Primary Posterior Blade Plate Tibiotalar Arthrodesis: A Salvage Procedure for Complex Nonreconstructable Pilon Fractures

Abebe, Ermias; Farrell, Dana J.; Zelle, Boris A.; Gruen, Gary S.

doi:10.1097/bot.0000000000000911

Cited by 17 publications

(9 citation statements)

References 23 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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“…That has led some physicians to advocate for primary arthrodesis in some of those patients. 14,15,17 Ideally, that treatment should be reserved for a select cohort of patients who are at increased risk for complications after ORIF. However, very little has been done to define those factors associated with arthrodesis following operative fixation of pilon fractures.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of ankle fusion after pilon fracture: a retrospective review

Massey

Oladeji

Esposito

et al. 2022

Current Orthopaedic Practice

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Background:Pilon fractures are associated with a high incidence of complications, yet there continues to be uncertainty regarding variables associated with adverse outcomes after pilon open reduction and internal fixation (ORIF). This study sought to characterize the rate of arthrodesis and identify risk factors that increase the likelihood of ankle arthrodesis in patients with ORIF pilon fractures. Methods:After institutional review board approval, a retrospective review was conducted to identify patients who underwent ORIF of pilon fractures at an ACS Level I trauma center from 2005 to 2014. Medical records and radiographs were reviewed retrospectively for patient demographics, comorbidities, fracture characteristics, associated injuries, mechanism of injury, and functional activity. Logistic regression analyses were performed to identify risk factors associated with arthrodesis. Results:282 pilon fractures (279 patients) met inclusion criteria. There were 182 men and 97 women with an average age of 43.8 ± 15.2 yr. Overall, 15 pilon fractures (5.3%) in six male patients and nine female patients were treated with an ankle arthrodesis an average of 1.73 ± 5.15 yr after their initial injury. Following multivariable logistic regression analysis, age greater than 40 yr, tobacco use, and nonunion were identified as independent predictors of arthrodesis. Conclusions:This study found a number of patient-related factors associated with an increased risk of arthrodesis after a pilon fracture was sustained. Multivariable logistical analysis identified age greater than 40 yr, tobacco use, and nonunion as independent predictors of arthrodesis following pilon fracture ORIF.

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“…In this case, preserving ankle joint function was challenging given the large bone defect and the absence of almost half of the cartilage on the joint surface. Some recent studies have reported that primary arthrodesis has resulted in good functional outcomes [[7], [8], [9], [10]]. The patient was made aware of this fact and that primary arthrodesis was one treatment option that would allow for his early reintegration into society.…”

Section: Discussionmentioning

confidence: 99%

Ankle joint reconstruction by circular frame external fixator for a severely comminuted and contaminated open tibial pilon fracture (AO 43-C3.3). Case report

Harada¹,

Teramoto²,

Takaki³

et al. 2019

Trauma Case Reports

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A severely comminuted and contaminated open tibial pilon fracture is one of the most challenging fractures we face. Although nowadays conducting multiple operations over various stages is a common treatment option taking into account the possibility of soft tissue damage, a gold standard protocol for severe pilon fractures has not yet been established. This case concerns a 56-year-old gentleman who suffered a severely comminuted and contaminated Gustilo 3b open tibial pilon fracture (AO 43C3.3) that was successfully treated using a circular frame external fixator without flap. Two years six months after the injury, there were no indications of any skin conditions at the site of the open wound, the range of ankle motion had been maintained and independent walking was possible. The score under the JSSF (Japanese Society of Surgery of the foot) ankle/hind foot scale was 81. This indicates that use of a circular frame external fixator is a useful treatment method in the event of a severe open pilon fracture where there is a large osteochondral bone defect.

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Primary Posterior Blade Plate Tibiotalar Arthrodesis: A Salvage Procedure for Complex Nonreconstructable Pilon Fractures

Cited by 17 publications

References 23 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

Incidence and risk factors of ankle fusion after pilon fracture: a retrospective review

Ankle joint reconstruction by circular frame external fixator for a severely comminuted and contaminated open tibial pilon fracture (AO 43-C3.3). Case report

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