A Retrospective Analysis of Outcomes From Foot and Ankle Arthrodesis and Open Reduction and Internal Fixation Using Cellular Bone Allograft Augmentation

2020 ◽  
pp. 193864002095230
Author(s):  
Thomas E. Moran ◽  
Sean Sequeira ◽  
Minton Truitt Cooper ◽  
Joseph Park
Keyword(s):  
Internal Fixation ◽  
Complication Rate ◽  
Open Reduction ◽  
Bone Cells ◽  
Bone Matrix ◽  
Case Series ◽  
Matrix Product ◽  
Foot And Ankle ◽  
Bony Healing ◽  
Cellular Bone

Background ViviGen is an allogeneic cellular bone matrix product containing lineage-committed bone cells, and can be used as an alternative to autograft bone or other augments to aid in arthrodesis or to enhance bony healing in open reduction and internal fixation (ORIF) procedures. Methods This study included 153 consecutive patients undergoing ankle, midfoot, or hindfoot arthrodesis or ORIF procedures from January 2017 to October 2018, in which an allogeneic cellular bone matrix product was used to aid in bony healing. Retrospective chart review identified patient demographic factors and medical comorbidities and evaluated clinical and radiographic data to determine fusion/union rate and complications. Results The overall fusion rate for the arthrodesis cohort was 97/113 (85.8%). The overall complication rate in this cohort was 22/113 (19.5%). Smokers had significantly lower rates of fusion compared with nonsmokers ( P = .01). The observed bony healing rate for the ORIF cohort was 19/22 (86.4%), with a complication rate of 3/22 (13.6%). Conclusion With satisfactory fusion rates and relatively few complications, our findings suggest that ViviGen is a safe and efficacious alternative to other forms of bone graft augmentation for fusion and ORIF procedures about the foot and ankle. Further study is needed to compare the efficacy of ViviGen with autograft bone and other augments. Levels of Evidence: Level IV: Case series

scholarly journals A Retrospective Analysis of Outcomes from Foot and Ankle Arthrodesis and Open Reduction and Internal Fixation using Cellular Bone Allograft Augmentation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0036
Author(s):  
Thomas E. Moran ◽  
Sean Sequeira ◽  
M. Truitt Cooper ◽  
Joseph S. Park
Keyword(s):  
Body Mass Index ◽  
Bone Cells ◽  
Bone Matrix ◽  
Case Series ◽  
Fusion Rate ◽  
Matrix Product ◽  
Foot And Ankle ◽  
Charcot Foot ◽  
Bony Healing ◽  
Cellular Bone

Category: Other; Ankle; Basic Sciences/Biologics; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Surgical arthrodesis of joints in the foot and ankle is common in patients who have failed nonoperative management for a variety of conditions. ViviGen is an allogeneic cellular bone matrix product that contains lineage-committed bone cells, and can be used as an alternative to autograft bone or other augments in order to aid in arthrodesis or to enhance bony healing in open reduction and internal fixation (ORIF) procedures. However, compared with autograft bone, ViviGen does not introduce potential for donor site morbidity. Due to the lack of studies examining outcomes following foot and ankle surgeries in which ViviGen is utilized, further investigation is required to determine its efficacy and safety for use in foot and ankle joint arthrodesis and skeletal fracture fixation. Methods: This study included 153 consecutive patients undergoing ankle, midfoot or hindfoot arthrodesis or ORIF procedures in which ViviGen was used as an augment. Pediatric patients and cases involving structural allografts or metal wedges were excluded. Patients were not excluded based on the amount of ViviGen used, type of instrumentation or implants used, or due to comorbidity. This series included revision as well as primary arthrodesis procedures and included various fixation types. Retrospective chart review was used to identify patient demographic factors and medical comorbidities, as well as to evaluate clinical and radiographic data to determine outcome. Results: 135 patients were available for analysis at final evaluation. 113 patients underwent arthrodesis (mean age of 56.29 years, mean body mass index of 32.19). 22 patients underwent an ORIF procedure (mean age of 36.35 years, mean body mass index of 32.79). The fusion rate for the arthrodesis cohort was 97/113 (85.8%). Table 1 demonstrates the fusion rate stratified by region of the foot. Smokers had significantly lower rates of fusion compared to nonsmokers (p=0.01). There was not a statistically significant difference in the rate of fusion between primary and revision arthrodesis (p=0.8650). The rate of fusion was significantly lower in patients with Charcot foot in comparison to patients without Charcot foot (p=0.0076). The bony healing rate for the ORIF cohort was 19/22 (86.4%). Conclusion: This large case series of patients undergoing a wide variety of procedures about the ankle, hindfoot, and midfoot with ViviGen bone graft augmentation demonstrates satisfactory outcomes with regard to fusion rate and successful union, as well as minimal complications. To date, this is the largest case series in the literature of patients undergoing foot and ankle procedures with an allogenic cellular bone matrix product that contains lineage-committed bone cells. Our findings help to introduce ViviGen as a safe and efficacious alternative to other forms of augmentation for fusion and ORIF procedures about the foot and ankle. [Table: see text]

scholarly journals Identification of Postoperative Step-Offs and Gaps With Brodén’s View Following Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 40 (7) ◽  
pp. 797-802 ◽  
Author(s):  
Rosalie C. Looijen ◽  
Dominique Misselyn ◽  
Manouk Backes ◽  
Siem A. Dingemans ◽  
Jens A. Halm ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Excellent Agreement ◽  
Open Reduction ◽  
Interobserver Reliability ◽  
Case Series ◽  
Intraobserver Reliability ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Intraoperative Fluoroscopy ◽  
Level Of Agreement

Background: To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén’s view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet. Methods: Six observers estimated the size of step-offs and gaps on Brodén’s view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs). Results: An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps. Conclusion: Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén’s view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy. Level of Evidence: Level IV, case series.

scholarly journals Functional Outcomes of Open Reduction and Internal Fixation Treatment of Lisfranc Injuries

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0017
Author(s):  
Daniel Corr ◽  
Trevor McBride ◽  
Ryan G. Rogero ◽  
Steven M. Raikin ◽  
Rachel J. Shakked
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Case Series ◽  
High Energy ◽  
Low Energy ◽  
Foot And Ankle ◽  
Lisfranc Injury ◽  
Functional Scores ◽  
Lisfranc Injuries

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Prior reports have suggested that primary partial arthrodesis may be superior to open reduction and internal fixation (ORIF) for the ligamentous Lisfranc injury. Although this may be true for the high energy Lisfranc injury, little has been studied regarding outcomes after operative fixation of low energy Lisfranc injuries. The purpose of this study is to present a large case series of patients who underwent ORIF for low energy ligamentous Lisfranc injuries including functional outcomes, complications, and reoperation rates. Methods: We included adult patients who underwent ORIF for low-energy Lisfranc injuries with fellowship-trained foot and ankle surgeons at our institution within 6 weeks of injury. Patients were excluded if the mechanism of injury or initial radiographs were consistent with a high-energy mechanism such as significant subluxation of multiple tarsometatarsal joints rather than subtle diastasis with weight-bearing images. Patients were also excluded if there were any significant fractures aside from avulsion fractures, other associated injuries, or underlying neuropathic pathophysiology. Patients completed the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, Visual Analog Scale for Pain (VAS), and Short Form-12 questionnaires before their procedures and then at least 2 years post-operatively. Standard demographic data was collected. Spearman’s correlations and Student’s t-tests were performed to evaluate outcomes after surgery and any relationship between patient characteristics and functional scores. Results: Eighty-seven patients completed functional scores an average of 4.9 years following their procedure (range 2.0 - 8.9), with average age of 41 and average BMI of 27.5. Fifty-two patients (59.8%) were female, and average time from injury to procedure was 15.2 days (range 1-36). Average FAAM-ADL improved from 27.83 to 88.36 postoperatively (p<.001), average FAAM-Sports improved from 7.47 to 76.36 (p<.001), and average VAS pain rating was reduced from 62.83 to 21.78 (p<.001). Hardware removal was performed in 36 cases (41.4%). One patient required removal of hardware and revision ORIF 30 days after the index procedure as a result of hardware complication. Both age at the time of surgery and BMI were negatively correlated with followup SF-12 Physical Health scores (r=-0.254, p=0.018; r=-0.263, p=0.014 respectively). Conclusion: This study is one of the largest case series of low energy Lisfranc injuries. We demonstrate that ORIF for low- energy Lisfranc injuries results in significant functional improvement and pain reduction while maintaining low rates of loss of correction or reoperation. Further investigation is necessary to evaluate this subset of Lisfranc injuries in terms of optimal surgical treatment patient functional outcomes following the use of primary arthrodesis in the treatment of Lisfranc procedures, and to assess the efficacy of the various hardware choices available for the procedure. [Table: see text]

Utilization of regional anesthesia for open reduction and internal fixation of clavicular fractures is associated with increased same-day discharge and not readmissions

2020 ◽  
Vol 45 (9) ◽  
pp. 716-719
Author(s):  
Alexander Beletsky ◽  
Brittany Nicole Burton ◽  
Matthew W Swisher ◽  
John J Finneran IV ◽  
Rodney Allanigue Gabriel
Keyword(s):  
Internal Fixation ◽  
Regional Anesthesia ◽  
Nerve Block ◽  
Open Reduction ◽  
Case Series ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Improvement Program ◽  
Same Day Discharge ◽  
Significant Difference

BackgroundRegional anesthesia is becoming increasingly used for analgesia in clavicular surgery. The purpose of the study is to examine same-day discharge and readmissions in patients with clavicular fractures receiving open reduction and internal fixation, comparing those who received regional anesthesia to those that did not.MethodsThe National Surgical Quality Improvement Program registry was used to build a retrospective cohort with the primary and secondary outcomes of same-day discharge and readmission rates, respectively. The independent variable was type of anesthesia (ie, regional vs general). Unadjusted univariable followed by multivariable logistic regression analysis for the association of each covariate with the primary and secondary outcome was performed. A p<0.05 was considered statistically significant.ResultsA total of 2300 patients were included, in which 346 (15.0%) of received a nerve block. The only factor associated with same-day discharge on crude analysis was the use of a nerve block (OR 1.70, 95% CI 1.21 to 2.40, p<0.01). Factors not associated with same-day discharge included geriatric age (OR 0.39, 95% CI 0.26 to 0.57, p<0.01), diabetes mellitus (OR 0.54, 95% CI 0.33 to 0.89, p=0.01), dependent functional status (OR 0.27, 95% CI 0.11 to 0.69, p<0.01), hypertension (OR 0.39, 95% CI 0.29 to 0.52, p<0.01), bleeding disorder (OR 0.24, 95% CI 0.10 to 0.59, p<0.01) and an American Society of Anesthesiologists Physical Status score ≥3 (OR 0.33, 95% CI 0.25 to 0.45, p<0.01). On adjusted analysis, regional anesthesia was associated with increased odds of same-day discharge (OR 1.67, 95% CI 1.18 to 2.37, p<0.01), but not 30-day readmission (OR 0.57, 95% CI 0.13 to 2.52, p=0.46).ConclusionRegional anesthesia use in patients with clavicular fractures is associated with higher odds for same-day discharge. There is no significant difference in the rates of hospital readmission within a 30-day period.Level of EvidenceIV, retrospective case series.

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

scholarly journals Findings of Routine Diagnostic Ankle Arthroscopy for Management of AO 44-C Fibular Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Daniel Dean ◽  
Francis McGuigan ◽  
Nicholas Casscells
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
High Energy ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Mechanism Of Injury ◽  
Loose Bodies ◽  
Therapeutic Benefits ◽  
Articular Damage

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: High fibula fractures, including Maisonneuve and Weber type C fractures are commonly associated with syndesmotic injuries resulting in subluxation and dislocation of the ankle. These injuries to the joint are rarely evaluated or addressed during operative fixation, which generally consists of open reduction internal fixation of the fibula with or without fixation of the syndesmosis. Chondral lesions and loose bodies in ankle fractures may predict a poor result and can be addressed using arthroscopy to avoid exacerbating articular damage. The purpose of this study is to identify the frequency and severity of articular pathology in Weber C and Maisonneuve fibula fractures. Methods: A single surgeon case series of operatively managed ankle fractures with arthroscopic assessment from 2011-2015 was retrospectively reviewed. Inclusion criteria were patients with AO 44-C ankle fractures who were aged >17 and underwent arthroscopic assessment of the ankle joint prior to open reduction and internal fixation. Patients were excluded from the series if they presented <2 weeks from the time of injury, had a pilon variant, or had incomplete medical records available. Demographic information on the patients including age, sex, and BMI were collected. Information on mechanism of injury was recorded. Operative reports were reviewed and the presence of chondral injury and loose bodies was recorded. Descriptive statistics were performed on the collected data. Results: 18 patients (12 male, 6 female) with a mean age of 38.3 years (range 17-61; SD 13.9) were included in the case series. The average BMI 29.6 (SD 6.92). Five of the included fractures were Maisonneuve fractures while the remaining 13 were Weber C ankle fractures. The mechanism of injury of the fracture was low energy in 12, high energy in 1, and unknown in 5. On arthroscopic examination, 12 (66.7%) of the fractures were associated with full thickness articular cartilage injury requiring formal chondroplasty, 16 (88.9%) were associated with a minimum of partial articular damage, and only 2 (11.1%) had no articular damage identified on arthroscopy. Additionally, 12 (66.7%) had loose bodies that were removed during ankle arthroscopy. Conclusion: This study adds to a growing collection of literature concerning chondral injuries during ankle fractures. The data from this study suggest that AO 44-C fibular fractures are associated with a high rate of intraarticular pathology that can be effectively identified and managed during arthroscopy. Prospective studies are required to determine if there are therapeutic benefits to routine ankle arthroscopy in AO 44-C ankle fractures.

Arthrodesis or Open Reduction Internal Fixation for Lisfranc Injuries: A Meta-analysis

2020 ◽  
pp. 193864002097141
Author(s):  
Christopher J. Levy ◽  
David Yatsonsky ◽  
Muhammad Z. Moral ◽  
Jiayong Liu ◽  
Nabil A. Ebraheim
Keyword(s):  
Internal Fixation ◽  
Revision Surgery ◽  
Complication Rate ◽  
Open Reduction ◽  
Meta Analysis ◽  
Open Reduction Internal Fixation ◽  
T Test ◽  
Fracture Dislocation ◽  
Significant Difference ◽  
Vas Scores

The purpose of this study is to determine if arthrodesis, compared with open reduction and internal fixation (ORIF), produces favorable American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores, and to determine if differences in complication, revision surgery, and secondary arthrodesis rates exist for patients with Lisfranc fracture/dislocation injuries. Searches were performed in PubMed using the keywords “Lisfranc fracture,” “metatarsal fracture,” “ORIF,” “open reduction internal fixation,” “arthrodesis,” and “fusion.” These criteria left 183 articles for review. Exclusions left 21 articles and 2 translations of Chinese abstracts. Data analysis was performed using Student’s 2-sample t test for samples of equal variance, and chi-square test for goodness of fit. The t test revealed a significant difference ( P = .03) between the average AOFAS score for patients who underwent primary arthrodesis (84.7 ± 6.14) compared with those who were treated with ORIF (78.9 ± 5.09). There was no significant difference for the average VAS scores ( P = .33) of the arthrodesis and ORIF groups. The complication rate of arthrodesis patients was significantly lower than ORIF patients ( P = .04), and the rates of revision surgery ( P = .22) and secondary arthrodesis ( P = .53) were not significant between the groups. The results of this study indicate that arthrodesis may be a better surgical option than ORIF, due to the higher functional scores and the lower complication rate. Levels of Evidence: Level III: A meta-analysis

Predictors of Time to Union After Operative Fixation of Closed Ankle Fractures

2016 ◽  
Vol 10 (4) ◽  
pp. 308-314 ◽  
Author(s):  
Andrew P. Matson ◽  
Kamran S. Hamid ◽  
Samuel B. Adams
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Patient Characteristics ◽  
High Energy ◽  
Delayed Union ◽  
Ankle Fractures ◽  
Patient Counseling ◽  
Chi Square ◽  
Energy Mechanism

Background. Ankle fractures are common and represent a significant burden to society. We aim to report the rate of union as determined by clinical and radiographic data, and to identify factors that predict time to union. Methods. A cohort of 112 consecutive patients with isolated, closed, operative malleolar ankle fractures treated with open reduction and internal fixation was retrospectively reviewed for time to clinical union. Clinical union was defined based on radiographic and clinical parameters, and delayed union was defined by time to union >12 weeks. Injury characteristics, patient factors and treatment variables were recorded, and statistical techniques employed included the Chi-square test, the Student’s T-test, and multivariate linear regression modeling. Results. Forty-two (37.5%) of patients who achieved union did so in less than 12 weeks, and 69 (61.6%) of these patients demonstrated delayed union at a mean of 16.7 weeks (range, 12.1-26.7 weeks), and the remaining patient required revision surgery. Factors associated with higher rates of delayed union or increased time to union included tobacco use, bimalleolar fixation, and high energy mechanism (all p<0.05). In regression analysis, statistically significant negative predictors of time to union were BMI, dislocation of the tibiotalar joint, external fixation for initial stabilization and delay of definitive management (all p<0.05). Conclusion. Patient characteristics, injury factors and treatment variables are predictive of time to union following open reduction and internal fixation of closed ankle fractures. These findings should assist with patient counseling, and help guide the provider when considering adjunctive therapies that promote bone healing. Levels of Evidence: Prognostic, Level IV: Case series

Surgical resection of severe heterotopic ossification after open reduction and internal fixation of acetabular fractures: A case series of 18 patients

Injury ◽  
2014 ◽  
Vol 45 (10) ◽  
pp. 1604-1610 ◽  
Author(s):  
Xin-Bao Wu ◽  
Ming-Hui Yang ◽  
Shi-Wen Zhu ◽  
Qi-Yong Cao ◽  
Hong-Hua Wu ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Heterotopic Ossification ◽  
Surgical Resection ◽  
Open Reduction ◽  
Case Series ◽  
Acetabular Fractures
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