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Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3577-3584. [PMID: 37245183 PMCID: PMC10225040 DOI: 10.1007/s00590-023-03592-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate. METHODS Single-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III-IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures. RESULTS A significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking. CONCLUSION In high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.
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Affiliation(s)
- Natalia Gutteck
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany.
| | - Karl-Stefan Delank
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
| | - Sebastian Schilde
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
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Chen ZX, Wang MY, Zhang C, Ding ZQ, Chen W. Treatment of talipes equinovarus after triceps surae intramuscular hemangioma surgery by Ilizarov technology in adults: A case report. World J Clin Cases 2023; 11:2803-2810. [PMID: 37214575 PMCID: PMC10198100 DOI: 10.12998/wjcc.v11.i12.2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Postoperative complications of triceps surae intramuscular hemangioma surgery with talipes equinovarus have rarely been described, and the evidence for treatment is limited. The purpose of this case study was to report the new application of the Ilizarov technique, which successfully treated talipes equinovarus in adults after triceps surae intramuscular hemangioma.
CASE SUMMARY A 29-year-old woman treated with the Ilizarov technique for talipes equinovarus in the right leg after triceps surae intramuscular hemangioma surgery. The equinus deformity was roughly corrected after 2 years of follow-up, without significant secondary sequelae.
CONCLUSION Talipes equinovarus caused by postoperative sequelae of intramuscular hemangioma was successfully corrected by the Ilizarov technique. The Ilizarov technique may be used for treating talipes equinovarus caused by various causes.
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Affiliation(s)
- Zhang-Xin Chen
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Meng-Yuan Wang
- School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Cong Zhang
- School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Zhen-Qi Ding
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
| | - Wei Chen
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 363000, Fujian Province, China
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Cibura C, Lotzien S, Rosteius T, Ull C, Godolias P, Schildhauer TA, Königshausen M. Rate of progressive healing with a carbon-fiber orthosis in cases of partial union and nonunion after ankle arthrodesis using the Ilizarov external fixator. J Foot Ankle Res 2023; 16:15. [PMID: 36964559 PMCID: PMC10039608 DOI: 10.1186/s13047-023-00613-3] [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: 07/04/2022] [Accepted: 03/12/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The Ilizarov fixator is a popular device for treating arthrodesis of the ankle joint in complex situations. However, the therapy can fail, with nonunion or partial union that might not be load stable. There is the possibility of follow-up surgery or extended wearing of the fixator. Full weight bearing with a carbon orthosis remains another treatment option, which has not yet been investigated.The aim of the study was to determine the rate of progress that can be obtained with a carbon orthosis in cases of partial union or nonunion after fixator removal. METHODS In this retrospective observational study thirty-three patients received a carbon orthosis after fixator removal due to nonunion or partial union. All patients were allowed to walk with the orthosis under full load. The consolidation rate was determined radiologically and compared with the imaging data obtained during the last follow-up. In addition to demographic data, the Foot and Ankle Ability Measure and pain using a numeric rating scale were determined. Nine patients had to be excluded due to insufficient follow-up, and finally n = 24 patients were included in the study. RESULTS The average duration of fixator use was 21 weeks (range 15-40 weeks), and the total average follow-up after removal of the fixator was 16 months (range 4- 56). For 14 (58.33%) patients, there was a further increase in consolidation with the orthosis after the fixator was removed. CONCLUSION The results show that if there is only partial union or nonunion, further consolidations can be achieved after the application of a carbon orthosis. In a difficult patient population, using an orthosis should therefore be attempted to avoid unnecessary revision operations.
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Affiliation(s)
- Charlotte Cibura
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany.
| | - Sebastian Lotzien
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Rosteius
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Christopher Ull
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Periklis Godolias
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Matthias Königshausen
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
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Tay KS, Langit M, Fenton C, Grupping R, Muir R, Moulder E, Sharma H. Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction. Foot Ankle Int 2023; 44:403-414. [PMID: 36942403 DOI: 10.1177/10711007231157710] [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: 03/23/2023]
Abstract
BACKGROUND Circular frames for ankle fusion are reserved for complex clinical scenarios. The literature is heterogenous and conflicting. We aim to present the indications and outcomes of this procedure. METHODS A retrospective cohort study based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow-up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiologic and clinical outcomes, and adverse events. Factors influencing radiologic and clinical outcomes were analyzed. RESULTS 47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT. CONCLUSION Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. Identified risk factors for poorer outcomes should be considered in patient counselling and prognostication. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
| | - Mickhael Langit
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Carl Fenton
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Rachael Grupping
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Ross Muir
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Elizabeth Moulder
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Hemant Sharma
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
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Reinke C, Lotzien S, Yilmaz E, Hanusrichter Y, Ull C, Baecker H, Schildhauer TA, Geßmann J. Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients. Arch Orthop Trauma Surg 2022; 142:1359-1366. [PMID: 33484305 PMCID: PMC9217898 DOI: 10.1007/s00402-021-03751-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 01/01/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. MATERIALS AND METHODS Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. RESULTS The average time spent in the fixator was 22 (range 14-34) weeks. The average follow-up in 17 patients was 116 (range 4-542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. CONCLUSION Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.
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Affiliation(s)
- Charlotte Reinke
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Emre Yilmaz
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Yannik Hanusrichter
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Christopher Ull
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Hinnerk Baecker
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Thomas A. Schildhauer
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Jan Geßmann
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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Ma N, Li Z, Li D, Hu Y, Sun N. Clinical evaluation of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis: A retrospective study. Medicine (Baltimore) 2020; 99:e23921. [PMID: 33350796 PMCID: PMC7769368 DOI: 10.1097/md.0000000000023921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
To analyze the efficacy of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis.This retrospective study included 88 patients with end-stage (stage-3) ankle osteoarthritis according to Morrey-Wiedeman classification who underwent arthrodesis with Ilizarov external fixator from January 2016 to January 2019. There were 47 males and 41 females with a mean age of (57.21 ± 7.12) years old (range 49-76). Outcomes were measured by the American Orthopaedic Foot and Ankle society (AOFAS) Ankle Hindfoot Scale, Visual Analog Scale (VAS) pain scores, complications, subjective satisfaction, ankle function, correction of deformity, and complications.With an average follow-up of (13.50 ± 5.41) months (range 10-21), all 88 patients returned for final follow-up. All patients achieved bony healing with a success rate of 100%. Mean postoperative healing time (3.56 ± 1.04) months (range 3-6). Two patients developed sinus tract infection, delayed healing in 1 patient, and 2 patients had pain and swelling again in the ankle joint. No serious complications occurred in other patients. All the patients evaluated with the VAS scores and AOFAS scores at final follow-up showed significant improvement (P < .05). Through imaging analysis, medical tibial talar angle (MTTA) improved from (85.76 ± 6.01) degrees to (88.98 ± 1.35) degrees postoperative. Lateral talar station (LTS) decreased from (5.32 ± 3.81) mm to (2.71 ± 2.62) mm after operation (P < .05). The overall satisfaction of patients is 88.64%.In the treatment of end-stage ankle osteoarthritis, arthrodesis with Ilizarov external fixator can achieve good radiological and clinical outcomes with low prevalence of ankle joint malalignment and high fusion rates and satisfaction.
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Affiliation(s)
- Nan Ma
- Department of Orthopaedic Trauma
| | - Zhi Li
- Department of infection management
| | - Delei Li
- Department of Orthopaedic Trauma
| | - Yehua Hu
- Department of Rehabilitation, General Hospital of Jizhong Energy Xingtai Mining Group Co., Ltd, Xingtai, Hebei, 054000
| | - Ning Sun
- Department of Orthopaedic, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, PR China
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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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