IIIB Segmental Open Tibial Plafond Fracture Treated with Ankle Joint Salvage and Bone Transport

2015 ◽  
pp. 1-7
Author(s):  
Craig A. Robbins
Keyword(s):  
Ankle Joint ◽  
Bone Transport ◽  
Tibial Plafond

scholarly journals Analysis of bone transport for ankle arthrodesis as a limb salvage procedure for the treatment of septic pilon fracture nonunion

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thomas Rosteius ◽  
Sebastian Lotzien ◽  
Matthias Königshausen ◽  
Valentin Rausch ◽  
Charlotte Cibura ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Limb Salvage ◽  
Ankle Joint ◽  
Functional Results ◽  
Ankle Arthrodesis ◽  
Bone Transport ◽  
Functional Score ◽  
Salvage Procedure ◽  
Pilon Fracture ◽  
Additional Surgery

AbstractSeptic nonunion of the pilon region with ankle joint infection is challenging for orthopedic surgeons to treat and is associated with a high risk of limb loss. Therefore, the aim of this study was to evaluate the effectiveness of bone transport for ankle arthrodesis in salvaging the limp after septic ankle destruction of the pilon region. We conducted a single-center, retrospective study including 21 patients treated for septic pilon nonunion with accompanying septic ankle destruction via Ilizarov bone transport between 2004 and 2018. In all cases, the complete excision of the nonunion and the resection of the ankle joint were carried out, followed by treating the bone and joint defect with a bone transport into the ankle arthrodesis. In 12/21 patients an additional flap transfer was required due to an accompanying soft tissue lesion. The overall healing and failure rate, final alignment and complications were recorded by the patients’ medical files. The bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and a modified American Orthopedic Foot and Ankle Society (AOFAS) scale. After a mean follow-up of 30.9 ± 15.7 months (range 12–63 months), complete bone and soft tissue healing occurred in 18/21 patients (85.7%). The patients had excellent (5), good (7), fair (4), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 6 patients had excellent, 7 good, and 6 fair results. The modified AOFAS score reached 60.6 ± 18 points (range, 29–86). In total, 33 minor complications and 28 major complications occurred during the study period. In 2 cases, a proximal lower leg amputation was performed due to a persistent infection and free flap necrosis with a large soft tissue defect, whereas in one case, persistent nonunion on the docking side was treated with a carbon orthosis because the patient refused to undergo an additional surgery. Bone transport for ankle arthrodesis offers the possibility of limb salvage after septic ankle destruction of the pilon region, with acceptable bony and functional results. However, a high number of complications and surgical revisions are associated with the treatment of this severe complication after pilon fracture.

Ankle Salvage Following Nonunion of Distal Tibia Fractures

2018 ◽  
Vol 39 (10) ◽  
pp. 1210-1218 ◽  
Author(s):  
Giovanni Lovisetti ◽  
Alexander Kirienko ◽  
Charles Myerson ◽  
Ettore Vulcano
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Case Series ◽  
Bone Transport ◽  
Radiographic Evaluation ◽  
Leg Length ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Close Proximity ◽  
American Orthopaedic

Background: Nonunions of the distal tibia in close proximity to the ankle joint can be a challenge to treat. The purpose of this study was to evaluate radiographic and clinical outcomes of patients who underwent ankle-sparing bone transport for periarticular distal tibial nonunions. Methods: Twenty-one patients underwent ankle-sparing bone transport between January 2006 and July 2016. The mean age of the patients was 48.6 years, and 71% (15/21) were male. Patients were followed for an average of 14.6 months (range, 10.6-17.7 months), with an average of 8.6 months in-frame. Thirteen of 21 patients had infected nonunions. Primary endpoints included time to union and American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All fractures achieved union. Mean time to union was 37.4 weeks. Mean AOFAS score was 86.3 points (range, 37-100). A score of 37 was observed in 1 patient with preexisting Charcot foot. Radiographic evaluation at 6 months revealed a mean lateral distal tibial angle of 89.2 degrees and a mean anterior distal tibial angle of 76 degrees. Leg length discrepancy was less than 1.2 cm in all patients. Superficial pin infection was observed in 7 patients, and operative wound infection at the level of bone resection was observed in 3 patients. Conclusion: The ankle-sparing bone transport technique was an effective alternative to bone graft and arthrodesis for the treatment of periarticular nonunions of the distal tibia and was safe for use in patients with infected nonunions in close proximity to the ankle joint. Level of Evidence: Level IV, case series.

scholarly journals Percentage of Articular Surface Debridement is Equivalent in Arthroscopic and Open Ankle Fusions

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Michael Anderson ◽  
Ashlee MacDonald ◽  
Sandeep Soin ◽  
Adolph Flemister ◽  
John Ketz
Keyword(s):  
Soft Tissue ◽  
Ankle Joint ◽  
Articular Surface ◽  
Wound Complications ◽  
Arthroscopic Debridement ◽  
Talar Dome ◽  
Ankle Arthritis ◽  
Tibial Plafond ◽  
Significant Difference ◽  
Open Debridement

Category: Ankle Arthritis, Arthroscopy Introduction/Purpose: Tibiotalar arthrodesis is a reliable option in the treatment of end-stage ankle arthritis and both open and arthroscopically assisted techniques are well described. When compared head to head, multiple studies have demonstrated advantages of arthroscopic arthrodesis over open fusions including decreased morbidity, and shorter hospital stays while achieving equivalent or increased rates of fusion. It is unclear why arthroscopic fusion may be favorable to open surgery, however, it is hypothesized that patient selection and soft tissue trauma may play a role. No study, however, has evaluated the extent of articular debridement afforded by each technique. The purpose of this study was to evaluate the amount of articular cartilage denuded via open arthrodesis and via arthroscopic arthrodesis with time of procedure evaluated as a secondary measure. Methods: Six matched sets of fresh frozen cadaver lower extremities were acquired for study. One limb from each set was randomly assigned to open articular debridement while the other limb was assigned to arthroscopic debridement. The duration of each procedure was timed. The tibiotalar joints were disarticulated following debridement and the talus was dissected free of all soft tissue attachments. Photographs of the weight bearing portion of the articular surfaces were then taken and residual cartilage was mapped using ImageJ software. The percentage of the joint debrided was determined by the area of denuded bone divided by the total area of the articular surface to allow for comparison across specimens. The mapping process was blinded to the type of debridement undertaken. Repeated measurements were taken to determine intra- and inter-reliability of the measurements. Student t-tests were used to compare the percentage of joint debrided and differences in time of the procedure. Results: The average percentage of cartilage debrided in the arthroscopic procedure was 88.99+11.19% for the tibial plafond and 88.84.08+5.45% for the talar dome. For the open procedure, 82.93+6.91% of the tibial plafond was debrided and 84.08+5.45% of the talar dome was debrided. There were no significant differences of the tibia or talus between the open and arthroscopic procedures (p>0.05). Inter- and intra-reliability were calculated for all measurements with r>.8. There was a significant difference in the time of the procedure with the arthroscopic debridement taking 50.17+5.57 minutes to complete while the open debridement took 30.67+5.16 minutes to complete (p<0.01). Conclusion: There were no differences in the percentage of articular surface debrided when comparing arthroscopic versus open arthrodesis of the ankle joint in cadaver specimens. The arthroscopic debridement took significantly longer, however this difference may be offset by a decrease in time required for wound closure. Furthermore, an increased time of debridement may be warranted if it results in decreased wound complications and pain. The results of this study support previous clinical findings that arthroscopic debridement can yield fusion rates comparable to, or better, than open debridement of the ankle joint.

scholarly journals Changes in the Mechanical Axis and Weight-Bearing Line of the Ankle After Varus Knee Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0026
Author(s):  
Seung Yeol Lee ◽  
Soon-Sun Kwon ◽  
Kyoung Min Lee
Keyword(s):  
Femoral Head ◽  
Ankle Joint ◽  
Subtalar Joint ◽  
Mechanical Axis ◽  
Weight Bearing ◽  
Tibial Osteotomy ◽  
Varus Knee ◽  
Concentrated Load ◽  
Joint Axis ◽  
Tibial Plafond

Category: Ankle, Hindfoot Introduction/Purpose: Varus limb malalignment results in an imbalance of force transmission to the knee joint, resulting in a concentrated load in the medial compartment. A varus knee correction may affect the ankle and subtalar joint, because the weight-bearing load on the lower extremity extends from the hip to the foot. A previous study suggested that the true mechanical axis of the lower limb should be calculated with a line from the center of the femoral head to the lowest point of the calcaneus, not to the center of the tibial plafond. Therefore, we performed this study to evaluate changes in the mechanical axis and weight- bearing line of the ankle after varus knee correction. Methods: Patients with a varus knee who were followed-up after they had undergone high tibial osteotomy (HTO) or total knee replacement arthroplasty (TKA) at an age of >20 years, and who had undergone preoperative and postoperative scanogram were included in this study. The hip-knee-ankle (HKA) angle, mechanical axis, and weight-bearing line (line from the center of the femoral head to the lowest point of the calcaneus) were measured on the radiographs. The point at which the mechanical axis and weight-bearing line passed through the tibial plafond was the ankle joint axis point. The postoperative change in the ankle joint axis point on the mechanical axis and weight-bearing line according to the HKA angle correction was adjusted by multiple factors using a linear mixed model. Results: A total of 257 limbs from 198 patients were included in this study. The preoperative HKA was 7.3 ± 4.7° and corrected to 0.4 ± 3.8°. Although the ankle axis points on both axes moved laterally after HTO and TKA, the ankle joint axis of the weight- bearing line showed a significant larger lateral movement (22.5±35.7%) (Fig.) than that of the mechanical axis (15.7±16.0%) in terms of rate of change (p = 0.006). The ankle joint axis point on the weight-bearing line moved laterally by 0.9% per degree of postoperative HKA angle decrease (p < 0.001). The change in the ankle joint axis point on the mechanical axis was not statistically significant after HTO and TKA (p = 0.223). Conclusion: The mechanical axis and weight-bearing line of the ankle moved laterally after the varus knee correction. The ankle joint axis on the weight-bearing line moved laterally as the HKA angle decreased after the surgery, whereas the varus knee correction did not significantly affect the ankle joint axis on the mechanical axis. The varus knee correction might affect the subtalar joint as well as the ankle joint. Therefore, we believe that our findings warrant consideration in pre- and postoperative evaluations using the weight-bearing line of patients undergoing varus knee correction.

Single Hemicerclage for Lateral Type B Malleolar Fracture - A Novel, Minimal and Reliable Osteosynthesis

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 283-288
Author(s):  
Maurer ◽  
Stamenic ◽  
Stouthandel ◽  
Ackermann ◽  
Gonzenbach
Keyword(s):  
Ankle Joint ◽  
Weight Bearing ◽  
Fracture Type ◽  
Type B ◽  
Malleolar Fracture ◽  
Metallic Wire ◽  
Long Term Outcome ◽  
X Ray ◽  
Upper Ankle Joint ◽  
Upper Ankle

Aim of study: To investigate the short- and long-term outcome of patients with isolated lateral malleolar fracture type B treated with a single hemicerclage out of metallic wire or PDS cord. Methods: Over an 8-year period 97 patients were treated with a single hemicerclage for lateral malleolar fracture type B and 89 were amenable to a follow-up after mean 39 months, including interview, clinical examination and X-ray controls. Results: The median operation time was 35 minutes (range 15-85 min). X-ray controls within the first two postoperative days revealed an anatomical restoration of the upper ankle joint in all but one patient. The complication rate was 8%: hematoma (2 patients), wound infection (2), Sudeck's dystrophy (2) and deep vein thrombosis (1). Full weight-bearing was tolerated at median 6.0 weeks (range 2-26 weeks). No secondary displacement, delayed union or consecutive arthrosis of the upper ankle joint was observed. All but one patient had restored symmetric joint mobility. Ninety-seven percent of patients were satisfied or very satisfied with the outcome. Following bone healing, hemicerclage removal was necessary in 19% of osteosyntheses with metallic wire and in none with PDS cord. Conclusion: The single hemicerclage is a novel, simple and reliable osteosynthesis technique for isolated lateral type B malleolar fractures and may be considered as an alternative to the osteosynthesis procedures currently in use.

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