Adding a First Metatarsal Pin to An Ankle Tubular External Fixator Does Not Reduce the Incidence of Early Reduction Loss

Albagli, Assaf; Rotman, Dani; Tudor, Adrian; Senderey, Adi Berliner; Ashkenazi, Itay; Schermann, Haggai; Dallich, Alison A; Steinberg, Ely L.; Luger, Elchanan

doi:10.1053/j.jfas.2020.10.012

Cited by 2 publications

(2 citation statements)

References 11 publications

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“…Two recent studies helped shed light on revision rates for ankle external fixation. Albagli et al 24 found a 18.9% revision rate but failed to identify any notable predictive factors, including the addition of a first metatarsal pin to the delta frame construct. The study by Shah et al 25 compared ankle external fixator placement in the operating room versus the emergency department and reported a 15% overall revision rate.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Revision of External Fixation of Unstable Ankle Injuries

Schlauch,

Shah,

Crawford

et al. 2024

JAAOS Glob Res Rev

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Introduction: External fixation of unstable ankle injuries is commonly done by orthopaedic surgeons. An improper technique can negate the benefits of the procedure and necessitate revision. This study sought to determine the risk factors for revision of external fixation of unstable ankle injuries. Methods: Retrospective cohort at a level I academic trauma center of 120 consecutive patients underwent external fixation of an unstable ankle injury. Exclusion criteria included external fixation for reason other than fracture, inadequate intraoperative imaging, skeletal immaturity, and follow-up less than 30 days. Primary outcome measurement was revision of external fixation within 30 days. Results: Ninety-seven patients met inclusion criteria. Eighteen (18.6%) underwent revision within 30 days of whom 5 (28%, P < 0.001) had a poor reduction intraoperatively. No patients with a good reduction required revision. Revised patients had a significantly higher talar tilt (P < 0.001) and were more likely to lack a first metatarsal pin (P = 0.018). Multivariate analysis revealed talar tilt >0.5° (odds ratio, 22.62; 95% confidence interval, 6.52 to 50.63) as an independent risk factor for revision. Discussion: For external fixation of unstable ankle injuries, poor reduction quality is a risk factor for need for revision surgery. Orthopaedic surgeons should be critical of their final intraoperative assessment to prevent revision.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Revision of External Fixation of Unstable Ankle Injuries

Schlauch,

Shah,

Crawford

et al. 2024

JAAOS Glob Res Rev

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show abstract

“…Maintaining the forefoot in a plantigrade posture requires the placement of Schanz pins into the midfoot or forefoot. Interestingly, a retrospective study suggested that the addition of a first metatarsal pin to ankle-spanning external fixation yields rates of reduction loss that are comparable with those without a first metatarsal pin 58 . However, the extent to which minor changes in alignment are clinically important is unclear; external fixation is a form of traction and the primary goals are to preserve gross length and alignment and to protect the soft-tissue envelope until a definitive procedure can be performed.…”

Section: Initial Managementmentioning

confidence: 99%

Management of High-Energy Tibial Pilon Fractures

Mittwede

Wawrose

Belayneh

et al. 2023

Journal of Bone and Joint Surgery

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ä Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.ä Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.g., smoking) should be addressed perioperatively.ä Delayed internal fixation with interval temporizing external fixation represents the preferred technique for managing most high-energy pilon fractures presenting with characteristically substantial soft-tissue trauma. In some cases, surgeons elect to utilize circular fixation for these scenarios.ä Although there have been treatment advances, the results have been generally poor, with high rates of posttraumatic arthritis, despite expert care.ä Primary arthrodesis may be indicated in cases with severe articular cartilage injury that, in the opinion of the treating surgeon, is likely unsalvageable at the time of the index management.ä The addition of intrawound vancomycin powder at the time of definitive fixation represents a low-cost prophylactic measure that appears to be effective in reducing gram-positive deep surgical site infections.Tibial pilon fractures in younger patient populations are frequently devastating high-energy intra-articular injuries and pose a difficult clinical problem in both academic and community practices. Representing approximately 5% to 7% of all tibial fractures 1-4 , pilon fractures are impaction injuries of the weightbearing surface of the distal tibia 5-8 . These most frequently occur in men in their fourth and fifth decades via an axial loading mechanism from motor vehicle trauma or a fall from a height 1,5-10 . The term "pilon" was first described in 1911 by Destot, due to the injury mechanism being analogous to a mortar and "pestle." 11 Extensive soft-tissue trauma is predictable and increases the risk of surgical complications (e.g., infection, nonunion, malunion), as well as the need for secondary intervention, including revision procedures and/or amputation 6,[12][13][14] . Despite treatment advances over the past several decades, long-term functional outcomes reveal persistent disability and the development of posttraumatic arthritis [15][16][17] , thereby negatively impacting the quality of life [18][19][20][21] . As many as ‡50% of patients may develop posttraumatic arthritis within 4 years after the injury 14,16 , and pilon fractures are among the worst musculoskeletal injuries for both functional and healthrelated outcomes 1,15,22 . In this article, an evidence-based critical discussion of the evaluation, classification, management, and strategies for optimization of these injuries is presented. Initial Management Clinical EvaluationTibial pilon fractures secondary to high-energy trauma are often accompanied by trauma to the head, spine, chest, or abdomen Disclosure: ...

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Adding a First Metatarsal Pin to An Ankle Tubular External Fixator Does Not Reduce the Incidence of Early Reduction Loss

Cited by 2 publications

References 11 publications

Risk Factors for Revision of External Fixation of Unstable Ankle Injuries

Risk Factors for Revision of External Fixation of Unstable Ankle Injuries

Management of High-Energy Tibial Pilon Fractures

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