Primary Ankle Arthrodesis for Severely Comminuted Tibial Pilon Fractures

Al-Ashhab, Mohamed Ebrahim Ali

doi:10.3928/01477447-20161202-04

Cited by 20 publications

(15 citation statements)

References 15 publications

(15 reference statements)

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“…AOFAS scores was reported in only one other study [39]. Our average value of 53.0 is lower than their value of 85.4.…”

Section: Proms and Bone Unioncontrasting

confidence: 85%

“…Reason could be twofold. We reported AOFAS scores at 6 months post-injury, but Al-Ashhab et al reported it at final follow-up [39]. Also, 45% of our patients had open fractures, whereas their cohort had no open fractures [39].…”

Section: Proms and Bone Unionmentioning

confidence: 55%

“…We reported AOFAS scores at 6 months post-injury, but Al-Ashhab et al reported it at final follow-up [39]. Also, 45% of our patients had open fractures, whereas their cohort had no open fractures [39]. Our average O&M score 6 months post-injury of 50.9 concurs with a recent systematic review on intramedullary nailing in ankle fractures, which suggested that the mean O&M score for patient cohorts treated with TTC nailing in the literature was 50-62 [17].…”

Section: Proms and Bone Unionmentioning

confidence: 78%

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Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Tennyson

Zhang

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails. Methods A retrospective observational study was performed on patients who underwent intramedullary nailing with a tibiotalocalcaneal nail. Twenty patients met the inclusion criteria of being over sixty and having multiple co-morbidities. Patient demographics, AO/OTA fracture classification, intra-operative and post-operative complications, time to mobilisation and union, AOFAS and Olerud-Molander scores, and patient mobility were recorded. Results There were seven males and thirteen females, with a mean age of 77.82 years old, five of whom are type 2 diabetics. Thirteen patients returned to their pre-operative mobility state, and the average Charlson Co-morbidity Index (CCI) was 5.05. Patients with a low CCI are more likely to return to pre-operative mobility status (p = 0.16; OR = 4.00). All patients achieved radiographical union, taking on average between 92.5 days and 144.6 days. The mean post-operative AOFAS and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection, four cases of broken or loose distal locking screws. There were no deep infections, periprosthetic fractures, nail breakages, or non-unions. Conclusion Tibiotalocalcaneal nailing is an effective and safe option for managing unstable ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.

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“…AOFAS scores was reported in only one other study [39]. Our average value of 53.0 is lower than their value of 85.4.…”

Section: Proms and Bone Unioncontrasting

confidence: 85%

Section: Proms and Bone Unionmentioning

confidence: 55%

Section: Proms and Bone Unionmentioning

confidence: 78%

See 1 more Smart Citation

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Tennyson

Zhang

et al. 2021

Eur J Orthop Surg Traumatol

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“…Other indications include arthrosis from previous infection, talar avascular necrosis, 59 neuropathy, inflammatory arthropathy 121 including hemophilia, 11 salvage of failed arthroplasty, 57 and rarely primary treatment following severe ankle trauma. 2,112 Many techniques have been described for ankle fusion, and they broadly fall into 2 categories: open arthrotomy and minimally invasive. One major concern of arthrodesis is the acceleration of adjacent joint arthritis, which has been shown to be present in the triple joint complex, naviculocuneiform, tarsometatarsal, and first metatarsophalangeal joints after ipsilateral ankle fusion at 22-year follow-up.…”

Section: Surgical Treatmentmentioning

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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“…3,9,17,28 Described methods for ankle arthrodesis include tibiotalocalcaneal (TTC) hindfoot nails, ringed external fixators, and tibiotalar arthrodesis with crossed screws or plating. Although primary arthrodesis has been described for the management of severe pilon fractures, 1,14 there is a paucity of literature describing its role in acute diabetic ankle fractures without concomitant Charcot arthropathy. Here, we present a case series of 13 diabetic ankle fractures that underwent primary arthrodesis following an ankle fracture with a focus on patient and injury characteristics and operative outcomes/complications.…”

Section: Introductionmentioning

confidence: 99%

Primary Arthrodesis for Diabetic Ankle Fractures

Grote

Tucker

Stumpff

et al. 2020

Foot & Ankle Orthopaedics

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Background: Treatment of ankle fractures in patients with diabetes is associated with increased complication rates. Ankle arthrodesis is considered a salvage procedure after failed ankle fracture fixation, yet primary ankle arthrodesis has been proposed as a treatment option for patients with significant diabetes-related complications. To date, the characteristics of patients who undergo primary ankle arthrodesis and the associated outcomes have not been described. Methods: A retrospective review was performed of 13 patients with diabetes who underwent primary arthrodesis for traumatic ankle fracture. Patient demographics were characterized in addition to their diabetes complications, Adelaide Fracture in the Diabetic Ankle (AFDA) score, and fracture type. Outcomes assessed included reoperation rates, infection rates, wound complications, nonunion/malunion, amputation, and development of Charcot arthropathy postoperatively. Results: Patients who underwent primary arthrodesis had high rates of diabetes complications, average AFDA scores of 6.4, and high rates of severe injuries, including 38.5% open fractures and 69.2% fracture dislocations. The overall complication rate for primary arthrodesis of ankle fractures in diabetes patients was more than 75% in this cohort. Complications included a 38.5% reoperation rate, 38.5% infection rate, 53.8% wound complication rate, and 23.1% amputation rate. Despite a high nonunion rate at the attempted fusion sites, 89.9% of fractures healed and patients had a stable extremity. Conclusion: This review is the first to characterize the epidemiology and complications of diabetes patients undergoing primary ankle arthrodesis for ankle fractures. In this cohort, patients with multiple diabetic complications and severe injuries underwent primary arthrodesis, which led to an overall high complication rate. Further research is needed to determine the appropriate treatment option for these high-risk patients, and tibiotalocalcaneal stabilization without arthrodesis may be beneficial. Level of Evidence: Level IV, retrospective case series.

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Primary Ankle Arthrodesis for Severely Comminuted Tibial Pilon Fractures

Cited by 20 publications

References 15 publications

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Ankle fusion with tibiotalocalcaneal retrograde nail for fragility ankle fractures: outcomes at a major trauma centre

Ankle Arthritis

Primary Arthrodesis for Diabetic Ankle Fractures

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