Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation

Objective

To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

Methods

From June 2013 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution. Conventional double‐feet standing X‐ray films were taken before and after operation. The tibiotalar angle on X‐ray image was measured to evaluate the degree of talipes varus and valgus. The Foot and Ankle pain score of American Orthopaedics Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) were compared by using paired t‐test to evaluate the functional recovery.

Results

All of the patients acquired effective postoperative 18–49 months follow‐up, with an average of 31.5 months. All patients were included in the analysis, among which 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). All ankles achieved bony fusion; the clinical healing time was 12.7 weeks on average (11–18 weeks). The AOFAS score was 45.36 ± 6.43 preoperatively and 80.25 ± 9.16 at 12 months post‐operation, with a statistically significant difference (p < 0.0001). The VAS score was 8.56 ± 1.85 on average preoperatively and 2.72 ± 0.83 at 12 months post‐operation, with a statistically significant difference (p < 0.0001). The tibiotalar angle was 101.93° ± 4.12° preoperatively and 94.45° ± 2.37° at 12 months post‐operation, with a statistically significant difference (p < 0.0001). The results of the functional evaluation indicated that 44 patients (61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.

Conclusion

Our study demonstrated that it is possible to obtain satisfactory outcome with Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

Screw Internal Fixation and Ilizarov External Fixation: A Comparison of Outcomes in Ankle Arthrodesis

The purpose of this study was to compare the mid-term clinical outcomes between screw internal fixation and Ilizarov external fixation in patients who underwent ankle arthrodesis and to elucidate the differences between the 2 fixation methods. This study investigated 43 ankles in 41 patients who underwent ankle arthrodesis at 1 of the 2 study institutions. There were 15 men and 26 women, and their mean age was 66.2 (range 49 to 87) years. The primary disease included osteoarthritis (OA) (79%), rheumatoid arthritis (RA) (16.3%), and Charcot joint (4.7%). Patients were divided into 2 groups depending on the surgical approach: the screw group (S) and the Ilizarov group (I). The following items were evaluated and compared between the 2 groups: patient characteristics, Tanaka-Takakura classification based on preoperative plain X-ray images, duration of surgery, blood loss, surgical complications, time to start weightbearing, and the Japanese Society of Surgery of the Foot (JSSF) standard rating system for the ankle-hindfoot. Duration of surgery was significantly shorter in the S group (162.3 versus 194.9 min), and the amount of blood loss was also significantly lower in the S group (29.2 versus 97.5 ml). Preoperative JSSF scale was significantly lower in the I group (44.8 versus 33), but postoperative JSSF scale was not significantly different between the 2 groups (82.1 versus 77.9). The S group had satisfactory clinical outcomes with a shorter duration of surgery and smaller amount of blood loss than the I group. However, severe patients in the I group achieved similar treatment outcomes.

Validation of the Chinese Version of the Modified Gait Efficacy Scale for Patients Removing Ilizarov External Fixation Device for Over One Year

OBJECTIVE

To validate the Chinese version of the modified Gait Efficacy Scale (C-mGES) in people who have had an Ilizarov external fixation apparatus removed more than 1 year ago.

METHODS

(1) Translating and cultural adapting the English version mGES into Chinese. (2) Validation of the C-mGES with the Perceived Efficacy Patient-Physician Interactions Scale (PEPPI-10), Self-Efficacy for Rehabilitation Outcome Scale (SER), Lower Extremities Function Assessment Scale (LEFS), and Pain Self-Efficacy Questionnaire (PSEQ). Instrument measurements included item generation, construct validity, reliability testing, test-retest reliability and correlation with other scales. Confirmatory factor analysis (CFA) was applied to determine internal consistency and construct validity. One hundred five persons who had Ilizarov external fixation devices removed more than 1 year ago were investigated.

RESULTS

One hundred and two patients were included in this research. Our study showed that the C-mGES has high internal consistency (Cronbach's α-coefficient 0.928). CFA confirmed good fit indices for a unidimensional model of the C-mGES. In test-retest reliability, 97 patients were analyzed. The results showed that the substantial kappa coefficient is 0.680, and the ICC is 0.98 (95% CI).

CONCLUSION

Our study showed that the Chinese version mGES has a good internal consistency, construct validity and satisfactory criterion-related validity. This scale can assist in the assessment of walking self-efficacy in patients who have had Ilizarov external fixation devices removed for over 1 year.

Detecting reasons for recurrent deformity in treatment of patients with vitamin D-resistant rickets using diagnostic imaging

PURPOSE

To assess age related manifestations of the femur and tibia in patients with vitamin D-resistant rickets (VDR) and explore causes for recurrent deformity using imaging modalities.

METHODS

Computed tomography (CT), magnetic resonance imaging (MRI) and dual energy X-ray densitometry (DEXA) were used to assess conditions of long bones of lower limbs in patients with vitamin D-resistant rickets aged from 4 years to 30 years preoperatively and after limb lengthening.

RESULTS

Age related MRI findings showed specific structure of the femur and tibia in patients with VDR preoperatively and after operative treatment. Abundant irregular osteoid formed in femoral and tibial physes was shown to reveal complicated nature of bone deformity causing recurrence in patients with VDR at childhood. CT findings allowed us to detect early cortical injury, measure its length with forming Looser's zones, examine significant differences in density measurements of Looser's zones preoperatively and after deformity correction using transosseous osteosynthesis.

CONCLUSION

Recurrent deformity can develop in patients with VDR due to progression of the disease, irregular osteoid deposited in the medial and lateral metaepiphysis, osteoid area measuring over 50% of epiphyseal cross section, insufficient regenerate mineralization, and formation of Looser's zones.

[Effectiveness analysis of Ilizarov external fixation and ankle arthrodesis in treatment of late traumatic ankle arthritis]

Objective

To evaluate the effectiveness of Ilizarov external fixation and ankle arthrodesis in the treatment of late traumatic ankle arthritis.

Methods

Between June 2013 and June 2015, 27 patients with late traumatic ankle arthritis were treated with Ilizarov external fixation technique. There were 16 males and 11 females with an age of 27-69 years (mean, 45.7 years). Sixteen cases were on the left side, 11 on the right side. All the patients suffered from traumatic ankle fractures or ligament damages caused by initial traumas. After 6 months of standard conservative treatment, the results was invalid and all patients had ankle joint pain and movement disorders. The disease duration was 3-39 years (mean, 11.5 years). According to Takakura ankle arthritis staging, there were 16 cases in stage 3 and 11 cases in stage 4. The tibial-talar angle before operation was (102.55±4.02) ° measured on conventional double-feet loading anteroposterior and lateral X-ray films. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot joint score was 45.72±6.45, and the visual analogue scale (VAS) score was 8.61±1.96.

Results

All the patients were followed up 15-42 months (mean, 28.1 months). All ankles achieved bony fusion, the clinical healing time was 12.9 weeks on average (range, 11-18 weeks). No persistent bleeding in the incisions and needle tract occurred during the follow-up. There were 4 cases of mild needle infection, 2 cases of anterior dislocation of talus, and 3 cases with different degree of limited activity. No traumatic bone defect, bone disconnection, and false joint formation was observed. At 12 months after operation, the AOFAS ankle and foot joint score, VAS score, and tibial-talar angle were 80.53±9.14, 2.77±0.82, and (94.36±2.48)°, respectively, which were significantly improved when compared with preoperative ones ( t=16.17, P=0.00; t=14.28, P=0.00; t=9.01, P=0.00). The effectivenss was excellent in 9 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 81.5%.

Conclusion

Satisfactory effectiveness can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of traumatic ankle arthritis, showing certain application prospect, while long-term effectiveness should be comfirmed by large sample randomized controlled trials.

Revisional Surgery of the Diabetic Charcot Foot and Ankle

Charcot neuroarthropathy (CN) is a difficult problem for the foot and ankle surgeon. If surgery is required, little is known or available regarding the best methods and timing. When the initial attempt of reconstruction fails, revision of CN is even more demanding. One must take in to account all aspects, including nutrition, vascular status, infection control, short- and long-term blood glucose management, as well as other factors requiring laboratory monitoring and consult services. Once optimized, the biomechanics of the deformity can be addressed and decisions can be made on fixation devices.

Ilizarov external frame technique for pirogoff amputations with ankle disarticulation and tibiocalcaneal fusion

BACKGROUND

The high rates of wound failure, persisting infection, and nonunion of the tibiocalcaneal arthrodesis are the main reasons why the Pirogoff ankle disarticulation is rarely used for limb salvage. Use of the Ilizarov external frame has increased our fusion rate. The purpose of this study was to review our experience with the use of the Ilizarov external frame as a technique for Pirogoff amputations with ankle disarticulation and tibiocalcaneal fusion.

METHODS

Twenty-four patients (median age, 57.4 years; range, 29-76 years) underwent a Pirogoff amputation with Ilizarov external frame use between January 2004 and June 2011. The most common indications were gangrene with uncontrollable infection due to Charcot arthropathy or chronic osteomyelitis. Four patients had sustained crush injuries of the foot. All patients were clinically and radiographically followed for a minimum of 12 months. Additionally, 15 patients were evaluated using the Taniguchi rating scale for Pirogoff amputations after a mean follow-up of 44.9 months (range, 12-86 months).

RESULTS

In 21 patients (87.5%), a well-healed Pirogoff stump was achieved after a mean external fixation time of 18.1 weeks (range, 12.7-26.6 weeks). Impaired vascular perfusion was found to be the limiting factor for successful wound healing and an overall successful Pirogoff amputation. According to the Taniguchi scale, 67% of the patients achieved good or excellent functional results. Fair (27%) and poor (6%) results were observed only in the diabetic patients.

CONCLUSION

Using the Ilizarov external frame allowed safe fixation and a high success rate, even in neuropathic feet. The frame allowed for immediate weight-bearing and soft tissue control; however, frame-associated complications were common and could result in revision surgery.

LEVEL OF EVIDENCE

Level IV, case series.