Role of Rotation in Total Ankle Replacement

2019 ◽  
Vol 40 (12) ◽  
pp. 1358-1367 ◽  
Author(s):  
Ali-Asgar Najefi ◽  
Yaser Ghani ◽  
Andy Goldberg
Keyword(s):  
Pearson Correlation ◽  
Axial Rotation ◽  
Total Ankle Replacement ◽  
Ct Scans ◽  
Tibial Torsion ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Preoperative Ct ◽  
The Mean ◽  
Foot Position

Background: The importance of total ankle replacement (TAR) implant orientation in the axial plane is poorly understood with major variation in surgical technique of implants on the market. Our aim was to better understand the axial rotational profile of patients undergoing TAR. Methods: In 157 standardized computed tomography (CT) scans of patients with end-stage ankle arthritis planning to undergo primary TAR surgery, we measured the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA), and the tibiotalar angle. The foot position was measured in relation to the TMA with the foot plantigrade. The variation between the medial gutter line and the line bisecting both gutters was assessed. Results: The mean external tibial torsion was 34.5 ± 10.3 degrees (11.8-62 degrees). When plantigrade, the mean foot position relative to the TMA was 21 ± 10.6 degrees (0.7-38.4 degrees) internally rotated. As external tibial torsion increased, the foot position became more internally rotated relative to the TMA (Pearson correlation, 0.6; P < .0001). As the tibiotalar angle became more valgus, the foot became more externally rotated relative to the TMA (Pearson correlation, −0.4; P < .01). The mean difference between the medial gutter line and a line bisecting both gutters was 4.9 ± 2.8 degrees (1.7-9.4 degrees). More than 51% of patients had a difference greater than 5 degrees. The mean angle between the medial gutter line and a line perpendicular to the TMA was 7.5 ± 2.6 degrees (2.8-13.7 degrees). Conclusion: There was a large variation in rotational profile of patients undergoing TAR, particularly between the medial gutter line and the TMA. Surgeon designers and implant manufacturers should develop consistent methods to guide surgeons toward judging the appropriate axial rotation of their implant on an individual basis. We recommend careful clinical assessment and preoperative CT scans to enable the correct rotation to be determined. Level of Evidence: Level IIc, outcomes research.

scholarly journals The Role of Axial Rotation in Total Ankle Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
Ali-Asgar Najefi ◽  
Andrew Goldberg
Keyword(s):  
Surgical Techniques ◽  
Axial Rotation ◽  
Total Ankle Replacement ◽  
Tibial Tuberosity ◽  
Ct Scans ◽  
Patient Specific ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Wright Medical Technology ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: The importance of implant orientation in the axial rotational plane is ill understood. No Total ankle replacement (TAR) implant deals specifically with rotation as part of the surgical technique. Preoperative computed tomography (CT) scan–derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis, TN) have been developed for TAR scanning the knee and ankle for the purposes of patient specific instrumentation. The objectives of this study were to establish the range and relationship between the transtibial axis at the knee, the tibial tuberosity, and the transmalleolar axis using these CT scans in an adult population with ankle arthritis. Methods: 150 CT Scans of patients with end stage ankle osteoarthritis undergoing Psi, we measured the relationship between the transtibial axis, the tibial tuberosity and the transmalleolar axis (Figure 1). All CT scans were analysed using the Solidworks software (Dassault Systèmes). Varus or valgus arthritis, tibiotalar angle and presence of deformity was also recorded. Results: The mean difference in the axial plane between the transmalleolar axis and the tibial tuberosity was 17.9 ± 9.3 degrees externally rotated. There was a large range which was between -5 and 53 degrees of external rotation. The mean foot angle was 15.4 ± 11.1 degrees relative to the implant position. All planned implant positions were mean 1.0 ± 1.8 degrees (range -3.8 – 1.7 degrees) internally rotated to the transmalleolar axis. Varus or valgus ankle arthritis did not correlate with rotation of the tibial axis (p=0.4). Conclusion: There is a wide variation in rotational alignment of the tibia, which cannot be accurately assessed clinically or using plain radiographs. Surgical techniques that reference the tibial tuberosity to plan component alignment can be misleading and lead to implant malalignment. We recommend routine preoperative CT scanning prior to ankle replacement surgery and recommend research to assess the effects of axial rotation of implant performance and survival.

Intraoperative Assessment of the Axial Rotational Positioning of a Modern Ankle Arthroplasty Tibial Component Using Preoperative Patient-Specific Instrumentation Guidance

2019 ◽  
Vol 40 (10) ◽  
pp. 1160-1165
Author(s):  
Oliver J. Gagne ◽  
Andrea Veljkovic ◽  
Dave Townshend ◽  
Alastair Younger ◽  
Kevin J. Wing ◽  
...  
Keyword(s):  
Tibial Component ◽  
Rotation Angle ◽  
Pearson Correlation ◽  
Case Series ◽  
Axial Rotation ◽  
Patient Specific ◽  
P Value ◽  
Level Of Evidence ◽  
Patient Specific Instrumentation ◽  
Preoperative Ct

Background: The use of patient-specific instrumentation (PSI) in modern total ankle replacement (TAR) has augmented positioning of the tibial component, eliminating the need for complex jigs. Coronal and sagittal alignment are intuitive with this design and have been studied, but axial rotation has not. The purpose of this study was to assess the relationship between the planned preoperative axial rotation as set by the PSI guide and the rotation determined intraoperatively with non-PSI instrumentation. Methods: This was a prospective cohort study of 22 consecutive cases. The axial rotation angle between the medial gutter and the tibial implant position on the preoperative CT-scan based plan was extracted. At the time of surgery, the medial gutter alignment instrument from the non-PSI instrumentation was inserted and an intraoperative axial photograph obtained to record the angle between the medial gutter and the axial rotation guide pins set by the PSI instrumentation. The 2 measurements were compared and further statistical analysis included Pearson correlation and paired Student t test. Results: The average axial rotation angle between the medial gutter and the implant on the PSI preoperative plan was 5.4 ± 2.9 degrees, whereas the intraoperative photograph from the medial gutter alignment instrument to the pin was 5.9 ±3.8 degrees. This demonstrated a Pearson correlation of R = 0.54 and a P value of .53. The average difference between the two was −0.46 (95% CI: –2.04, 1.10), meaning that components were either slightly externally rotated or that the fork was aimed internally. Based on this group, 50% (11/22) were within 2 degrees of the target and 77% (17/22) were within 4 degrees of the target. Conclusion: Patient-specific guides allowed for reproducible rotational tibial component implantation in modern TAR. Further work is needed to better understand the biomechanical effects of the rotational profile and consequences on survivorship. Level of Evidence: Level IV, case series.

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

2019 ◽  
Vol 41 (1) ◽  
pp. 1-9 ◽  
Author(s):  
François Lintz ◽  
Jef Mast ◽  
Alessio Bernasconi ◽  
Nazim Mehdi ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Roc Curves ◽  
Threshold Value ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Ankle Replacement ◽  
Increased Risk ◽  
The Mean ◽  
American Orthopaedic

Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

2021 ◽  
pp. 107110072110044
Author(s):  
Catherine Conlin ◽  
Ryan M. Khan ◽  
Ian Wilson ◽  
Timothy R. Daniels ◽  
Mansur Halai ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Qualitative Description ◽  
Level Of Evidence ◽  
Foot Placement ◽  
Advantages And Disadvantages ◽  
Ankle Fusion ◽  
Ankle Replacement ◽  
Patient Reported

Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

Revision Rates After Total Ankle Replacement: A Comparison of Clinical Studies and Arthroplasty Registers

2021 ◽  
pp. 107110072110538
Author(s):  
Georg Hauer ◽  
Reinhard Hofer ◽  
Markus Kessler ◽  
Jan Lewis ◽  
Lukas Leitner ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Revision Rate ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Second Step ◽  
Fixed Bearing ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference

Background: The aim of this study was to assess the outcome of total ankle replacement (TAR) regarding revision rates by comparing clinical studies of the last decade to data displayed in arthroplasty registers. The secondary aim was to evaluate whether dependent clinical studies show a superior outcome to independent publications. Additionally, revision rates of mobile bearing implants (MB-TARs) were compared to those of fixed bearing implants (FB-TARs). Methods: Clinical studies on TARs between 2010 and 2020 were systematically reviewed, with the endpoint being a revision for any reason. The parameter “revision rate per 100 observed component years (CYs)” was calculated for each publication. The pooled revision rate for clinical studies was compared to the data reported in arthroplasty registers. In a second step, revision rates were subdivided and analyzed for independent and dependent publications and for FB-TARs and MB-TARs. Results: A total of 43 publications met the inclusion criteria comprising 5806 TARs. A revision rate of 1.8 per 100 observed CYs was calculated, corresponding to a 7-year revision rate of 12.6%. The 3 arthroplasty registers included showed revision rates ranging from 8.2% to 12.3% after 7 years. No significant difference between dependent and independent publications nor between FB-TARs and MB-TARs was detected. Conclusion: Revision rates of clinical studies and arthroplasty registers are comparable. Surgeons can compare their own revision rates with those from this study. Dependent studies do not seem to be biased, and no superiority for one bearing type can be described. Level of Evidence: Level III, systematic review of level III studies

Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement

2019 ◽  
Vol 40 (11) ◽  
pp. 1239-1248 ◽  
Author(s):  
James A. Nunley ◽  
Samuel B. Adams ◽  
Mark E. Easley ◽  
James K. DeOrio
Keyword(s):  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference ◽  
Patient Reported ◽  
End Stage

Background: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported long term for MB-TAR and at intermediate- to long-term follow-up for newer generation FB-TAR. Although comparisons between the 2 total ankle designs have been reported, to our knowledge, no investigation has compared the 2 designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes, and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65 years, range 35-85 years) were enrolled; a demographic comparison between the 2 cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees, or extensive talar dome wear pattern (“flat-top talus”). Prospective patient-reported outcomes, physical examination, and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score, Short Form 36, Foot and Ankle Disability Index, Short Musculoskeletal Functional Assessment, and American Orthopaedic Foot & Ankle Society ankle-hindfoot score. Surgeries were performed by a nondesign team of orthopedic foot and ankle specialists with total ankle replacement expertise. Statistical analysis was performed by a qualified statistician. At average follow-up of 4.5 years (range, 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, 1 had died, 4 were withdrawn after enrolling but prior to surgery, and 4 were lost to follow-up. Results: In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up with no statistically significant difference between the 2 groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FH-TAR, respectively. Reoperations were performed in 8 MB-TARs and 3 FH-TARs, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: With a high level of evidence, our study found that patient-reported and clinical outcomes were favorable for both designs and that there was no significant difference in clinical improvement between the 2 implants. The incidence of lucency/cyst formation was similar for MB-TAR and FH-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not necessarily correlate with radiographic findings. Reoperations were more common for MB-TAR and, in most cases, were to relieve impingement or treat cysts rather than revise or remove metal implants. Level of Evidence: Level I, prospective randomized study.

scholarly journals Perspectives in Treatments of End-Stage Ankle Arthritis Among Orthopaedic Surgeons

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141877997
Author(s):  
Phinit Phisitkul ◽  
Natalie Glass ◽  
Patrick B. Ebeling ◽  
Sandra E. Klein ◽  
Jeffrey E. Johnson
Keyword(s):  
United States ◽  
The United States ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Cross Sectional Survey ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Orthopaedic Surgeons ◽  
Ankle Replacement ◽  
End Stage

Background: This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method: A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results: Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role ( P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon’s experience affected the consideration of these clinical factors as contraindications. Conclusions: Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence: Level III, therapeutic.

scholarly journals 2019 IFFAS Award for Excellence Winner: Peri-Prosthetic Cysts and Alignment in Total Ankle Replacement: A 3-D, Weight Bearing Topographical Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Francois Lintz ◽  
Jef Mast ◽  
Nazim Mehdi ◽  
Alessio Bernasconi ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Coronal Plane ◽  
Unequal Distribution ◽  
Hindfoot Alignment ◽  
Cyst Volume ◽  
Ankle Replacement ◽  
The Mean ◽  
The Difference

Category: Ankle, Ankle Arthritis Introduction/Purpose: Peri-prosthetic cysts (PPC) in Total Ankle Replacement (TAR) are a common failure cause but the mechanisms of their development remains unclear. One possible explanation could be hindfoot malalignment and subsequent unequal distribution of load inside the joint. However, how residual malalignment influences the evolution of PPC remains unclear. Computed tomography (CT) has demonstrated superiority on conventional radiography in the follow up of PPC. Weight Bearing CT (WBCT), by combining 3D imaging and weight bearing measurements seems a valid tool to investigate this further. The objective for this work was to study the effects of residual hindfoot deformity on the distribution of PPC in the coronal plane. We hypothesized that cysts would be found predominantly medially in varus configuration, and laterally in valgus configuration. Methods: Retrospective comparative study, ethics committee approved. Forty-eight cases of TAR were included, with relevant demographics. Inclusion criteria were cases of primary TAR with available WBCT imaging of their ankle as part of normal follow up. Exclusion criteria were subsequent implant revision or cyst grafting. In each case, the localization and size of PPC’s were documented and their volume calculated by approximation of the closest ellipsoid. Hindfoot alignment was evaluated by the percentage Foot Ankle Offset (FAO) (foot-length normalized 3D ratio between the midline of the foot and the center of the ankle) using a WBCT dedicated semi-automatic software. The mean FAO value with 95%CI for the population was calculated. The difference in medial and lateral cyst volume defined by their position relative to the median axis in the coronal plane was compared in varus and valgus cases by a Mann-Whitney non-parametric test for unpaired samples. Results: Demographic distributions of the series were 32% female, mean age 65 (45-85) years. Mean FAO value was 0.12% (95%CI -1.09 to 1.33). Mean follow up was 43 months (6 to 239). The mean total cyst volume per case was 1190,7 mm3. In varus cases (defined by FAO<-1.09%), the volume of medial cysts was greater than laterally by a mean 197 mm3, whereas in valgus cases (defined by FAO>1.33%), the volume of lateral cysts was greater than medially by a mean 332 mm3. The difference was statistically significant (p<0.05). There was a weak, significant positive correlation (r=0.25, p<0,001) between FAO and total cyst volume and a moderate, significant correlation (r=0,56, p<0,001) between time to follow up and total cyst volume. Conclusion: Our hypothesis was confirmed. Periprosthetic cysts volume in this series of primary TAR was found to be relatively greater medially in postoperative varus configurations and vice-versa laterally in valgus. This confirms a possible correlation between the direction of residual hindfoot malalignment and the coronal localization of PPC in TAR, although this is certainly not the only pathophysiologic factor involved in PPC onset. Weightbearing CT may be helpful in Total Ankle Replacement follow up, in order to early detect PPC development and possibly to identify situations at risk of a more rapid evolution.

scholarly journals Total ankle replacement and simultaneous subtalar arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Luigi Manzi ◽  
Cristian Indino ◽  
Camilla Maccario ◽  
Claudia Di Silvestri ◽  
Riccardo D’Ambrosi ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Surgical Techniques ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Ct Scans ◽  
Talonavicular Joint ◽  
Joint Fusion ◽  
Subtalar Fusion ◽  
Ankle Replacement ◽  
Functional Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Patients with arthritis or severe dysfunction involving both the ankle and the subtalar joints can benefit tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. With the evolution of prosthetic design and surgical techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint and talonavicular joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. Methods: This study includes 11 patients who underwent primary TAR and simultaneous subtalar and talonavicular fusion from May 2011 to January 2015. Six males and five females were enrolled with a mean age of 61 years (41-75). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2±11.6 months. Radiographic examination included a postoperative CT scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. Results: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92% and the talonavicular fusion rate was 88%. There was a statistically significant increase in American Orthopedic Foot & Ankle Society ankle/hindfoot score from 25.9 to 74.1 at 12 months post-operatively. Ankle range of motion significantly increased from 10.2° to 30.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale (VAS) pain score from 8.8 to 1.9. Conclusion: TAR and simultaneous subtalar and talonavicular joint fusion are reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopaedic surgeons in determining the degree of successful fusion of subtalar and talonavicular arthrodesis.

The Die Punch Fragment: Analysis of Fragment Geometry and Need for Fixation

2020 ◽  
Author(s):  
Sezai Özkan ◽  
Svenna H. W. L. Verhiel ◽  
Samantha A. Jayasinghe ◽  
Chaitanya S. Mudgal
Keyword(s):  
Fragment Size ◽  
Distal Radioulnar Joint ◽  
Dorsal Approach ◽  
Level Of Evidence ◽  
Locked Plating ◽  
Fragment Analysis ◽  
Number Of Patients ◽  
Preoperative Ct ◽  
Type C ◽  
The Mean

Abstract Introduction Die punch (DP) fragments are among the most common fracture fragments to lose reduction after volar locked plating of articular distal radius fractures (DRFs). We aimed to report the number of patients in our institution who had a computed tomography (CT)-confirmed DP fragment and who had open reduction and internal fixation (ORIF) through a dorsal approach; to report the length of the radioulnar portion of the DP fragment relative to the total distal radioulnar joint (DRUJ) length; and to identify if an association exists between this length and the choice for a volar versus a dorsal operative approach to the DP fragment. Materials and Methods We performed measurements on the preoperative CT scans of 94 skeletally mature patients with a DP fragment. We also collected data related to their demographics, injury, and treatment. Of the 94 patients in this study, 84 (89%) had AO type C fractures. Results Thirteen out of 94 patients (14%) who had ORIF of their DRF with a DP fragment had a separate dorsal incision. The mean proportion of the DP fragment length relative to the total DRUJ length was 0.51 ± 0.19. There was no association between the length of the DP fragment and volar versus dorsal approach. Conclusion DP fragment size is not an indicator of the need for or use of a dorsal approach in DRF fixation. Level of Evidence This is a Level IV,—retrospective study.

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