Clinical Outcomes of Nonunions of Hindfoot and Ankle Fusions

Krause, Fabian; Younger, Alastair; Baumhauer, Judith F.; Daniels, Timothy R.; Glazebrook, Mark; Evangelista, Peter; Pinzur, Michael S.; Thevendran, Gowreeson; Donahue, Rafe; DiGiovanni, Christopher W.

doi:10.2106/jbjs.14.00872

Cited by 32 publications

(34 citation statements)

References 41 publications

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“…* References 1,5,8,10,21,23,25,27,28,30,33,38,39. modifying their workplace requirements even existed. Similar studies 12,20,41 describing patients suffering from back pain found that return to work can be increased remarkably when the employer can offer work that is physically less demanding.…”

Section: Discussionmentioning

confidence: 99%

Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery

et al. 2018

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“…For example, there are only two case series found that describe the use of DBM in foot or ankle arthrodesis. 55 , 56 Foot and ankle arthrodesis are known to have a high nonunion rate leading to poor functional outcomes, 72 however, whether DBM is capable of reducing the nonunion rate, similar to autologous bone grafts, 73 remains unknown.…”

Section: Discussionmentioning

confidence: 99%

The available evidence on demineralised bone matrix in trauma and orthopaedic surgery

Stok

Hartholt

Schoenmakers

et al. 2017

Bone & Joint Research

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ObjectivesThe aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery.MethodsA total of 17 DBM products were used as search terms in two available databases: Embase and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. All articles that reported the clinical use of a DBM-product in trauma and orthopaedic related surgery were included.ResultsThe literature search resulted in 823 manuscripts of which 64 manuscripts met the final inclusion criteria. The included manuscripts consisted of four randomised controlled trials (level I), eight cohort studies (level III) and 49 case-series (level IV). No clinical studies were found for ten DBM products, and most DBM products were only used in combination with other grafting materials. DBM products were most extensively investigated in spinal surgery, showing limited level I evidence that supports the use Grafton DBM (Osteotech, Eatontown, New Jersey) as a bone graft extender in posterolateral lumbar fusion surgery. DBM products are not thoroughly investigated in trauma surgery, showing mainly level IV evidence that supports the use of Allomatrix (Wright Medical, London, United Kingdom), DBX (DePuy Synthes, Zuchwil, Switzerland), Grafton DBM, or OrthoBlast (Citagenix Laval, Canada) as bone graft extenders.ConclusionsThe clinical level of evidence that supports the use of DBM in trauma and orthopaedic surgery is limited and consists mainly of poor quality and retrospective case-series. More prospective, randomised controlled trials are needed to understand the clinical effect and impact of DBM in trauma and orthopaedic surgery.Cite this article: J. van der Stok, K. A. Hartholt, D. A. L. Schoenmakers, J. J. C. Arts. The available evidence on demineralised bone matrix in trauma and orthopaedic surgery: A systemati c review. Bone Joint Res 2017;6:423–432. DOI: 10.1302/2046-3758.67.BJR-2017-0027.R1.

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“…Nonunion has been reported in approximately 10% of patients, heightened among subpopulations that include smokers and patients with poorly controlled diabetes or neuropathy. 5 Studies have also reported high rates of eventual adjacent joint arthritis, presumably due to the increased stress inherent to the loss of a motion segment, although few of these patients seem to require further intervention. 3 Furthermore, small case studies have reported tibial stress fracture following ankle arthrodesis, presumably due to a stress transfer to the distal tibia.…”

Section: Introductionmentioning

confidence: 99%

Tibial Stress Fracture Following Ankle Arthrodesis

et al. 2020

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Background: End-stage ankle arthritis is frequently treated with either tibiotalar or tibiotalocalcaneal (TTC) arthrodesis, but the inherent loss of accommodative motion increases mechanical load across the distal tibia. Rarely, patients can go on to develop a stress fracture of the distal tibia without any antecedent traumatic event. The purpose of this study was to determine the incidence of tibial stress fracture after ankle arthrodesis, highlight any related risk factors, and identify the effectiveness of treatment strategies and their healing potential. Methods: A retrospective chart review was performed at 2 large academic medical centers to identify patients who had undergone ankle arthrodesis and subsequently developed a stress fracture of the tibia. Any patient with a tibial stress fracture before ankle arthrodesis, or with a nontibial stress fracture, was excluded from the study. Results: A total of 15 out of 1046 ankle fusion patients (1.4%) developed a tibial stress fracture at a mean time of 42 ± 82 months (range, 3-300 months) following the index procedure. The index procedure for these 15 patients who went on to subsequently develop stress fractures included isolated ankle arthrodesis (n = 8), ankle arthrodesis after successful subtalar fusion (n = 2), primary TTC arthrodesis (n = 2), and ankle arthrodesis subsequent to successful subtalar fusion with resultant ankle nonunion requiring revision TTC nailing (n = 3). Four patients had undergone fibular osteotomy with subsequent onlay strut fusion, and 5 had undergone complete resection of the lateral malleolus. Stress fracture location was found to be at the level of the fibular osteotomy in 2 patients and at the proximal end of an existing or removed implant in 9. Fourteen of the 15 patients had a nondisplaced stress fracture and were initially treated with immobilization and activity modification. Of these, 3 failed to improve with nonoperative treatment and subsequently underwent operative fixation (intramedullary nail in 2; plate fixation in 1). Only 1 of the 15 patients presented with a displaced fracture and underwent immediate plate fixation. All patients reported pain improvement and were ultimately healed at final follow-up. Conclusion: In this case series review, we found a 1.4% incidence of tibial stress fracture after ankle arthrodesis, and both hardware transition points and a fibular resection or osteotomy appear to be risk factors. Operative intervention was required in approximately 25% of this population, but the majority of tibial stress fractures following ankle fusion were successfully treated nonoperatively, and ultimately all healed. Level of Evidence: Level IV, retrospective case series.

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Clinical Outcomes of Nonunions of Hindfoot and Ankle Fusions

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 32 publications

References 41 publications

Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery

Prospective Cohort Study on the Employment Status of Working Age Patients After Recovery From Ankle Arthritis Surgery

The available evidence on demineralised bone matrix in trauma and orthopaedic surgery

Tibial Stress Fracture Following Ankle Arthrodesis

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