Comparison of Posterior Approach With Intramedullary Nailing Versus Lateral Transfibular Approach With Fixed-Angle Plating for Tibiotalocalcaneal Arthrodesis

Mulligan, Ryan P.; Adams, Samuel B.; Easley, Mark E.; DeOrio, James K.; Nunley, James A.

doi:10.1177/1071100717731728

Cited by 27 publications

(28 citation statements)

References 48 publications

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“…Posterior and lateral plate fixation have been developed to avoid the high rate of wound complications and hardware irritation associated with anterior arthrodesis. 14-17 It should be noted that lateral and posterior plate fixation are also reasonable options for tibiotalar arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Ankle Arthrodesis With Anterior Plate Fixation in Patients at High Risk for Nonunion

Steginsky

Suhling

Vora

2019

Foot & Ankle Specialist

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Between January 1, 2011, and January 1, 2017, an orthopaedic foot and ankle surgeon performed tibiotalar arthrodesis on 221 patients. Thirty-two were included in this study. Inclusion criteria included patients with at least one risk factor for nonunion and/or malunion, isolated anterior ankle arthrodesis with plate fixation, patients older than 18, and a minimum of 1-year follow-up. Risk factors were avascular necrosis of the talus, severe segmental bone defect, smoking, inflammatory arthropathy, coronal deformity greater than 15°, diabetes mellitus, septic nonunion, failed ankle arthrodesis, and body mass index greater than 35. Functional outcome questionnaires (Ankle Osteoarthritis Score [AOS] and Foot Function Index [FFI]) were collected at the latest visit or by phone. Twenty-six (26/32, 81.2%) patients included in the study had computed tomography images available for review at an average of 3.2 months after surgery. The rate of successful arthrodesis was 93.8% (30/32) at an average of 78 days. Overall, 14 patients (14/32, 43.8%) developed a postoperative complication, including 1 patient that had a delayed nonunion and 2 patients that proceeded to nonunion. Twenty-three patients (23/32, 71.9%) completed the functional outcome questionnaires at an average of 26.8 months. Mean AOS and FFI scores improved significantly postoperatively ( P < .001). Sagittal tibiotalar and coronal tibiotalar alignment improved significantly in patients with severe preoperative deformity ( P < .001). Tibiotalar arthrodesis with anterior plate fixation in a high-risk cohort results in high union rates and significantly improved functional outcomes. Levels of Evidence: Therapeutic, Level IV: Prospective, comparative trial.

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Section: Discussionmentioning

confidence: 99%

Ankle Arthrodesis With Anterior Plate Fixation in Patients at High Risk for Nonunion

Steginsky

Suhling

Vora

2019

Foot & Ankle Specialist

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“…In addition to physiologically augmenting the potential of bone to heal, we sought to biomechanically optimize TTC arthrodesis by means of operative technique. Similar to prior studies, 6,16,21,25,33 we used an intramedullary nail to achieve rigid internal fixation, stabilize plantigrade axial loading, and, ultimately, facilitate fusion. In addition, TTC arthrodesis has traditionally been performed with the assistance of a pneumatic tourniquet.…”

Section: Discussionmentioning

confidence: 95%

Biologic Augmentation of Tibiotalocalcaneal Arthrodesis With Allogeneic Bone Block Is Associated With High Rates of Fusion

et al. 2021

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Background: The orthopedic conditions and systemic comorbidities that occur in patients who require bone block tibiotalocalcaneal (TTC) arthrodesis have made this procedure associated with a higher-than-normal risk of nonunion, graft collapse, hardware failure, and amputation. Here, we present a novel approach to bone block TTC arthrodesis using adjunctive osteoinductive agents and a prolonged course of protected weightbearing to assess if we could improve on historical outcomes. We also evaluated the efficacy of a vascularized medial femoral condyle (MFC) free flap to augment TTC arthrodesis. Methods: Fourteen adult patients underwent bone block TTC arthrodesis biologically augmented with fresh-frozen femoral head allograft, bone marrow aspirate concentrate, and demineralized bone matrix cortical fibers. Three patients with soft tissue defects underwent vascularized reconstruction with an MFC free flap. Radiographic union, the Foot Function Index (FFI), and PROMIS pain interference (PI), and physical function (PF) scores were assessed at follow-up. Results: TTC fusion was documented on plain radiograph in 13 of 14 patients (92.9%) and CT in 10 of 11 patients (90.9%). Mean time to fusion was 183.2 ± 83.2 days. One patient (7.1%) experienced nonunion and persistent infection requiring amputation. Patients who underwent vascularized bone grafting had significantly shorter time to fusion (112.3 ± 31.7 days vs 204.4 ± 82.7 days, P = .05). Patient-reported outcomes revealed mild to moderate pain and dysfunction after 1 year (mean FFI = 41.0% ± 23.1%, PROMIS PI = 58.3 ± 1.8, PROMIS PF = 39.0 ± 2.2). Conclusion: In this relatively small series, the biologic augmentation of bone block TTC arthrodesis with osteoinductive agents and protective weightbearing resulted in excellent rates of fusion, modest pain, and preserved function of the lower extremity in almost all those treated. Osseous healing appears to be enhanced and accelerated with application of an MFC flap. We believe that this approach offers a viable salvage option for these challenging clinical problems. Level of Evidence: Level IV, case series.

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“…There was the pain in type III os trigonum, which was mostly caused by the thickening of the posterior capsule of ankle joint caused by impacted tenosynovitis of pollicis longus muscle and edema of soft tissue around it [18,24]. In the case of fracture of the neck of the talus, type III os trigonum could be used for the posterior approach screw implantation and internal fixation [7,12]. The measurement of the macro- and minor-axis, position relationship, and distance as the point of entry provided the basis for estimating the diameter of the bone tunnel and the length of screw [25–28], and it was more suitable for the general public.…”

Section: Discussionmentioning

confidence: 99%

“…Repeated impacts on the posterior triangular bone of the adjacent soft tissue may cause pain in the posterior side of the ankle and swelling around the triangular bone [4,5]. The fracture of the posterior process of talus and the fracture of the posterior triangle of the talus are easy to be confused clinically, and computed tomography (CT) scans and magnetic resonance imaging can detect the associated bone and soft tissue abnormalities, thus complementing each other [6,7].…”

Section: Introductionmentioning

confidence: 99%

Implications of Classification of Os Trigonum: A Study Based on Computed Tomography Three-Dimensional Imaging

Fu¹,

Zeng

et al. 2019

Med Sci Monit

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Background The os trigonum is an accessory bone that is not fully fused with the talus during secondary ossification, and is one of the risk factors of posterior malleolus impact syndrome. The purpose of this study was to classify the os trigonum and to guide the diagnosis and treatment of related clinical diseases. Material/Methods Ankle computed tomography (CT) scans of 586 Chinese patients between October 2014 and October 2018 were reviewed. CT images of 1011 ankle joints were reconstructed to evaluate the classification of the os trigonum and the measurement of anatomical parameters. Results The incidences of os trigonum in 3 groups were determined as type I (1.9%), type II (10.5%), and type III (14.7%). The macro-axis of type II (0.89±0.31) cm was significantly larger than with type I (0.65±0.24 cm) and type III (0.74±0.23 cm) (p<0.05).The minor axis of similar of type I (0.41±0.23 cm) was significantly shorter than that of type II (0.58±0.32 cm) and type III (0.55±0.16 cm) (p<0.05).The distance from os trigonum to calcaneal tubercle was significantly different than that of type I (1.33±0.52 cm), type II (1.67±0.55 cm), and type III (1.84±0.45 cm) (p<0.05). Conclusions This study showed that os trigonum has a high incidence. Type I was the least common, the volume of type II was larger, and type III was more common. The anatomical parameters of each type may improve treatment of related diseases and the further development of ankle arthroscopic surgery.

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Comparison of Posterior Approach With Intramedullary Nailing Versus Lateral Transfibular Approach With Fixed-Angle Plating for Tibiotalocalcaneal Arthrodesis

Abstract: Level III, retrospective comparative study.

Cited by 27 publications

References 48 publications

Ankle Arthrodesis With Anterior Plate Fixation in Patients at High Risk for Nonunion

Ankle Arthrodesis With Anterior Plate Fixation in Patients at High Risk for Nonunion

Biologic Augmentation of Tibiotalocalcaneal Arthrodesis With Allogeneic Bone Block Is Associated With High Rates of Fusion

Implications of Classification of Os Trigonum: A Study Based on Computed Tomography Three-Dimensional Imaging

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