Simultaneous septic arthrodesis of the tibiotalar and subtalar joints with the Ilizarov external fixator—an analysis of 13 patients

Abstract Purpose Treatment of joint destruction of the tibiotalar and subtalar joints caused by acute or chronic infections in compromised hosts is a challenging problem. In these cases, simultaneous septic arthrodesis with the use of the Ilizarov external fixator represents a possible alternative to amputation. This case series presents the results and complications of patients with acute or chronic infection of the tibiotalar and subtalar joints. Methods Between 2005 and 2015, 13 patients with acute or chronic infections were treated by simultaneous single-stage debridement/arthrodesis of the tibiotalar and subtalar joints. In seven patients, there was a florid infection with fistula formation and soft tissue defects, and in six patients, there was chronic osteomyelitis with closed soft tissue. In addition to the demographic data, the time spent in the fixator, the major and minor complications and the endpoint of consolidation were reviewed. Results The mean time spent in the fixator was 18 (min 15, max 26) weeks. The mean follow-up time for nine patients was 100 (min 3, max 341) weeks. Complete osseous consolidation of both the tibiotalar and subtalar joints was achieved in 10 patients (77%). In three (23%) patients, there was complete consolidation of one of the joints and partial consolidation of the other joint. Conclusion The Ilizarov external fixator allows for simultaneous arthrodesis of the tibiotalar and subtalar joints in septic joint destruction. However, the healing rates are below the rates reported in the literature for isolated tibiotalar or tibiocalcaneal arthrodesis in comparable clinical situations.

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Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03751-0 ◽

2021 ◽

Author(s):

Charlotte Reinke ◽

Sebastian Lotzien ◽

Emre Yilmaz ◽

Yannik Hanusrichter ◽

Christopher Ull ◽

...

Keyword(s):

External Fixator ◽

Demographic Data ◽

Joint Destruction ◽

Salvage Procedure ◽

Aofas Score ◽

Ilizarov External Fixator ◽

Tibiocalcaneal Arthrodesis ◽

Ilizarov Fixator ◽

Lost To Follow Up

Abstract Introduction Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. Materials and methods Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. Results The average time spent in the fixator was 22 (range 14–34) weeks. The average follow-up in 17 patients was 116 (range 4–542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. Conclusion Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

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Correction of Ankle and Hindfoot Deformities by Supramalleolar Osteotomy

Foot & Ankle International ◽

10.1177/107110070302400103 ◽

2003 ◽

Vol 24 (1) ◽

pp. 22-28 ◽

Cited By ~ 24

Author(s):

Cengiz Sen ◽

Mehmet Kocaoglu ◽

Levent Eralp ◽

Murat Cinar

Keyword(s):

Soft Tissue ◽

External Fixator ◽

Aofas Score ◽

Ilizarov External Fixator ◽

Surgical Interventions ◽

Supramalleolar Osteotomy ◽

Osteotomy Technique ◽

Hindfoot Deformities ◽

The Mean

Ankle and hindfoot deformities in 11 patients with a mean age of 15 (range, four to 35) have been gradually corrected by an Ilizarov external fixator. In all patients, supramalleolar osteotomy was utilized by percutaneous drilling and osteotomy technique. The patients were evaluated clinically by the AOFAS scoring system and radiologically by malorientation and malalignment tests described by Paley. The purpose of the current study is to evaluate the efficacy of supramalleolar osteotomy and correction by an Ilizarov device in treating hindfoot and ankle deformities. The mean external fixation period was five (2.5 to eight) months. The mean interval between the operation and last follow-up examination was 19 (13 to 26) months. The patients improved an average of 30 points after the operation regarding to AOFAS score. A plantigrade foot was achieved in the whole group. Radiologically, no malalignment or malorientation was measured. Equal leg lengths were achieved in all nine patients with one exception. Complications were graded after Paley as minor problems in 11 patients and as obstacles requiring surgical interventions in four patients. Sequelae remained in only one patient. Ankle and hindfoot deformities caused by various etiologies are complicated by poor soft tissue condition and a short foot. A supramalleolar osteotomy and Ilizarov external fixator can safely and effectively correct these deformities.

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Autologous Matrix-Induced Chondrogenesis for Treatment of Focal Cartilage Defects in the Knee: A Follow-up Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120981872 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098187

Author(s):

Justus Gille ◽

Ellen Reiss ◽

Moritz Freitag ◽

Jan Schagemann ◽

Matthias Steinwachs ◽

...

Keyword(s):

Repeated Measures ◽

Demographic Data ◽

Case Series ◽

Defect Size ◽

Lysholm Score ◽

Outcome Analysis ◽

Cartilage Defects ◽

Chondral Defects ◽

The Mean

Background: Autologous matrix-induced chondrogenesis (AMIC) is a well-established treatment for full-thickness cartilage defects. Purpose: To evaluate the long-term clinical outcomes of AMIC for the treatment of chondral lesions of the knee. Study Design: Case series; Level of evidence, 4. Methods: A multisite prospective registry recorded demographic data and outcomes for patients who underwent repair of chondral defects. In total, 131 patients were included in the study. Lysholm, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) score for pain were used for outcome analysis. Across all patients, the mean ± SD age of patients was 36.6 ± 11.7 years. The mean body weight was 80.0 ± 16.8 kg, mean height was 176.3 ± 7.9 cm, and mean defect size was 3.3 ± 1.8 cm2. Defects were classified as Outerbridge grade III or IV. A repeated-measures analysis of variance was used to compare outcomes across all time points. Results: The median follow-up time for the patients in this cohort was 4.56 ± 2.92 years. Significant improvement ( P < .001) in all scores was observed at 1 to 2 years after AMIC, and improved values were noted up to 7 years postoperatively. Among all patients, the mean preoperative Lysholm score was 46.9 ± 19.6. At the 1-year follow-up, a significantly higher mean Lysholm score was noted, with maintenance of the favorable outcomes at 7-year follow-up. The KOOS also showed a significant improvement of postoperative values compared with preoperative data. The mean VAS had significantly decreased during the 7-year follow-up. Age, sex, and defect size did not have a significant effect on the outcomes. Conclusion: AMIC is an effective method of treating chondral defects of the knee and leads to reliably favorable results up to 7 years postoperatively.

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Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02021-w ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Qin Boquan ◽

Ren Yi ◽

Gan Tingjiang ◽

Liu Xi ◽

Zhang Hui

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Therapeutic Strategy ◽

Case Series ◽

Soft Tissue Balance ◽

Soft Tissue Release ◽

Osteotomy Site ◽

Foot Deformities ◽

Limb Deformities ◽

The Mean

Abstract Aim The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results. Methods A retrospective review of CFD associated with LLD simultaneous correction utilizing the Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted. Results Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient and lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, the ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study. Conclusion The therapeutic strategy by using the Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD. Level of evidence Level IV, retrospective case series

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Hip Distraction Without a Perineal Post: A Prospective Study of 1000 Hip Arthroscopy Cases

The American Journal of Sports Medicine ◽

10.1177/0363546517741704 ◽

2017 ◽

Vol 46 (3) ◽

pp. 632-641 ◽

Cited By ~ 24

Author(s):

Omer Mei-Dan ◽

Matthew J. Kraeutler ◽

Tigran Garabekyan ◽

Jesse A. Goodrich ◽

David A. Young

Keyword(s):

Soft Tissue ◽

Hip Arthroscopy ◽

Case Series ◽

Edge Angle ◽

Center Edge ◽

Hip Distraction ◽

The Mean ◽

Distraction Force ◽

Lateral Center Edge Angle ◽

Center Edge Angle

Background: Hip arthroscopy has traditionally been performed with a perineal post, resulting in various groin-related complications, including pudendal nerve neurapraxias, vaginal tears, and scrotal necrosis. Purpose: To assess the safety of a technique for hip distraction without the use of a perineal post. Study Design: Case series; Level of evidence, 4. Methods: We prospectively analyzed a consecutive cohort of 1000 hips presenting to a dedicated hip preservation clinic; all patients had hip pain and were subsequently treated with hip arthroscopy. Demographic variables, hip pathology, and lateral center edge angle were recorded for each case. In the operating room, the patient’s feet were placed in traction boots in a specifically designed distraction setup, and the operative table was placed in varying degrees of Trendelenburg. With this technique, enough resistance is created by gravity and friction between the patient’s body and the bed to allow for successful hip distraction without the need for a perineal post. In a subset of 309 hips (n = 281 patients), the degrees of Trendelenburg as well as the distraction force were analyzed. Results: The mean ± SD Trendelenburg angle used among the subset of 309 hips was 11° ± 2°. The mean initial distraction force necessary was 90 ± 28 lb, which decreased to 65 ± 24 lb by 30 minutes after traction initiation ( P < .0001). The most important variables in determining initial force for this cohort of patients were, in order of magnitude, sex ( P < .0001), weight ( P < .0001), and lateral center edge angle ( P < .01). No groin-related complications occurred among the entire cohort of patients, including soft tissue or nerve-related complications. The rate of deep venous thrombosis was 2 in 1000. Conclusion: The use of the Trendelenburg position and a specially designed distraction setup during hip arthroscopy allows for safe hip distraction without a perineal post, thereby eliminating groin-related soft tissue and nerve complications. Certain patient variables can be used to estimate the required distraction force and inclination angle with this method.

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Complex Foot Deformities Associated With Lower Limb Deformities: a New Therapeutic Strategy for Simultaneous Correction Using Ilizarov Procedure Together With Osteotomy and Soft Tissue Release

10.21203/rs.3.rs-45634/v1 ◽

2020 ◽

Author(s):

Qin Boquan ◽

Ren Yi ◽

Gan Tingjiang ◽

Liu Xi ◽

Zhang Hui

Keyword(s):

Soft Tissue ◽

Lower Limb ◽

Therapeutic Strategy ◽

Case Series ◽

Soft Tissue Balance ◽

Soft Tissue Release ◽

Osteotomy Site ◽

Foot Deformities ◽

Limb Deformities ◽

The Mean

Abstract Aim The aim of the current study is to introduce a new therapeutic strategy for simultaneous correction of complex foot deformities (CFD) and the associated lower limb deformities (LLD) by using Ilizarov technique with osteotomy and soft tissue procedure and to report its early clinical results.Methods A retrospective review of CFD associated with LLD simultaneous correction utilizing Ilizarov procedure together with osteotomy and soft tissue balance from 2015 to 2019 was conducted.Results Thirty-two patients were followed for an average of 42.8 months. The mean external fixation time (EFT) was 6.5 months. The mean healing index (HI) was 1.7 months/cm. At the time of fixator removal, plantigrade feet were achieved in all patient, lower limb deformities were corrected. No recurrence of the deformities occurred. The mean LLRS AIM score was improved from 7.5 to 0.3. At the final follow-up, ASAMI-Paley score was graded as excellent in all limbs in the aspect of bone results, and functional results were defined as excellent in 29 (90.6%) limbs and good in 3 (9.4%) limbs. The mean Modified Dimeglio score was significantly improved from 7.2 to 1.3. No deep infection of the osteotomy site or nonunion was noted in the current study.Conclusion The therapeutic strategy by using Ilizarov procedure together with osteotomy and soft tissue balance is a safe and effective way to simultaneously correct CFD and LLD.Level of Evidence Level IV, retrospective case series

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Static monolateral external fixation for the Rolando fracture: a simple solution for a complex fracture

Annals of The Royal College of Surgeons of England ◽

10.1308/003588412x13171221501140 ◽

2012 ◽

Vol 94 (2) ◽

pp. 112-115 ◽

Cited By ~ 9

Author(s):

D Marsland ◽

AP Sanghrajka ◽

B Goldie

Keyword(s):

External Fixation ◽

External Fixator ◽

Case Series ◽

X Rays ◽

Site Infection ◽

Study Support ◽

Pin Site ◽

The Mean ◽

Joint Incongruity ◽

Mean Time

INTRODUCTION Rolando fractures are often difficult to manage because of their inherent instability. We describe a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, two-pin external fixator spanning the trapeziometacarpal joint, and present the results of a single-surgeon case series. METHODS Eight consecutive patients (mean age: 32.8 years) with Rolando fractures were treated using a Hoffmann II® Micro small bone external fixator using blunt ended 2.0mm half pins, inserted into the trapezium and diaphysis of the first metacarpal. Functional outcome was assessed with the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at a mean time of 2.7 years following the fracture (range: 4 months – 6.0 years). The mean time to frame removal was 28 days. RESULTS There were three cases of superficial pin site infection. Follow-up x-rays at four months did not demonstrate significant joint incongruity or malunion in any case. The mean QuickDASH score was 7.95 and all patients returned to their previous levels of activity. CONCLUSIONS Although external fixation risks pin site infection, the results of this study support the use of spanning trapeziometacarpal external fixation for Rolando fractures as it reliably gives excellent functional outcomes.

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Lengthening Temporalis Myoplasty: Objective Outcomes and Site-Specific Quality-of-Life Assessment

Otolaryngology ◽

10.1177/0194599817717458 ◽

2017 ◽

Vol 157 (6) ◽

pp. 966-972 ◽

Cited By ~ 6

Author(s):

Davide Thomas Panciera ◽

Claudio Sampieri ◽

Alberto Deganello ◽

Giovanni Danesi

Keyword(s):

Quality Of Life ◽

Demographic Data ◽

Case Series ◽

Life Assessment ◽

Life Outcomes ◽

A Value ◽

The Mean ◽

Objective Outcomes ◽

Oral Commissure

Objective Evaluate outcomes of the lengthening temporalis myoplasty in facial reanimations. Study Design Case series with planned data collection. Setting Ospedali Riuniti, Bergamo, and AOUC Careggi, Florence, Italy. Subjects and Methods From 2011 to 2016, 11 patients underwent lengthening temporalis myoplasty; demographic data were collected for each. Pre- and postoperative photographs and videos were recorded and used to measure the smile angle and the excursion of the oral commissure, according to the SMILE system (Scaled Measurements of Improvement in Lip Excursion). All patients were tested with the Facial Disability Index, and they also completed a questionnaire about the adherence to physiotherapy indications. Results All patients demonstrated a significant improvement in functional parameters and in quality of life. On the reanimated side, the mean z-line and a-value, measured when smiling, significantly improved in all patients: from 22.6 mm (95% CI, 20.23-25.05) before surgery to 30.9 mm (95% CI, 27.82-33.99) after surgery ( P < .001) and from 100.5° (95% CI, 93.96°-107.13°) to 111.6° (95% CI, 105.63°-117.64°; P < .001), respectively. The mean postoperative dynamic gain, passing from rest to a full smile at the reanimated side, was 3.1 mm (95% CI, 1.30-4.88) for the z-line and 3.3° (95% CI, 1.26°-5.29°) for the a-value. The Facial Disability Index score increased from a preoperative mean of 33.4 points (95% CI, 28.25-38.66) to 49.9 points (95% CI, 47.21-52.60) postoperatively ( P < .001). Conclusions The lengthening temporalis myoplasty can be successfully used for smile reanimation, with satisfying functional and quality-of-life outcomes.

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Use of Bivector Traction for Stabilization of the Head and Maintenance of Optimal Cervical Alignment in Posterior Cervical Fusions

Global Spine Journal ◽

10.1177/2192568217694146 ◽

2017 ◽

Vol 7 (3) ◽

pp. 227-229 ◽

Cited By ~ 2

Author(s):

Isaac O. Karikari ◽

David B. Bumpass ◽

Jeffrey Gum ◽

Patrick Sugrue ◽

Todd M. Chapman ◽

...

Keyword(s):

Sagittal Alignment ◽

Intraoperative Complications ◽

Demographic Data ◽

Case Series ◽

Cervical Lordosis ◽

Consecutive Case ◽

Vertical Alignment ◽

Cervical Sagittal Alignment ◽

Novel Method ◽

The Mean

Study Design: Retrospective analysis of consecutive case series. Objective: To introduce a novel method of stabilizing the cranium using bivector traction in posterior cervical fusions. Methods: A retrospective review of 50 consecutive patients undergoing instrumented posterior cervical arthrodesis was performed. All patients had at least 3 levels of subaxial fusion using the bivector traction apparatus. Patients’ demographic data was recorded for the following: pre- and postoperative cervical lordosis, pre- and postoperative cervical sagittal vertical alignment (cSVA), and intraoperative complications from pin placements. Results: A total of 50 patients were studied. There were 31 females and 19 males. The mean age at the time of surgery was 49 years (range 35-79). A mean 5.8 levels were fused. The most common levels fused were C2-T3 in 14 patients followed by C2-T2 in 7 patients. In no case did the surgeon or assistant have to scrub out to adjust the alignment. The mean pre- and postoperative cervical lordosis was −6.0° and −10°, respectively ( P = .04). The mean pre-and postoperative cSVA was 30.5 mm and 32 mm, respectively ( P = .6). There were no complications related to placement of the Gardner-Well tongs. Conclusion: The bivector traction is an easy, safe, and effective method of stabilizing the head and obtaining adequate cervical sagittal alignment.

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Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

Foot & Ankle International ◽

10.1177/1071100717735074 ◽

2017 ◽

Vol 39 (1) ◽

pp. 93-98 ◽

Cited By ~ 8

Author(s):

Hani El-Mowafi ◽

Mazen Abulsaad ◽

Yasser Kandil ◽

Ahmed El-Hawary ◽

Samer Ali

Keyword(s):

External Fixator ◽

Intramedullary Nail ◽

Case Series ◽

Poor Quality ◽

Charcot Arthropathy ◽

Hybrid Fixation ◽

Level Of Evidence ◽

Ankle Fusion ◽

The Mean

Background: Ankle fusion is difficult to achieve in the diabetic Charcot ankle Brodsky type 3a because of the poor quality of the bone and the inability to achieve a stable biomechanical construct. The aim of this study was to report the outcome of ankle fusion using a combination of an intramedullary nail and a circular external fixator in patients with diabetic Charcot arthropathy. Methods: We prospectively studied 24 patients with diabetic Charcot arthropathy of the ankle who were treated by fusion of the tibiotalar joint using a combined retrograde intramedullary nail and Ilizarov external fixator. Their mean age was 50.7 ± 6.9 (range, 43-62) years. The mean follow-up after surgery was 36.4 ± 5.8 (range, 24-98) months. Results: Twenty-two patients (92%) achieved clinical and radiographic solid bony fusion. No patients in this series needed amputation. All the patients were pain free, and the mean American Orthopaedic Foot & Ankle Society Score (AOFAS) improved significantly from 34.6 ± 6.8 to 66.4 ± 4.5 at the last follow-up. Two patients developed an ulcer over the heel due to a prominent nail. The ulcer healed after nail removal. Eight patients developed pin tract infection. Conclusion: We report a successful outcomes of ankle fusions using combined intramedullary nail locked only proximally and ring external fixator (hybrid fixation) in patients with diabetic Charcot arthropathy. Level of Evidence: Level IV, case series.

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