | - Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud, Madrid, Spain; Faculty Medicine UEM, Madrid, Spain
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16
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Abstract
BACKGROUND Three-dimensional custom cages can be used to treat complex ankle and hindfoot pathology and bone loss with potentially better patient satisfaction and higher fusion rates than tibiotalocalcaneal (TTC) fusion alone or in combination with bulk femoral head allograft. Yet there is limited literature to support this procedure. The purpose of this study is to objectively quantify the clinical and radiologic outcomes of patients undergoing patient-specific 3D-printed custom cage implantation to fill large defects around the ankle joint region as part of a limb-salvaging TTC fusion. METHODS This is a retrospective review of 21 patients (mean age 59.3 years) who underwent custom cage implantation with a TTC retrograde fusion nail by a single surgeon for massive bone loss of the ankle and hindfoot. Patient charts were reviewed for pain and functional outcomes, complications, and various demographics, including number of previous surgeries to the ipsilateral ankle. Mean follow-up was 32 months. All 21 patients had preoperative and postoperative pain and function scores available for analysis. RESULTS A total of 20 (95.2%) of the 21 patients had their cage in situ at final follow-up. Overall, with the numbers available, visual analog scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM) activities of daily living subscale, and the 12-Item Short Form Health Survey (SF-12) mental and physical health scores significantly improved from preoperative to final follow-up. However, when compared to the overall US population of age-matched 55- to 64-year-old individuals, patients still remained relatively disabled. There were 2 failures, one of which required amputation and the other was treated nonoperatively with bracing. CONCLUSION In conclusion, in this relatively small, single-surgeon series, we found that 3D-printed custom cage technology offered a viable option for complex TTC fusion procedures performed in the presence of significant bone loss, with good fusion rates, however relatively modest improvement in functional outcomes. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | - Jared Raikin
- Syndey Kimmel Medical College, Philadelphia, PA, USA
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17
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Linder A, Steiger V, Hubert L, Rony L. Clinical and radiological outcomes of internal fixation of complex talar neck and body fractures with locking plates through a dual approach. Orthop Traumatol Surg Res 2022; 108:103368. [PMID: 35850424 DOI: 10.1016/j.otsr.2022.103368] [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: 12/19/2020] [Revised: 08/15/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Talar fractures are rare and surgical treatment has not been standardized. The literature is rather poor on preserving talar vascularization in single or dual approaches. A dual approach allows better exposure and should limit devascularization. Locking plates are one of the modern solutions for challenging comminuted fractures. The aim of this study was to determine clinical and radiological outcomes in complex talar fracture (CTF) of the neck and body, fixed by locking plates through a dual approach with at least one locking plate. HYPOTHESIS Locking-plate fixation of CTF through a dual approach leads to good clinical outcome. MATERIAL AND METHODS A single-center retrospective study included 12 cases of CTF treated between January 2007 and May 2019. 3D CT was systematically performed to plan surgery. A dual approach and at least one locking plate were used for fixation. Clinical outcome was evaluated on AOFAS score. Reduction quality and correlation to clinical results were evaluated, reduction with<2mm joint step being considered satisfactory. Consolidation rate and occurrence of avascular necrosis of the talus (ANT), post-traumatic arthritis (PTA) and postoperative complications were analyzed. RESULTS Mean follow-up was 27 months (range, 15-47). Mean AOFAS score was 70±18 (range, 30-97). Inframillimetric reduction was achieved in 67% of cases, without significant correlation with clinical results. The consolidation rate was 91.6%, ANT rate 18.2% and PTA rate 45.5%. One patient presented septic osteoarthritis secondary to scar necrosis. CONCLUSION Locking plate fixation of CTF through a dual approach provided acceptable clinical outcomes. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Adrien Linder
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Vincent Steiger
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Laurent Hubert
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Louis Rony
- Département de Chirurgie Osseuse, Centre Hospitalier Universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France.
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Huang Q, Ma T, Ren C, Xu Y, Li M, Wang Q, Lu Y, Li Z, Zhang K. Shortening and re-lengthening versus bone transport for the treatment of distal tibial periarticular post-traumatic defects. Sci Rep 2022; 12:16303. [PMID: 36175612 PMCID: PMC9523061 DOI: 10.1038/s41598-022-20760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
In the present study, we presented our experience with a new modified technique of shortening and re-lengthening using a monolateral external frame combined with a calcaneal intramedullary nail and compared it with the bone transport technique for the treatment of distal tibial periarticular post-traumatic defects. Forty-one patients were retrospectively analyzed. Among them 19 were treated using our modified shortening and re-lengthening technique (MSR group) and 22 by bone transport (BT group). The difference in external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS), and complications were compared between the two groups. The mean EFT was 3.4 ± 0.6 months in the MSR group and 7.5 ± 1.4 months in the BT group; the EFI was 0.57 ± 0.06 month/cm and 1.32 ± 0.23 month/cm, respectively. The EFT, EFI, and SAS scores were significantly lower in the MSR group than in the BT Group (p < 0.05). The mean number of complications per patient in the BT group was nearly 2.4 times that of the MSR group (p < 0.05). Our modified shortening and re-lengthening technique reduced the EFI and complication incidence compared to the bone transport technique. Therefore, patients with distal tibial periarticular post-traumatic defects can achieve great satisfaction with this new technique.
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Affiliation(s)
- Qiang Huang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China.
| | - Teng Ma
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China.
| | - Cheng Ren
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - YiBo Xu
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Ming Li
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Qian Wang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Yao Lu
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Zhong Li
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, 710054, Shaanxi, China
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Muacevic A, Adler JR. Charcot-Marie-Tooth Disease as a Risk Factor for Periprosthetic Fractures in Tibiotalocalcaneal Fusion With Intramedullary Nailing. Cureus 2022; 14:e28036. [PMID: 36120283 PMCID: PMC9473675 DOI: 10.7759/cureus.28036] [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] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction The treatment for severe fixed hindfoot osteoarthritis secondary to Charcot-Marie-Tooth disease (CMT) is tibiotalocalcaneal (TTC) arthrodesis. In our centre, we have noticed a disproportionate rate of periprosthetic fractures in CMT patients following TTC arthrodesis with retrograde hindfoot nailing. The aim of this study was to test this hypothesis by evaluating our local cohort of TTC arthrodesis with retrograde hindfoot nailing. Methods A retrospective review of patients who had TTC arthrodesis with intramedullary nailing was conducted over a seven-year period. Results There were 45 patients (30 male, 15 female) in our cohort. Forty-one patients achieved radiological and clinical fusion of their TTC arthrodesis. All three patients who had CMT sustained periprosthetic fracture at the tip of the nail at an average of four (range: 2.5-6) months from index operation. In comparison, no patients in the rest of the cohort sustained periprosthetic fractures. The nail position of the patients with CMT was central in both planes in all three patients. None of the patients with CMT had abutment of the cortex on either plane. Conclusion We found that there was a disproportionate rate of periprosthetic fractures in CMT patients in our cohort of TTC arthrodesis with retrograde hindfoot nailing. This suggests that CMT is a significant risk factor. The authors propose a longer nail to reduce the lever arm, with a long period of protected weight bearing till union, followed by consideration of elective removal of the nail to prevent this phenomenon from occurring.
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Phillips M, Bullock G, Scott A. Use of the Straight Retrograde Intramedullary Nail for Tibiotalocalcaneal Arthrodesis: A Single-Institution, Single-Surgeon, Single-Implant Retrospective Series. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221123804. [PMID: 36185348 PMCID: PMC9523874 DOI: 10.1177/24730114221123804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The hindfoot fusion nail has become a popular implant for tibiotalocalcaneal (TTC) arthrodeses given its rigidity, ease of insertion, and potential for less invasive surgical approaches. The purpose of this study was to evaluate fusion and complication rates following the use of a straight, retrograde intramedullary nail for TTC arthrodeses, and the influence of diabetes and smoking on these results. Methods: A review of patient cases performed by a single surgeon at a single institution was performed. Variables included age, comorbidities, smoking history, BMI, hemoglobin A1c, preoperative and postoperative visual analog scale pain scores, assessment of healing, and complications. Relative and absolute risk were assessed for smoking, diabetes, fusion, and surgical complications through risk ratios. Cox proportional hazards survival analyses were performed to assess the effects of smoking and diabetes on fusion rates and complications. Linear regressions were performed to investigate the effects of smoking and diabetes on patient-reported pain levels. Results: Of 103 patients, there were 37 cigarette smokers and 30 diabetic patients. Eighty-three patients achieved union of all involved joints and 19 patients achieved union of 1 or 2 joints. Smokers demonstrated a 1.46 (risk ratio) (95% CI 1.03-2.07) times greater risk of nonunion but were not at an increased risk of experiencing surgical complications (0.86, 95% CI 0.56-1.33). Diabetic patients did not demonstrate an increased risk of nonunion (0.86, 95% CI 0.56-1.33) or complications (1.18, 95% CI 0.76-1.83). Conclusion: Because of increased nonunion risk, patients undergoing elective tibiotalocalcaneal arthrodesis should be counseled increased nonunion risks associated with smoking. In this series, we did not find a relationship between diabetes and complications or nonunion. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- McLeod Phillips
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | - Aaron Scott
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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21
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Stołtny T, Dugiełło B, Pasek J, Szyluk K, Pyda M, Spyrka D, Białek M, Czuma P, Pijet B, Werner K, Cieślar G, Littner R, Pleva L, Koczy B. Tibiotalocalcaneal Arthrodesis in Osteoarthritis Deformation of Ankle and Subtalar Joint: Evaluation of Treatment Results. J Foot Ankle Surg 2022; 61:205-211. [PMID: 34635405 DOI: 10.1053/j.jfas.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/08/2020] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
Tibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. The study group consisted of 19 men who were subjected to intramedullary and intraosseous arthrodesis using an intramedullary nail. The average age of patients was 46 (range 19-68) years. The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group, clinical condition was assessed using the American Orthopedic Foot and Ankle Score (AOFAS) classification, quality of life using the SF-12 scale, and assessment of pain intensity using the visual-analog scale (VAS) scale. The above parameters were evaluated before surgery (under 2 years), intermediate (from 2 to 5 years), and late (over 5 years) postoperative period. The clinical condition on the AOFAS scale improved from an average of 20.6 points before tibiotalocalcaneal arthrodesis to 63.5 after the procedure. The result was statistically significant (p < .0001). Analyzing the results using the SF-12 scale, a statistically significant increase was found. In the physical sphere of Physical Health Component Score-12 (p = .0004) and in the mental sphere of Mental Health Component Score-12 (p = .030). The intensity of pain assessed in the VAS scale, decreased in all three periods-p < .05. The strongest analgesic effect was observed in the early postoperative follow-up period. Tibiotalocalcaneal arthrodesis using an intramedullary nail causes a significant improvement in the clinical condition according to the AOFAS classification, enabling most patients to move independently, a significant improvement quality of life assessed in the SF-12 scale and a significant reduction of pain ailments assessed in the VAS scale, especially in the early postoperative period.
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Affiliation(s)
- Tomasz Stołtny
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Bogdan Dugiełło
- Student of Medical University of Silesia in Katowice, Katowice, Polska
| | - Jarosław Pasek
- Faculty of Health Sciences, Tourism and Physiotherapy, Jan Długosz University in Częstochowa, Częstochowa, Poland.
| | - Karol Szyluk
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Michał Pyda
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Daniel Spyrka
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Michał Białek
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Przemysław Czuma
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Bartłomiej Pijet
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Krystian Werner
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine. Faculty of Medical Sciences in Zabrze. Medical University of Silesia in Katowice Bytom, Katowice, Poland
| | | | | | - Bogdan Koczy
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary, Śląskie, Poland
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22
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Levinson J, Reissig J, Schaheen E, Lee W, Park J. Complications and Radiographic Outcomes After Tibiotalocalcaneal Fusion With a Retrograde Intramedullary Nail. Foot Ankle Spec 2021; 14:521-527. [PMID: 32830574 DOI: 10.1177/1938640020950153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tibiotalocalcaneal (TTC) arthrodesis is a salvage reconstructive procedure for ankle and subtalar arthritis and deformity. This study aims to identify fusion rates and complications of TTC arthrodesis procedures performed at our institution using a specific retrograde intramedullary nail. Additionally, we analyzed the subpopulation that sustained an intramedullary nail break. METHODS A retrospective review was conducted of 45 patients who underwent 47 TTC arthrodesis procedures with intramedullary fixation using the Phoenix nail at our institution from October 2010 to September 2017. Patient age, body mass index, sex, smoking status, diabetes diagnosis, peripheral vascular disease, thyroid disease, inflammatory arthritis, steroid use, prior ankle fractures and procedures, fusion rates, nail diameter, time to hardware failure, preoperative coronal plane deformity, and return to work were obtained. RESULTS Successful fusion was confirmed in 79% of tibiotalar, 70% of subtalar, and 66% of combined tibiotalar and subtalar joints. Eight of 47 (17%) TTC nails suffered nail breakage postoperatively. Although statistical analysis was not performed due to the small population size, patients with nail failure had lower rates of tibiotalar (38% vs 87% of patients without nail failure) and combined tibiotalar/subtalar fusion (25% vs 74%). Ten percent of patients without nail breakage required revision surgery, compared to 75% of patient with nail breakage. CONCLUSION This study describes TTC arthrodesis outcomes at our institution. It demonstrates a high complication rate using a specific retrograde intramedullary nail, including nail breakage and non-union. Further analysis and improvement in technique and implant design may decrease revision rates and improve outcomes. LEVELS OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Joseph Levinson
- School of Medicine, University of Virginia, Charlottesville, Virginia (JL).,Department of Orthopedics and Foot and Ankle, University of Virginia, Charlottesville, Virginia (JR, ES, WL, JP)
| | - Jessica Reissig
- School of Medicine, University of Virginia, Charlottesville, Virginia (JL).,Department of Orthopedics and Foot and Ankle, University of Virginia, Charlottesville, Virginia (JR, ES, WL, JP)
| | - Emily Schaheen
- School of Medicine, University of Virginia, Charlottesville, Virginia (JL).,Department of Orthopedics and Foot and Ankle, University of Virginia, Charlottesville, Virginia (JR, ES, WL, JP)
| | - Wonyong Lee
- School of Medicine, University of Virginia, Charlottesville, Virginia (JL).,Department of Orthopedics and Foot and Ankle, University of Virginia, Charlottesville, Virginia (JR, ES, WL, JP)
| | - Joseph Park
- School of Medicine, University of Virginia, Charlottesville, Virginia (JL).,Department of Orthopedics and Foot and Ankle, University of Virginia, Charlottesville, Virginia (JR, ES, WL, JP)
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23
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Bejarano-Pineda L, Sharma A, Adams SB, Parekh SG. Three-Dimensional Printed Cage in Patients With Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Early Outcomes. Foot Ankle Spec 2021; 14:401-409. [PMID: 32390530 DOI: 10.1177/1938640020920947] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction. Segmental bone loss in the hindfoot hinders the chance of successful outcomes. Tibiotalocalcaneal arthrodesis is a reliable option; nevertheless, the risk of nonunion is high. Three-dimensional (3D) printed titanium implants offer a strong scaffold that can be customized and has demonstrated encouraging healing rates. In this study, we described the clinical outcomes and the radiologic union rate of a case series of patients with hindfoot arthrodesis, using a retrograde intramedullary nail associated to a 3D printed titanium cage. Methods. Seven patients undergoing hindfoot arthrodesis, using a retrograde intramedullary nail associated to a custom 3D printed titanium cage, were included. Demographic data were collected. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Score and the Visual Analogue Scale for pain. Hindfoot alignment and radiographic union were evaluated using weight-bearing radiographs and computed tomography scan, respectively. Results. A total of 6 (85%) patients had more than 50% bony bridging. Only 1 patient underwent below knee amputation due to recurrence of chronic osteomyelitis. Two additional patients had minor complications. Conclusion. Tibiotalocalcaneal arthrodesis using customized titanium cages for patients with large bone defects has shown a high rate of union in those at risk of nonunion. However, further research with larger series is needed.Levels of Evidence: Level IV: Case series.
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Affiliation(s)
- Lorena Bejarano-Pineda
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Illinois at Chicago, Illinois (LBP).,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (AS, SBA, SGP)
| | - Akhil Sharma
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Illinois at Chicago, Illinois (LBP).,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (AS, SBA, SGP)
| | - Samuel B Adams
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Illinois at Chicago, Illinois (LBP).,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (AS, SBA, SGP)
| | - Selene G Parekh
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Illinois at Chicago, Illinois (LBP).,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina (AS, SBA, SGP)
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24
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Coetzee JC, Den Hartog BD, Stone McGaver R, Seiffert KJ, Giveans MR. Femoral Head Allografts for Talar Body Defects. Foot Ankle Int 2021; 42:815-823. [PMID: 33541133 DOI: 10.1177/1071100720983811] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Large structural bone deficits after a failed ankle arthroplasty or avascular necrosis (AVN) of the talus present a complex reconstruction challenge. The aim of this study was to report the results of patients undergoing an ankle arthrodesis or tibiotalocalcaneal fusion using a femoral head allograft (FHA). METHODS All ankle and tibiotalocalcaneal fusions using FHA between February 2006 and January 2019 were included. Forty-four patients (45 ankles) with a mean follow-up of 42.8 months were studied. Males accounted for 58.1% (25/43 patients). All patients had either failure of primary or revision total ankle arthroplasty (TAA) or AVN of the talus. Pre- and postoperative Veterans RAND Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), Ankle Osteoarthritis Scale (AOS) and visual analog scale (VAS) for pain scores were obtained. A patient satisfaction survey was distributed postoperatively and results were tabulated. RESULTS Preoperatively to postoperatively, the VR-12 Mental score remained essentially unchanged (P = .752) and the VR-12 Physical score improved (P = .007); the FAAM Activities of Daily Living (ADL) and Sport scores improved (P < .001); the AOS Pain and Disability scores improved (P < .001); and the man VAS score improved (P < .001). The overall satisfaction rate was 78.6 on a 100-point scale. At an average of 18.7 weeks, 90.7% of the ankles were substantially fused. Five patients went on to nonunions and revision surgery. CONCLUSION The use of FHA to treat talar defects was a viable option. In this complex patient population, the arthrodesis rate was high at 89% with very positive patient-reported outcome scores. LEVEL OF EVIDENCE Level IV, case series.
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25
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Yoshimoto K, Fukushi JI, Tsushima H, Kamura S, Miyahara HA, Mizu-Uchi H, Akasaki Y, Nakashima Y. Does Preparation of the Subtalar Joint for Primary Union Affect Clinical Outcome in Patients Undergoing Intramedullary Nail for Rheumatoid Arthritis of the Hindfoot and Ankle? J Foot Ankle Surg 2021; 59:984-987. [PMID: 32576440 DOI: 10.1053/j.jfas.2019.08.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 02/03/2023]
Abstract
This study aimed to evaluate whether preparation of the subtalar joint affects the clinical outcomes after tibiotalocalcaneal arthrodesis using an intramedullary nail with fins for rheumatoid ankle/hindfoot deformity. Fifty-three joints in 51 patients who underwent tibiotalocalcaneal arthrodesis using an intramedullary nail with fins for rheumatoid arthritis at 2 institutions were included. Ten patients were male and 41 were female, with a mean age at surgery and follow-up period of 61.3 years and 71.6 months, respectively. Radiographic bone union was evaluated at the most recent visit. Univariate and multivariable analyses were performed to determine the risk factors associated with nonunion. The mean postoperative Japanese Society for Surgery of the Foot ankle/hindfoot scale was 65.3 (range, 5-84). The tibiotalar nonunion rate was 0%, whereas the subtalar nonunion rate was 43.3% (23 joints). Revision surgery was performed in 5, all of which were due to painful subtalar nonunion. Absence of subtalar curettage and earlier postoperative weightbearing were significantly associated with subtalar nonunion (p = .0451 and p = .0438, respectively). Subtalar nonunion after tibiotalocalcaneal arthrodesis for rheumatoid hindfoot is associated with higher revision rate. To decrease the risk of subtalar nonunion after tibiotalocalcaneal arthrodesis with an intramedullary nail in rheumatoid patients, curettage for the subtalar joint should be performed, and full weightbearing should be delayed until at least 26 days postoperatively.
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Affiliation(s)
- Kensei Yoshimoto
- Surgeon, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Surgeon, Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, Tokyo, Japan
| | - Jun-Ichi Fukushi
- Director, Department of Orthopedic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
| | - Hidetoshi Tsushima
- Surgeon, Department of Orthopedic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Satoshi Kamura
- Surgeon, Department of Orthopedic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hisa-Aki Miyahara
- Vice President, Department of Orthopedic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hideki Mizu-Uchi
- Assistant Professor, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukio Akasaki
- Assistant Professor, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Professor, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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26
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Hoang V, Anthony T, Gupta S, Chang R, Chan H, Watson T. Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer. Arthrosc Tech 2021; 10:e1187-e1195. [PMID: 34141530 PMCID: PMC8185523 DOI: 10.1016/j.eats.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Limb shortening due to structural bone loss in tibiotalocalcaneal arthrodesis is a concern that can negatively impact the patient's gait and weight-bearing. To aid in preventing the risk of limb shortening, the use of a femoral head allograft and intramedullary nail in tibiotalocalcaneal arthrodesis has been shown to successfully preserve limb length in patients with structural bone deficits. We present our technique using a femoral head allograft with a cup-and-cone reamer for the treatment of severe ankle and hindfoot deformity.
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Affiliation(s)
- Victor Hoang
- Valley Hospital Medical Center, Las Vegas, Nevada, U.S.A.,Address correspondence to Victor Hoang, D.O., Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV 89106.
| | - Taylor Anthony
- Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada, U.S.A
| | - Shivali Gupta
- Valley Hospital Medical Center, Las Vegas, Nevada, U.S.A
| | - Ryan Chang
- University of San Diego, San Diego, California, U.S.A
| | - Holman Chan
- Nevada Orthopedic & Spine Center, Henderson, Nevada, U.S.A
| | - Troy Watson
- Valley Hospital Medical Center, Las Vegas, Nevada, U.S.A.,Desert Orthopaedic Center, Las Vegas, Nevada, U.S.A.,The Foot & Ankle Institute, Henderson, Nevada, U.S.A
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27
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Powers NS, Brandao RA, St John JM, Burns PR. Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series. J Foot Ankle Surg 2021; 59:431-435. [PMID: 32131017 DOI: 10.1053/j.jfas.2018.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 02/03/2023]
Abstract
Retrograde intramedullary nails are often used for tibiotalocalcaneal arthrodesis to correct severe hindfoot deformities in high-risk patient populations. The purposes of the current study are to report outcomes of patients undergoing staged management of infection after intramedullary nail fixation for tibiotalocalcaneal arthrodesis and to review the surgical approach to management of this limb-threatening complication. The authors reviewed patients who underwent hindfoot intramedullary nailing with subsequent revision for infection between January 2006 and December 2016. Staged protocol with antibiotic nail for the management of deep infection was used in 19 patients. The mean follow-up was 115.87 ± 92.80 (range 2.29 to 341.86) weeks. Twelve of the patients had diabetes, 10 had Charcot neuroarthropathy, and 7 had arthrodesis for equinovarus deformity. Sixteen had peripheral neuropathy and 13 had history of ulceration on the operated extremity. Limb salvage with the use of this protocol was achieved in 14 (73.68%) of 19 patients. Five (26.32%) patients had proximal amputation with 3 (15.79%) deaths within the follow-up period. Amputation was more likely in the nonsmoking (p = .01) and insulin-dependent (odds ratio = 22, p = .02) patient cohorts, whereas death was associated only with higher body mass index (p = .03). Time to revision was greater in patients with external bracing postoperatively as well (p = .004). Outcomes, including total number of procedures and retained antibiotic rods, were not associated with any of the preoperative variables or indications. In high-risk patient populations, the presented staged management of infected intramedullary hindfoot nails showed promising outcomes for limb preservation.
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Affiliation(s)
- Nicholas S Powers
- Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA.
| | | | | | - Patrick R Burns
- Assistant Professor, Podiatric Medicine and Surgery Residency, Department of Orthopedic Surgery, University of Pittsburgh Medical Center Mercy, University Pittsburgh School of Medicine, Pittsburgh, PA
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28
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Steele JR, Lazarides AL, DeOrio JK. Tibiotalocalcaneal Arthrodesis Using a Novel Retrograde Intramedullary Nail. Foot Ankle Spec 2020; 13:463-469. [PMID: 31640417 DOI: 10.1177/1938640019883138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Tibiotalocalcaneal (TTC) arthrodesis is a common treatment option for complex hindfoot pathology. Overall union rates range from 50% to 86% but can be even lower in certain populations. A novel retrograde intramedullary nail has recently been developed. The purpose of this study was to report fusion rates, time to weight-bearing, and complications with the use of the A3 Fusion Nail. Methods. All patients 18 years or older who underwent TTC arthrodesis with an A3 Fusion Nail at a single institution from 2010 to 2015 with a minimum 3-month follow-up were included in this study. Rates of successful fusion, time to union, time to weight-bearing, and complications were evaluated. A total of 20 patients with an average age of 58.1 years and an average follow-up of 12.5 months met inclusion criteria. Results. Successful TTC arthrodesis was achieved in 14 of 20 patients (70%) overall. Average time to union was 8.1 months, and average time to weight-bearing was 6.8 weeks. Of 20 patients, 17 (85%) required femoral head allograft for bulk bone defects, and the union rate in this subset of patients was 76.5%. The rates of revision surgery (10%) and complications were low. Conclusion. The A3 Fusion Nail demonstrated a favorable safety profile and achieved TTC arthrodesis at a rate consistent with historical data despite being used in a patient population at high risk for nonunion. In patients with bulk bone defects at high risk for nonunion, the A3 Fusion Nail demonstrated superior rates of fusion (76.5%) to those reported in the literature (50%).Level of Evidence: Level III: Retrospective cohort study.
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Affiliation(s)
- John R Steele
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Alexander L Lazarides
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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29
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Chiu YC, Chen IC, Yang SC, Kuo SM, Kao YH, Jou IM, Tu YK. Using antibiotic cement nail with multiple screws fixation as a single-stage salvage procedure for patient with infected tibiotalocalcaneal arthrodesis: A case report. J Orthop Surg (Hong Kong) 2020; 28:2309499019899572. [PMID: 31994966 DOI: 10.1177/2309499019899572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tibiotalocalcaneal (TTC) arthrodesis with retrograde nail is a widely used treatment option for severe ankle arthropathy. With inherent biomechanical benefits in axial loading and strong bending stiffness, high union rate and good clinical outcomes have been reported in the literature. However, some undesired complications, such as osteomyelitis or implant failure, can develop after this procedure. Herein, we report the case of an 86-year-old man with right ankle osteomyelitis after TTC arthrodesis with retrograde nail. After removing the previous implants and extensive debridement, we used an antibiotic cement nail with multiple screws fixation as a salvage procedure in the same operation. The patient fully recovered without further surgical treatment.
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Affiliation(s)
- Yen-Chun Chiu
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - I-Chien Chen
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - Shih-Chieh Yang
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - Shyh-Ming Kuo
- Department of Biomedical Engineeing, I-Shou University, Kaohsiung
| | - Yu-Hsien Kao
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - I-Ming Jou
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
| | - Yuan-Kun Tu
- Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung
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30
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Velasco BT, Briceño J, Miller CP, Ye MY, Savage-Elliott I, Ellington JK, Kwon JY. Peri-implant fractures around hindfoot fusion nails: A systematic literature review and classification system. Injury 2020; 51:1497-1508. [PMID: 32389394 DOI: 10.1016/j.injury.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibio-talo calcaneal (TTC) arthrodesis is increasingly performed for hindfoot arthrosis and other indications. Peri-implant fracture around hindfoot fusion nails has been previously reported and can be problematic to treat given multiple surgical considerations including the status of hindfoot arthrodesis at time of fracture. We present a systematic review of the literature regarding peri-implant fractures around hindfoot fusion nails and propose a classification system to help guide treatment based on findings from the current literature as well as the collective experience of the senior authors. METHODS A review of the literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify clinical investigations in which peri-implant fractures or other hardware failures were observed as complications following TTC arthrodesis using hindfoot nails. The electronic database of PubMed/Medline/Cochrane Library was explored using specific search terms. Inclusion criteria was any clinical investigation that reported on outcomes after TTC arthrodesis using a hindfoot nail in at least one patient. Cadaveric and non-clinical investigations were excluded. RESULTS A total of 36 studies were identified which met inclusion criteria and reported clinical outcomes after TTC arthrodesis using a hindfoot fusion nail. Of the 36 studies, there was a total of 13 intraoperative fractures, 43 tibial stress fractures and 24 peri-implant fractures recorded in 12 of the 36 studies. CONCLUSION Peri-implant fracture following tibio-talo calcaneal arthrodesis using a hindfoot intramedullary nail is an uncommon but problematic condition to treat. General heterogeneity of patients and indications as well as a lack of descriptive detail in the current literature makes meta-analysis difficult. Given the lack of consensus on treatment, a classification system may be helpful to guide clinical practice.
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Affiliation(s)
- Brian T Velasco
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, United States.
| | - Jorge Briceño
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Christopher P Miller
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States.
| | - Michael Y Ye
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States.
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States.
| | - J Kent Ellington
- Department of Orthopaedic Surgery, OrthoCarolina, 250 N Caswell Rd, Charlotte, NC 28207, United States.
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
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31
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Steele JR, Kildow BJ, Cunningham DJ, Dekker TJ, DeOrio JK, Easley ME, Nunley JA, Parekh SG, Adams SB. Comparison of Tibiotalocalcaneal Arthrodeses Using a Sustained Dynamic Compression Nail Versus Nondynamized Nails. Foot Ankle Spec 2020; 13:193-200. [PMID: 31018671 DOI: 10.1177/1938640019843332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Tibiotalocalcaneal (TTC) arthrodesis is a common treatment option for hindfoot arthritis and deformity. Loss of compression over time with statically locked nails may contribute to nonunion. A novel retrograde intramedullary nail with an internal pseudoelastic component has recently been used to provide sustained dynamic compression (SDC). The purpose of this study was to compare fusion rates and time to union between the SDC and nondynamized (ND) nails. Methods. All patients who underwent TTC arthrodesis with an intramedullary nail at a single institution from 2013 to 2017 and who had at least 1 year of follow-up were included in this study. Baseline patient and operative characteristics were collected and compared between the sustained SDC and ND nail groups. The rate of successful fusion, time to union, and complications were compared between the groups. Results. The SDC cohort had a significantly faster time to union by 3.9 months (P = .049). The SDC cohort had a higher fusion rate (78.0%) compared with the ND nail cohort (75.0%), although this was not statistically significant (P = .75). The SDC nail was used significantly (P < .05) more often in patients with known risk factors for nonunion, including female sex, smoking, revision surgery, prior trauma, and patients requiring 3D cage implants for significant bone loss. There were no differences between the groups in terms of complications. Conclusion. The SDC nail has been shown to achieve successful arthrodesis in a population at high risk for nonunion, using less hardware, and at a faster rate than ND nails. Level of Evidence: Level III: Retrospective, comparative study.
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Affiliation(s)
- John R Steele
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Beau J Kildow
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Cunningham
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Travis J Dekker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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32
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Treatment of Stage 4 Flatfoot. Foot Ankle Clin 2020; 25:269-280. [PMID: 32381314 DOI: 10.1016/j.fcl.2020.02.002] [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] [Indexed: 02/02/2023]
Abstract
Stage 4 flatfoot represents only a small proportion of flatfoot cases and is likely to become even rarer. The evidence base to guide treatment is limited to case series and expert opinion. Therefore, a pragmatic approach to treatment must be taken. Low-demand individuals may manage well with conservative treatment. Surgical management is complex, likely to require staging, and has a significant complication profile. Patients should be fully informed and understanding of this. First principles of surgery should be followed, including restoring hindfoot and ankle joint alignment, appropriate soft tissue balancing, and optimizing function by limiting arthrodeses and subsequent stiffness.
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33
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Mosca M, Caravelli S, Fuiano M, Massimi S, Censoni D, Grassi A, Vocale E, Ceccarelli F, Zaffagnini S. Tibiotalocalcaneal arthrodesis through retrograde nailing for the treatment of juxtaarticular distal tibia aseptic non-unions: A retrospective study at a minimum follow-up of 4 years. Injury 2020; 51:1377-1381. [PMID: 32327237 DOI: 10.1016/j.injury.2020.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/07/2020] [Accepted: 03/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study is to determine the efficacy of tibiotalocalcaneal arthrodesis by reamed intramedullary nail in the management of the distal tibia non-unions, associated with end-stage osteoarthritis of ankle and subtalar joints. MATERIALS AND METHODS 8 patients with radiographical and clinical diagnosis of non-union of the distal tibia have been treated with tibiotalocalcaneal arthrodesis by intramedullary retrograde nail and were retrospectively evaluated. Patients were radiographically and clinically evaluated preoperatively and at final follow-up regarding: satisfaction, AOFAS, VAS. Surgical technique is described. RESULTS Mean follow-up was 69.2 ± 23.2 months (range 48-108). In terms of subjective outcome, patients reported a highly satisfying result. All patients returned to daily activities, with an average time of 24.7 ± 8.7 weeks. 6 patients could return to their previous work activity, with an average time of 23.6 ± 6.3 weeks. CONCLUSIONS The procedure showed good results at final follow up. Consolidation was achieved in all the treated cases. Considering AOFAS and VAS scores at final follow-up, there was an evident improvement of the conditions of the patients.
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Affiliation(s)
- Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Censoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Alammar Y, Sudnitsyn A, Neretin A, Leonchuk S, Kliushin NM. Closed arthrodesis in infected neuropathic ankles using Ilizarov ring fixation. Bone Joint J 2020; 102-B:470-477. [PMID: 32228076 DOI: 10.1302/0301-620x.102b4.bjj-2019-1158.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. METHODS We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. RESULTS The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. CONCLUSION We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470-477.
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Affiliation(s)
- Yaser Alammar
- Foot & Ankle Unit, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Anatoliy Sudnitsyn
- Purulent Osteology Clinic, Bone Infection Department No. 2, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Andrey Neretin
- Traumatology & Orthopaedist Department No. 5, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Sergey Leonchuk
- Traumatology & Orthopaedic Department No. 6, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Nikolay Mikhailovich Kliushin
- Purulent Osteology Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
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Baumbach SF, Maßen F, Böcker W, Polzer H. [Arthroscopic tibiotalocalcaneal arthrodesis using an intramedullary locking nail]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:158-170. [PMID: 31925449 DOI: 10.1007/s00064-019-00646-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arthroscopic tibiotalocalcaneal arthrodesis (TTCA) aims at reconstructing a pain-free, orthograde, and functional limb with reduced invasiveness and lower complication rates compared to open arthrodesis. INDICATIONS Combined osteoarthritis of the ankle and subtalar joint or hindfoot malalignment. CONTRAINDICATIONS Osteomyelitis/deep soft tissue infections, talus necrosis, severe deformity of hindfoot or distal tibia, pronounced boney defect, indication for combined total ankle replacement and subtalar fusion. SURGICAL TECHNIQUE Patient in supine position; arthroscopic debridement of the cartilage and subchondral zone, perforation of the subchondral bone marrow of the ankle and subtalar joint. Foot and hindfoot positioning. Special attention has to be paid to the calcaneus and talus inclination, hindfoot alignment and rotation. Temporary fixation, insertion of the guide wire, reaming and insertion of the retrograde, curved compression arthrodesis nail. If needed, autologous bone grafting. Proximal locking of the nail, application of compression, distal locking, wound closure. POSTOPERATIVE MANAGEMENT Lymphatic drainage, physical therapy, and restricted bed rest until wound healing. Non-weightbearing, immobilization for 8 weeks, then step-wise increase of weightbearing. Fitting of custom-made shoes. RESULTS Retrospectively included were 15 patients treated by arthroscopic TTCA with an intramedullary nail (average age 56 ± 10 years, 93% male, all had risk factors for postoperative complications). Due to a preoperative plantar ulceration, 4 patients (27%) had 3 ± 1.8 conditioning operations. Sufficient hindfoot correction was achieved in all patients. Major complications occurred in 33% (non-unions). In a subgroup analysis, the presence of a plantar ulceration significantly influenced the development of a major complication. In a case-control study, major complications occurred in 63% and wound complications in 50% of patients for the open technique compared to 33% and 0%, respectively, for the arthroscopic technique. Although the current data do not prove superiority of arthroscopic TTCA compared to open TTCA, there appears to be a strong trend towards considerably lower complication rates following arthroscopic TTCA.
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Affiliation(s)
- Sebastian Felix Baumbach
- Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - Felix Maßen
- Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - Wolfgang Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - Hans Polzer
- Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland.
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Klaue K, Wichelhaus A, Maik P, Mittlmeier T. The circular arc shaped nail for fixing the tibiotalocalcaneal arthrodesis. After clinical results. Injury 2019; 50 Suppl 3:23-31. [PMID: 31378544 DOI: 10.1016/j.injury.2019.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibiotalocalcaneal arthrodesis is commonly considered a salvage option for a variety of hindfoot disorders involving the ankle and subtalar joint mostly with concomitant deformity. Retrograde interlocking nailing represents one of the biomechanically most stable fixation modes after reduction of hindfoot geometry. The considerable complications, non-union and revision rates at a moderate outcome reported even with modern retrograde nails underscore the idea that the development of an optimized retrograde nail may be warranted. METHODS A novel circular shaped nail was designed with a perfect fit to the reamed canal and the implant geometry which respects physiologic hindfoot anatomy and alignment. The present clinical series reports the experience and the clinical and radiographic outcomes after application of the implant in the first 30 consecutive patients. Assessments included validated versions of the AOFAS Ankle/Hindfoot Score and the Foot Function Index. RESULTS Anatomical alignment was achieved and maintained in 29/30 cases with a single case of later loss of reduction due to a technical error which led to surgical reintervention two months after the index procedure. The overall union rate reached 93%. Two non-unions (one ankle, one subtalar joint) were observed without necessitating further surgery. Three superficial surgical site infections were registered which made a local flap coverage necessary in two patients due to local skin break-down. No deep infection occurred. There were 2 implant removals, one was not related to hindfoot nailing. At the time of follow-up, the AOFAS Ankle/Hindfoot Score was 57 (median) from a maximum of 86 points. The self-assessment via the Foot Function Index improved from preoperative 155 points to 62.5 postoperatively (median values, p<0.001, Wilcoxon test). CONCLUSION On the basis of our results, which saw a high rate of successful fusion and patient satisfaction and where the hindfoot reduction was maintained until definite healing in the vast majority of cases, the novel circular arc nail represents a viable and safe option for tibiotalocalcaneal arthrodesis with a low complication rate.
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Affiliation(s)
- Kaj Klaue
- Reparto di Chirurgia Ortopedica, Clinica Luganese, sede Moncucco, CH-6900, Lugano, Switzerland
| | - Alice Wichelhaus
- Rostock University Medical Center, Dept. of Trauma, Hand and Reconstructive Surgery, Schillingallee 35, D-18057, Rostock, Germany
| | - Paulina Maik
- Rostock University Medical Center, Dept. of Trauma, Hand and Reconstructive Surgery, Schillingallee 35, D-18057, Rostock, Germany
| | - Thomas Mittlmeier
- Rostock University Medical Center, Dept. of Trauma, Hand and Reconstructive Surgery, Schillingallee 35, D-18057, Rostock, Germany.
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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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Preis M, Bailey T, Marchand LS, Weinberg MW, Jacxsens M, Barg A. Conversion of painful tibiotalocalcaneal arthrodesis to total ankle replacement using a 3-component mobile bearing prosthesis. Foot Ankle Surg 2019; 25:286-293. [PMID: 29409180 DOI: 10.1016/j.fas.2017.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/12/2017] [Accepted: 12/04/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to assess the short-term clinical and radiographic outcomes in patients who underwent conversion of a painful tibiotalocalcaneal arthrodesis to a total ankle replacement. METHODS Six patients with painful ankle arthrodesis after tibiotalocalcaneal arthrodesis were included in this study. In all patients, conversion to total ankle replacement was performed using a 3rd-generation, non-constrained, cementless three-component prosthesis. The outcomes were analyzed at a mean follow-up of 3.4±1.9years (range 1.0-6.5). RESULTS One patient with painful arthrofibrosis underwent two open arthrolysis procedures at 1.2 and 5.6 years post index surgery, respectively. No revision of tibial or talar prosthesis components was necessary in this study. All patients reported significant pain relief and significant improvement in functional status. CONCLUSION In the present study, the conversion of a painful ankle arthrodesis following tibiotalocalcaneal arthrodesis to a total ankle replacement was a reliable surgical treatment.
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Affiliation(s)
- Markus Preis
- Department of Orthopaedics, Aukammklinik, Leibnizstrasse 21, 65191 Wiesbaden, Germany
| | - Travis Bailey
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Lucas S Marchand
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Maxwell W Weinberg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Matthijs Jacxsens
- Harold K. Dunn Orthopaedic Research Laboratory, Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Escudero MI, Poggio D, Alvarez F, Barahona M, Vivar D, Fernandez A. Tibiotalocalcaneal arthrodesis with distal tibial allograft for massive bone deficits in the ankle. Foot Ankle Surg 2019; 25:390-397. [PMID: 30321970 DOI: 10.1016/j.fas.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to assess the outcomes of distal tibial structural allograft to obtain a stable TTC fusion. METHODS Retrospectively, ten patients were carried out with a minimum one year follow-up. The median age was 72 (33-81). The median BMI was 28 (24-33). Indications for TTC arthrodesis included failed total ankle arthroplasty (n=7 patients), prior nonunion (n=2 patients), and a trauma injury. RESULTS Union rate was 80%. The median initial height of the distal tibial allograft was 19mm (14-24mm). In seven cases the allograft did not lose height. The AOFAS score median was 69 (31-84). SF-12 median physical component was 39 (30-53), and 59 (23-62) for mental component. The VAS median was 2 (0-8). CONCLUSIONS TTC using distal tibial allograft shows a lower rate of collapse than other structural grafts and provides a fusion rate higher or in accordance with the literature. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; Department of Orthopedics, Hospital Clinico, University of Chile, Santiago 8380456, Chile.
| | - Daniel Poggio
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Fernando Alvarez
- Department of Orthopedics, Hospital San Rafael, Passeig de la Vall d'Hebron, 107, 08035 Barcelona, Spain
| | - Maximiliano Barahona
- Department of Orthopedics, Hospital Clinico, University of Chile, Santiago 8380456, Chile
| | - Diego Vivar
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Alvaro Fernandez
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
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Ford SE, Kwon JY, Ellington JK. Tibiotalocalcaneal Arthrodesis Utilizing a Titanium Intramedullary Nail With an Internal Pseudoelastic Nitinol Compression Element: A Retrospective Case Series of 33 Patients. J Foot Ankle Surg 2019; 58:266-272. [PMID: 30612872 DOI: 10.1053/j.jfas.2018.08.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 02/03/2023]
Abstract
Nitinol has been shown to generate durable compression under loading via pseudoelastic shape memory. The purpose of this study was to evaluate the effectiveness of a hindfoot arthrodesis nail with an internal pseudoelastic nitinol compression element. Patients who had undergone tibiotalocalcaneal arthrodesis from 2013 to 2016 were identified at 2 tertiary referral centers (12-week follow-up minimum). Patients managed with a tibiotalocalcaneal nail with an internal nitinol compression element were identified for review. Sagittal computed tomographic scan reformats were reviewed to calculate a percentage of joint surface bony union. Intraoperative and postoperative radiographs were compared to calculate postoperative screw position change generated by the nitinol element, a surrogate for postoperative unloading of compressive forces. Thirty-three patients were included in analysis and 81% of patients had successful union of both tibiotalar and subtalar joints. Overall, 90% of all arthrodesis surfaces united. The union rate of arthrodesis surfaces among patients without Charcot osteoarthropathy was 94%. A history of Charcot was identified as a risk factor for subtalar nonunion (p = .04) and was associated with less complete computed tomography-based tibiotalar union: 94% versus 71% (p < .01). The posterior-to-anterior screw translated an average of 3.9 mm proximally relative to the rigid portion of the nail from intraoperative to initial postoperative radiographs (p < .0001). High rates of computed tomography-confirmed union were demonstrated in the face of challenging clinical scenarios. Shortening of the pseudoelastic nitinol element occurs early in the postoperative period, indicating continued unloading of the nitinol compression element through the arthrodesis sites after initial implantation.
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Affiliation(s)
- Samuel E Ford
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC
| | - John Y Kwon
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - J Kent Ellington
- Orthopaedic Surgeon, Foot and Ankle Institute, OrthoCarolina, Charlotte, NC.
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Lee M, Choi WJ, Han SH, Jang J, Lee JW. Uncontrolled diabetes as a potential risk factor in tibiotalocalcaneal fusion using a retrograde intramedullary nail. Foot Ankle Surg 2018; 24:542-548. [PMID: 29409267 DOI: 10.1016/j.fas.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/04/2017] [Accepted: 07/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibiotalocalcaneal (TTC) fusion using a retrograde intramedullary (IM) nail is an effective salvage option for terminal-stage hindfoot problems. However, as many patients who receive TTC fusion bear unfavorable medical comorbidities, the risk of nonunion, infection and other complications increases. This study was performed to identify the factors influencing outcomes after TTC fusion using a retrograde IM nail. METHODS Between September 2008 and February 2012, 34 consecutive patients received TTC fusion using a retrograde IM nail for limb salvage. All patients had a minimum follow-up of two years. Throughout follow-up, standard ankle radiography was performed along with clinical outcome assessment using a visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society Ankle-Hind Foot Scale (AOFAS A/H scale) and the Foot and Ankle Outcome Score (FAOS). For the retrospective analysis, demographic factors, preoperative medical status, laboratory markers, and etiology were comprehensively reviewed using medical records. The success of the index operation was determined using clinical and radiological outcomes. Finally, the effect of each factor on failure after the operation was analyzed using univariate logistic regression. RESULTS In a mean of seven months, 82% (28/34) achieved union, as evaluated by standard radiography. All clinical outcome parameters improved significantly after the operation, including VAS, AOFAS A/H scale, and FAOS (P<0.001). At the last follow-up, five cases of nonunion with less than AOFAS A/H scale of 80 and two cases of below knee amputation due to uncontrolled infection were determined to be failures. None of the factors (etiology, demographics, laboratory markers and medical status) significantly influenced failures. However, uncontrolled DM significantly increased the failure rate with an odds ratio of 10 (P=0.029). CONCLUSIONS TTC fusion with a retrograde intramedullary nail is a successful treatment for complicated hindfoot problems such as traumatic osteoarthritis, Charcot arthropathy and failed TAA. However, it should be used judiciously in patients with uncontrolled DM, as the risk of failure increases. DESIGN Retrospective cohort study.
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Affiliation(s)
- Moses Lee
- Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Republic of Korea
| | - Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Republic of Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Republic of Korea
| | - Jinyoung Jang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Republic of Korea.
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Chiu YC, Chung TC, Wu CH, Tsai KL, Jou IM, Tu YK, Ma CH. Chopart amputation with tibiotalocalcaneal arthrodesis and free flap reconstruction for severe foot crush injury. Bone Joint J 2018; 100-B:1359-1363. [DOI: 10.1302/0301-620x.100b10.bjj-2018-0118.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This study reports the outcomes of a technique of soft-tissue coverage and Chopart amputation for severe crush injuries of the forefoot. Patients and Methods Between January 2012 to December 2016, 12 patients (nine male; three female, mean age 38.58 years; 26 to 55) with severe foot crush injury underwent treatment in our institute. All patients were followed-up for at least one year. Their medical records, imaging, visual analogue scale score, walking ability, complications, and functional outcomes one year postoperatively based on the American Orthopedic Foot and Ankle Society (AOFAS) and 36-Item Short-Form Health Survey (SF-36) scores were reviewed. Results The mean length of follow-up was 18.6 months (13 to 28). Two patients had a local infection, flap necrosis was seen in one patient, and one patient experienced a skin graft wound healing delay. Of the 12 patients, one had persistent infection and eventually required below-knee amputation, but pain-free walking was achieved in all the other patients. The mean one-year postoperative AOFAS and SF-36 scores were 75.6 (68 to 80) and 82 (74 to 88), respectively. Conclusion Although our sample size was small, we believe that this treatment method may be a valuable alternative for treating severe foot crush injuries. Cite this article: Bone Joint J 2018;100-B:1359–63.
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Affiliation(s)
- Y-C. Chiu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - T-C. Chung
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - C-H. Wu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - K-L. Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-M Jou
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Y-K. Tu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - C-H. Ma
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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Dujela M, Hyer CF, Berlet GC. Rate of Subtalar Joint Arthrodesis After Retrograde Tibiotalocalcaneal Arthrodesis With Intramedullary Nail Fixation: Evaluation of the RAIN Database. Foot Ankle Spec 2018; 11:410-415. [PMID: 29154697 DOI: 10.1177/1938640017740674] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hindfoot arthritis or significant deformity involving the ankle and subtalar joint (STJ) is a disabling condition with few salvage options. Many surgeons note a decreased STJ fusion rate compared with ankle union when a retrograde nail construct is used. The purpose of this study was to report the STJ fusion rate of tibiotalocalcaneal (TTC) arthrodesis with retrograde nail. METHODS A chart and radiographic review was performed. TTC fusions performed in patients with osteoarthritis, posttraumatic arthritis, or deformity correction with retrograde nail fixation were included. Exclusion criteria included neuropathy, Charcot arthropathy, and failed total ankle replacement. RESULTS Ultimately, 66 retrograde TTC fusions (in 63 patients) met inclusion criteria. The average age was 57.0 years. There were 29 female and 34 male patients. Radiographic fusion of the ankle and STJ was demonstrated in 68.2% of the patients. There were 11 cases (16.7%) of ankle arthrodesis with STJ nonunion, 6 cases (9.1%) of STJ fusion but ankle nonunion, and 4 cases (6.1%) of stable radiographic nonunion of both joints. The mean time to subtalar fusion was 112.1 days. One patient required revision surgery and conversion to below-knee amputation. One patient required a CROW walker for assistance with gait. CONCLUSION A 22.8% radiographic nonunion rate of the STJ was noted in retrograde TTC fusion. Despite this, patients were stable and pain free. LEVELS OF EVIDENCE Level IV: Retrospective Case series.
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Affiliation(s)
- Michael Dujela
- Washington Orthopaedic Center, Centralia, Washington (MD).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH, GCB)
| | - Christopher F Hyer
- Washington Orthopaedic Center, Centralia, Washington (MD).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH, GCB)
| | - Gregory C Berlet
- Washington Orthopaedic Center, Centralia, Washington (MD).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH, GCB)
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Abstract
PURPOSE OF REVIEW The role of retrograde hindfoot nailing in the treatment of acute orthopedic trauma is explored. RECENT FINDINGS Tibio-talar calcaneal (TTC) nailing is an acceptable treatment alternative for the low-demand geriatric patient with peri-articular ankle trauma permitting immediate weight-bearing with low rates of complication and return to functionality. Hindfoot nailing can be used for limb salvage in the younger active patient; yet, joint-preserving reconstruction is preferred when feasible. Retrograde TTC nailing is a reliable option for hindfoot/distal tibia stabilization especially in the elderly frail population. Hindfoot nailing is reserved for a select subset of active patients when severity of bone, joint, and soft tissue injury are not amenable to more conventional reconstruction.
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Affiliation(s)
- Ivan S Tarkin
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 911 Kaufmann Building, Pittsburgh, PA, 15213, USA.
| | - Mitchell S Fourman
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, 911 Kaufmann Building, Pittsburgh, PA, 15213, USA
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45
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Lee BH, Fang C, Kunnasegaran R, Thevendran G. Tibiotalocalcaneal Arthrodesis With the Hindfoot Arthrodesis Nail: A Prospective Consecutive Series From a Single Institution. J Foot Ankle Surg 2018; 57:23-30. [PMID: 29129314 DOI: 10.1053/j.jfas.2017.05.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Indexed: 02/03/2023]
Abstract
Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure. We report a series of 20 patients who underwent TTCA using an intramedullary nail. Of the 20 patients, 7 (35%) had diabetes mellitus. The patient experiences and outcomes were analyzed. Their mean age was 61.1 (range 39 to 78) years. The minimum follow-up period was 13 (mean 28, range 13 to 49) months. Surgical indications included diabetic Charcot arthropathy in 7 (35%), hindfoot osteoarthritis in 10 (50%), and severe equinovarus deformity in 3 (15%). A calcaneal spiral blade was used in 2 patients (10%). Significant improvements (p < .05) were observed in 5 of 8 Short-Form 36-item Health Survey components, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (p < .001), and visual analog scale for pain (p < .001). The mean length of the hospital stay was 6.7 (range 1 to 27) days. Of the 20 patients, 76.9% had improvement in their activity postoperatively. Also, 81.8% were able to resume their preoperative work after a mean of 7.89 (range 3 to 24) months. Overall, 19 patients (95%) reported favorable outcomes. Superficial wound infection (n = 4; 20%) and deep wound infection (n = 3; 15%) were the most common complications (35%), with 1 case (5%) culminating in a below-the-knee amputation. Radiographic union was achieved in 16 of the tibiotalar joints (80%), 16 subtalar joints (80%), and 4 tibiocalcaneal fusions (20%). In a subgroup analysis of 7 patients with diabetes mellitus (35%), the incidence of wound complications and fusion was comparable to that of the primary cohort. TTCA performed with an intramedullary nail appears to offer a reliable and safe alternative for patients with severe ankle and hindfoot pathologic entities, including those with diabetes mellitus.
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Affiliation(s)
- Bing Howe Lee
- Medical Officer, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
| | - Christopher Fang
- Medical Officer, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Remesh Kunnasegaran
- Senior Resident, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Gowreeson Thevendran
- Consultant, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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46
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Gagné OJ, Veljkovic A, Glazebrook M, Daniels TR, Penner MJ, Wing KJ, Younger ASE. Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery. Foot Ankle Int 2018; 39:657-663. [PMID: 29506397 DOI: 10.1177/1071100718757722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND People who are affected by end-stage ankle arthritis are as disabled as those suffering from arthritis in other main articulations of the lower extremity. Once these patients become unable to perform their job duties, they leave the workforce and require financial aid from government agencies, which represents a considerable economic burden. Regardless of whether arthrodesis or arthroplasty is performed, we hypothesized that patients younger than 55 years at the time of surgery should be able to return to work within 2 years and require less social assistance. METHODS Patients from 2002 to 2014 included in the nationwide prospective Ankle Reconstruction Database treated for end-stage ankle arthritis with a total ankle replacement or an ankle arthrodesis and younger than 55 years at the time of surgery were included. This study used a standard preoperative survey (AAOS, SF-36) along with the same survey filled by patients in intervals up to 2 years postoperatively. Their employment status was determined at each time point. Participation in third-party wage assistance programs was recorded. This cohort had 194 patients with an average age of 47.0 ± 7.2 years and was balanced in terms of sex (104 female) and side (94 left). RESULTS The employment rate prior to surgery was 56%, which increased to 62% at the 2-year postoperative mark. With regards to worker's compensation, disability, and social security, 20% of patients left all subsidized programs whereas 4% entered at least 1 which is significant (P < .05). CONCLUSION The 2-year follow-up after tibiotalar arthrodesis/arthroplasty in patients younger than 55 years showed that significantly more people were able to leave subsidized work assistance programs than enroll in them. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Oliver J Gagné
- 1 University of British Columbia Orthopedics, Vancouver, BC, Canada
| | - Andrea Veljkovic
- 2 Saint-Paul's Hospital Department of Orthopedics, Vancouver, BC, Canada
| | - Mark Glazebrook
- 3 Queen Elizabeth Health Science Center, Halifax, NS, Canada
| | | | | | - Kevin J Wing
- 2 Saint-Paul's Hospital Department of Orthopedics, Vancouver, BC, Canada
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47
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Gaul F, Tírico LEP, McCauley JC, Bugbee WD. Long-term Follow-up of Revision Osteochondral Allograft Transplantation of the Ankle. Foot Ankle Int 2018; 39:522-529. [PMID: 29366342 DOI: 10.1177/1071100717750578] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral allograft (OCA) transplantation is a useful alternative for treatment of posttraumatic ankle arthritis in young patients but has a relatively high failure rate and further procedures are often required. The purpose of this study was to evaluate outcomes of patients who underwent revision OCA transplantation of the ankle after failed primary OCA transplantation. METHODS Twenty patients underwent revision OCA transplantation of the ankle between 1988 and 2015. Mean age was 44 years, 55% (11 of 20) were female. The mean time from primary to revision OCA was 3.0 ± 1.7 years. All patients had a minimum follow-up of 2 years. Outcomes included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM) and questionnaires evaluating pain and satisfaction. Failure of the revision OCA was defined as a conversion to arthroplasty, arthrodesis, or amputation. RESULTS Ten of 20 ankles required further surgery, of which 30% (6 of 20) were considered OCA revision failures (4 arthrodeses, 1 arthroplasty, and 1 amputation). The mean time to failure was 6.7 (range, 0.6-13.1) years. Survivorship of the revision OCA was 84% at 5 years and 65% at 10 years. The 14 patients with grafts remaining in situ had an average follow-up of 10.3 years; mean AAOS-FAM Core Score was 70.5 (range, 42.3-99). Of the patients who answered the follow-up questions, 4 of 7 reported moderate to severe pain, and 5 of 12 were satisfied with the results of the procedure. CONCLUSION Although the results of revision ankle OCA transplantation are not inferior to primary OCA transplantation, the high rates of persistent pain, further surgery, and graft failure suggest that the indications for OCA as a revision procedure should be carefully evaluated, with proper patient selection. Considering the treatment alternatives, revising a failed OCA transplantation can be a useful treatment option, especially for young and active patients who wish to avoid arthrodesis or arthroplasty. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Florian Gaul
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA.,2 Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Luís E P Tírico
- 3 Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, Brazil
| | - Julie C McCauley
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - William D Bugbee
- 4 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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48
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Affiliation(s)
- Andrew Dodd
- Division of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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49
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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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50
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Abstract
Total ankle arthroplasty is a treatment option for end-stage osteoarthritis of the ankle, as is ankle arthrodesis. Many variables, including patient characteristics, are thought to influence clinical outcome and survival. As with any surgery, but especially with total ankle replacement (TAR), patient selection is considered critical for good (long-term) outcome. In this review, we summarize the available scientific evidence regarding patient characteristics and its influence on the results of TAR.
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Affiliation(s)
| | - Daniël Haverkamp
- Slotervaart Center of Research and Education (SCORE), MC Slotervaart Hospital, Amsterdam, the Netherlands,
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