Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction

Luo, Huasong; Chen, Liaobin; Liu, Ke-Bin; Songming, Peng; Ji-en, Zhang; Yang, Yi

doi:10.1186/s40064-016-3601-7

Cited by 13 publications

(17 citation statements)

References 21 publications

(19 reference statements)

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“…All surgeries were performed by experienced surgeons. EFLIF has been commonly used in clinical practice and previously described by Marin et al 12 As described by Luo et al, arthroscopy-assisted minimally invasive therapy was performed in the following steps: 13 1) broken end was exposed through one posterolateral fibular incision, and plate fixation was performed after reduction under direct vision; 2) external fixator was used to achieve indirect reduction, protect soft tissue and reconstruct limb length; 3) two sides of distal tibia were unfolded to obtain adequate space in the ankle joint available for arthroscopy; 4) arthroscopic camera and instrument (Stryker Corporation, Kalamazoo, MI, USA) were inserted into the ankle through two incisions at the front of the ankle for observation and reduction, and blood clots and bone scraps were cleared under arthroscopy. One longitudinal tibial incision was made near the joint surface, and broken bone was exposed after blunt dissection.…”

Section: Methodsmentioning

confidence: 99%

Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture

Liu

Guo

Wen

et al. 2017

CIA

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ObjectivePilon fracture is so complex that its therapy poses a great challenge to surgeons. Few studies have compared arthroscopy-assisted minimally invasive therapy and external fixation combined with limited internal fixation (EFLIF), and an optimal choice of surgical therapy remains unclear in patients with type III Pilon fracture. Moreover, to our knowledge, very few studies have specifically evaluated arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture. The current study was performed to observe the clinical application of arthroscopy-assisted minimally invasive therapy, compared with EFLIF, in Chinese elderly with type III Pilon fracture.MethodsThere were 230 Chinese elderly with type III Pilon fracture assigned to undergo EFLIF (group A, n=115) or arthroscopy-assisted minimally invasive therapy (group B, n=115), and followed up for 1 year after surgery.ResultsAge, sex, causes, sides and types of Pilon fractures were not different between the two groups (P>0.05 for all). Compared with EFLIF, arthroscopy-assisted minimally invasive therapy achieved a better reduction result, bone union and Mazur system (P<0.05 for all). Patient satisfaction, screw loosening and infection prevalence were not different between the two groups (P>0.05 for all). There was no skin necrosis in the two groups. Traumatic arthritis had a significantly lower prevalence in participants with arthroscopy-assisted minimally invasive therapy than EFLIF (P<0.05 for all).ConclusionCompared with EFLIF, arthroscopy-assisted minimally invasive therapy for type III Pilon fracture significantly improved reduction result, bone union and functional status, and decreased traumatic arthritis, demonstrating that arthroscopy-assisted minimally invasive therapy is an optimal choice for type III Pilon fracture in Chinese elderly.

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Section: Methodsmentioning

confidence: 99%

Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture

Liu

Guo

Wen

et al. 2017

CIA

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“…Review of current literature identified 2 studies, 1 nonblinded randomized controlled trial (RCT) and 1 case series, that met criteria for this review. 25,26 The total number of patients from these studies was 243. There were 166 men and 77 women with ages ranging from 19 to 68 years old.…”

Section: Pilon Fracturesmentioning

confidence: 99%

Arthroscopically Assisted Internal Fixation of Foot and Ankle Fractures: A Systematic Review

Williams

Joo

et al. 2021

Foot & Ankle Orthopaedics

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Background: Patients undergoing fixation for foot and ankle fractures may experience poor outcomes despite achieving apparent anatomic reduction. Adjunct arthroscopy to identify missed concomitant injuries and subtle displacements has been proposed as a vehicle to enhance functional results for these patients. The purpose of this review is to provide an overview of the literature regarding arthroscopically assisted open reduction and internal fixation (AAORIF) methods for commonly encountered foot and ankle injuries including pilon, ankle, and calcaneus fractures published to date. Methods: A systematic review of the literature was performed using the PubMed database to access all studies reporting on arthroscopically assisted internal fixation methods for pilon, ankle, and calcaneus fractures. Relevant publications were analyzed for details on their respective study designs, the operative technique used, clinical outcomes, outcome instruments used, and reported complications. Results: A total of 32 studies were included in this review. Two studies on pilon fractures, a randomized controlled trial (RCT) and case series with a total of 243 patients, met inclusion criteria. Postoperative articular reductions, bone union, and Mazur scores were found to be significantly better for those using adjunct arthroscopy when compared to those with no arthroscopy use. Patient-reported outcomes were overall reported as excellent for most patients, with no difference in patient-reported outcomes reported in the RCT. For ankle fractures, a total of 17 studies comprising of 2 systematic reviews, 1 meta-analysis, 2 RCTs, 5 retrospective comparative studies, 6 case series, and 1 case-control study met inclusion criteria for this review. Results were mixed, though the overall consensus was that arthroscopy use may help to better visualize concomitant intra-articular injuries and is generally considered safe with at least comparable outcomes to conventional methods. For the calcaneus, 13 studies met the criteria. Two studies were review papers, 8 were case series, and 3 were retrospective comparative studies. A total of 308 patients with 316 fractures formed the basis of analysis. In general, the studies found comparable functional outcomes between with or without arthroscopy use, but found that anatomical reductions were significantly improved with the use of arthroscopy. Conclusions: Arthroscopy shows promise as a valuable adjunct tool for internal fixation of foot and ankle fractures, though definitive conclusions as to its clinical significance have yet to be drawn because of limited evidence. Potential advantages related to the direct visualization of the fracture site and minimally invasive nature of arthroscopy were suggested throughout studies examined in this review. The presence of intra-articular pathology may lead to unexpectedly poor outcomes seen in some patients who undergo surgical fixation of ankle fractures with an otherwise anatomic reduction on postoperative radiographs; the ability to diagnose and address these lesions with arthroscopy, therefore, has the potential to improve patient outcomes. To date, however, available literature has not shown that significant improvements in anatomical reductions and treatment of these intra-articular injuries provide any improvement in outcomes over standard fixation methods. Few prospective randomized controlled studies have been performed comparing these 2 operative techniques, rendering any suggestion that AAORIF improves clinical outcomes over traditional open fixation difficult to justify. Further research is indicated for what may be a potentially promising surgical adjunct prior to advocating for its routine use in patients.

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“…Ankle arthroscopy is a therapeutic procedure for ankle osteoarthritis, chondral lesion, loose body, and soft tissue impingement. [1][2][3][4][5] It is also performed as a diagnostic procedure for intra-articular disease. 6 For arthroscopic ankle surgery, possible anesthetic methods include spinal anesthesia (SA), nerve block, and local anesthesia (LA).…”

Section: Introductionmentioning

confidence: 99%

Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study

Wei

et al. 2020

J Orthop Surg (Hong Kong)

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Background: Local anesthesia (LA) is widely used in knee arthroscopic surgery but not in ankle arthroscopy. Objective: To understand the effectiveness and safety of LA combined with ropivacaine in pain control for ankle arthroscopy. Study Design: Retrospective cohort. Methods: We retrospectively collected data for patients who underwent ankle arthroscopy from April 2012 to April 2017. Patients were grouped by anesthesia method: LA, LA with ropivacaine (LA+R), spinal anesthesia (SA), and SA with ropivacaine (SA+R). Intra- and postoperative visual analog scale (VAS) scores, complications, doses of supplemental pain medication, hospitalization cost and duration, and satisfaction with pain control during hospitalization were analyzed. Results: The study included 276 patients (LA: 93; LA+R: 124; SA: 31; SA+R: 28). The LA and LA+R groups had significantly higher intraoperative VAS scores (LA vs. SA, p = 0.001; LA vs. SA+R, p = 0.002; LA+R vs. SA, p = 0.00; LA+R vs. SA+R, p = 0.00), but fewer complications, than the SA and SA+R groups. The LA+R and SA+R groups had significantly better outcomes for postoperative pain control (LA vs. LA+R, p = 0.01; LA vs. SA+R, p = 0.01; SA vs. SA+R, p = 0.01; SA vs. LA+R, p = 0.03) and required less supplemental pain medication. Hospitalization cost was lower and duration shorter in the LA and LA+R groups than in the SA and SA+R groups. There was no significant difference in satisfaction among the four groups. Limitations: This was a single-center retrospective and relatively short-term study. Conclusions: LA+R which could be safely applied in ankle arthroscopy provided satisfactory pain control, reduced postoperative pain intensity, fewer complications, shorter hospital stay, and good cost-effectiveness. It can be safely applied in ankle arthroscopy for the specific patients with ankle osteoarthritis.

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Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction

Cited by 13 publications

References 21 publications

Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture

Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture

Arthroscopically Assisted Internal Fixation of Foot and Ankle Fractures: A Systematic Review

Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study

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