Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Abstract

Background Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach. Questions/purposes We asked (1) what proportion of patients treated with this technique achieved osseous union; (2) what complications were observed; (3) were any patient-demographic or health-related factors associated with the likelihood that a patient would have a complication develop? Methods Between December 2001 and July 2014, 42 patients received a posterior blade plate. During the period in question, indications for hindfoot arthrodesis using posterior blade fixation were subtalar osteoarthritis below an ankle fusion, malunion or nonunion, failed tibiotalocalcaneal arthrodesis attributable to nonunion of the tibiotalar and/or subtalar joint; or tibiotalar and subtalar osteoarthritis in patients with impaired bone or soft tissue quality (particularly if the soft tissue problem was anterior). During that period, all patients who met those indications were treated with a posterior blade plate. Forty (95%) were included in this study, and two were lost to followup before the 1-year minimum required by the study. Demographics (age, gender, BMI, smoking status, and comorbidities) and surgical data (indication, previous treatment, and additional procedures) were analyzed. Of the 40 patients included, 27 (68%) were male and 13 (33%) were female, with a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). The mean age of the patients was 56 ± 13 years. Followup averaged 47 ± 28 months (range, 14-137

Novel Double Osteotomy Technique of Distal Tibia for Correction of Asymmetric Varus Osteoarthritic Ankle

“…Osteotomy fusion was defined as satisfying clinical criteria (no pain, no warmth, improvement in swelling, and stability to stress) and radiographic criteria (visible trabecular bridging across the osteotomy site and no lucency around the hardware). 13 Hindfoot alignment was assessed by measurement of the tibial ankle surface (TAS) angle, the tibiotalar (TT) angle, and TLS angle (Figure 4). 4,36 The talar position within the ankle mortise was calculated as the difference between the TAS and TT angles on AP weightbearing ankle radiographs.…”

Role of Extra-articular Tibiotalocalcaneal Arthrodesis and Posterior Approach in Highly Complex Cases

“…Recent studies by Gorman and colleagues showed fusion in 73% of patients operated on with a posterior plate within 6 months following surgery, although 10% had delayed union after 6 months and 18% had nonunion. 8 Another retrospective study showed 78% fusion and 22% non-union in 9 patients who underwent tibiotalocalcaneal fusion with a posterior anatomic plate. 15 In our study, the fusion rate was 95% at a mean follow-up of 38 months (range, 3-87 months).…”

Midterm Results of Radiographic and Functional Outcomes After Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft

“…17,[44][45][46][47][48] Studies looking at prognostic factors of outcomes of TTC fusions specifically with femoral head allografts have generally not identified factors that correlated with outcomes. 3,14,49,50 No previous studies were found that identified being male or a lateral operative approach as negative influencers of TTC fusion outcomes. Operative approach was addressed by Berkowitz et al, 16 who noted that the anterior approach had the advantages of allowing for substantial correction of malalignment and sparing of the lateral malleolus, which may improve rotational alignment, increase overall stability of the construct, and avoid future valgus malalignment.…”