Establishing the Relationship Between Clinical Outcome and Extent of Osseous Bridging Between Computed Tomography Assessment in Isolated Hindfoot and Ankle Fusions

Glazebrook, Mark; Beasley, William; Daniels, Timothy R.; Evangelista, Peter; Donahue, Rafe; Younger, Alastair; Pinzur, Michael S.; Baumhauer, Judith F.; DiGiovanni, Christopher W.

doi:10.1177/1071100713504746

Cited by 61 publications

(56 citation statements)

References 13 publications

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“…Clinical improvements did not increase significantly beyond 50% of bridging trabeculation. 6 This supports the use of 50% fusion area as an appropriate threshold for radiographic success; it is possible that if the cutoff had been lower in this study, the kappa values may have been even stronger. While the results of their study were substantial, the authors of this study utilized radiologist interpretation of the CT scans to validate their criteria for fusion.…”

Section: Discussionsupporting

confidence: 57%

“…In their study, the greatest amount of clinical improvement was seen when the degree of osseous bridging across the joint was at a minimum of 25%. 6 These studies raise the question of how reliable CT scan interpretation is in determining the degree of fusion present, particularly taking into account image degradation or artifact due to hardware, the 2…”

Section: (Original) Clinical Research Articlementioning

confidence: 99%

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Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions

et al. 2014

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Section: Discussionsupporting

confidence: 57%

Section: (Original) Clinical Research Articlementioning

confidence: 99%

Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions

et al. 2014

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“…The fusion mass at each joint was then graded using a 4-point scale (grade 1, 0% to 25% of the joint surface; grade 2, 26% to 50% of the joint surface; grade 3, 51% to 75% of the joint surface; and grade 4, 76% to 100% of the joint surface) by 2 independent reviewers in 2 separate settings (L.B.H., C.F.). Radiographic union was defined as a fusion mass of grade !2 according to the most recent radiographs, as described by Glazebrook et al (31). Interobserver and intraobserver reliability were determined for this measurement.…”

Section: Follow-up Protocolmentioning

confidence: 99%

Tibiotalocalcaneal Arthrodesis With the Hindfoot Arthrodesis Nail: A Prospective Consecutive Series From a Single Institution

Lee

Fang

Kunnasegaran

et al. 2018

The Journal of Foot and Ankle Surgery

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Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure. We report a series of 20 patients who underwent TTCA using an intramedullary nail. Of the 20 patients, 7 (35%) had diabetes mellitus. The patient experiences and outcomes were analyzed. Their mean age was 61.1 (range 39 to 78) years. The minimum follow-up period was 13 (mean 28, range 13 to 49) months. Surgical indications included diabetic Charcot arthropathy in 7 (35%), hindfoot osteoarthritis in 10 (50%), and severe equinovarus deformity in 3 (15%). A calcaneal spiral blade was used in 2 patients (10%). Significant improvements (p < .05) were observed in 5 of 8 Short-Form 36-item Health Survey components, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (p < .001), and visual analog scale for pain (p < .001). The mean length of the hospital stay was 6.7 (range 1 to 27) days. Of the 20 patients, 76.9% had improvement in their activity postoperatively. Also, 81.8% were able to resume their preoperative work after a mean of 7.89 (range 3 to 24) months. Overall, 19 patients (95%) reported favorable outcomes. Superficial wound infection (n = 4; 20%) and deep wound infection (n = 3; 15%) were the most common complications (35%), with 1 case (5%) culminating in a below-the-knee amputation. Radiographic union was achieved in 16 of the tibiotalar joints (80%), 16 subtalar joints (80%), and 4 tibiocalcaneal fusions (20%). In a subgroup analysis of 7 patients with diabetes mellitus (35%), the incidence of wound complications and fusion was comparable to that of the primary cohort. TTCA performed with an intramedullary nail appears to offer a reliable and safe alternative for patients with severe ankle and hindfoot pathologic entities, including those with diabetes mellitus.

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“…CT scans can be used to assess percentage of fusion or to guide mobility, with 25% fusion mass indicative of a clinically successful fusion, although more fusion is shown to be beneficial. 41 Time to union has been reported to average 14.5 weeks with open arthrodesis. 82 Minimally invasive techniques.…”

Section: Ankle Arthrodesismentioning

confidence: 99%

Ankle Arthritis

Veljkovic

Salat

et al. 2019

Foot & Ankle Orthopaedics

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Ankle arthritis is a major source of morbidity impacting a younger working age population than hip and knee arthritis. Unlike the hip and knee, more than 70% of ankle arthritis cases are post-traumatic, with the remainder being inflammatory or primary arthritis. Nonoperative treatment begins with lifestyle and shoe-wear modifications and progresses to bracing, physical therapy, anti-inflammatory medications, and intra-articular injections. Ankle arthrodesis and total ankle arthroplasty are the 2 main surgical options for end-stage ankle arthritis, with debridement, realignment osteotomy, and distraction arthroplasty being appropriate for limited indications.Level of Evidence:Level V, expert opinion.

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Establishing the Relationship Between Clinical Outcome and Extent of Osseous Bridging Between Computed Tomography Assessment in Isolated Hindfoot and Ankle Fusions

Abstract: Level IV, case series.

Cited by 61 publications

References 13 publications

Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions

Reproducibility of Computed Tomography to Evaluate Ankle and Hindfoot Fusions

Tibiotalocalcaneal Arthrodesis With the Hindfoot Arthrodesis Nail: A Prospective Consecutive Series From a Single Institution

Ankle Arthritis

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