Periprosthetic Ankle Fractures

Category: Ankle Introduction/Purpose: Total ankle replacements (TAR) are an increasingly popular option for the management of tibiotalar arthritis. Periprosthetic fracture is an uncommon but challenging complication of patients undergoing arthroplasty. Evidence on the management of and outcomes from periprosthetic fractures about a TAR are limited. The purpose of this study was to evaluate patients with postoperative periprosthetic fractures about a TAR and determine clinical outcomes of these patients following operative fixation. Additionally, we propose an algorithm for the management of these patients. Methods: We retrospectively analyzed 400 patients who underwent TAR from 2007 through 2017. Charts were reviewed and patients with postoperative fractures were selected for inclusion. Patients with a fracture >4 weeks from index surgery were considered candidates for inclusion. Patients with intraoperative fractures were excluded. Univariate analyses were used to identify differences in outcomes. Results: 32 patients were identified with a postoperative periprosthetic fracture about a TAR. Average age was 65.3 years. Average time to fracture was 39.5 months while average follow up from fracture was 26 months. Fractures were primarily located about the medial malleolus (60.6%). 76.8% of fractures were deemed to be stable (Table 1); 75% of these fractures were managed with ORIF or IMN, while 21% of these fractures were treated with immobilization. 80% of patients with stable fractures treated with immobilization ultimately required surgical intervention. 24.2% of fractures were deemed to be unstable. Fractures about the talus were always unstable and always required revision TAR surgery (100%, p= 0.0002). Conclusion: This retrospective review demonstrates that the majority of periprosthetic fractures about a TAR involve the medial malleolus. Additionally, the majority of stable fractures about a TAR required operative fixation. Despite attempts at nonoperative management, management with immobilization is fraught with a high rate of subsequent surgical intervention. Fractures about the talus should be treated with revision TAR surgery or arthrodesis. Based on these findings, we propose an algorithm for the management of patients with a periprosthetic fracture about a TAR.

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Algorithm for Management of Periprosthetic Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100719834542 ◽

2019 ◽

Vol 40 (6) ◽

pp. 615-621 ◽

Cited By ~ 2

Author(s):

Alexander L. Lazarides ◽

Tyler J. Vovos ◽

Gireesh B. Reddy ◽

James K. DeOrio ◽

Mark E. Easley ◽

...

Keyword(s):

Periprosthetic Fracture ◽

Nonoperative Treatment ◽

High Rate ◽

Periprosthetic Fractures ◽

Medial Malleolus ◽

Implant Stability ◽

Level Of Evidence ◽

Ankle Replacement ◽

Patient Reported ◽

Operative Fixation

Background: Evidence on the management of and outcomes from periprosthetic fractures about a total ankle replacement (TAR) are limited. The purpose of this study was to develop an algorithm for the management of patients with postoperative periprosthetic fractures about a TAR. Methods: This was a retrospective analysis of patients undergoing a TAR from 2007 through 2017 with a subsequent periprosthetic fracture >4 weeks from index surgery. Implant stability was defined radiographically and intraoperatively where appropriate. Univariate and multivariate analyses were used to identify differences in outcomes. Thirty-two patients were identified with a remote TAR periprosthetic fracture with an average follow-up of 26 months (range, 3-104 months). Results: Most fractures were located about the medial malleolus (62.5%); the majority of fractures (75%) were deemed to have stable implants. Fractures of the talus always had unstable implants and always required revision TAR surgery (100%, P = .0002). There was no difference in patient-reported outcomes between stable and unstable fractures at an average of 36 months. In a multivariate analysis, fracture location (talus), less time to fracture, and implant type were found to be predictive of unstable implants ( P < .001). Implant stability was independently associated with the need for revision surgery ( P < .049). Nonoperative treatment was independently associated with treatment failure ( P < .001). Conclusion: The majority of stable fractures about a TAR required operative fixation. Management with immobilization was fraught with a high rate of subsequent surgical intervention. We found that fractures about the talus required revision TAR surgery or arthrodesis. Level of Evidence: Level III, retrospective cohort study.

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SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽

10.1142/s0218810413500202 ◽

2013 ◽

Vol 18 (02) ◽

pp. 175-178 ◽

Cited By ~ 7

Author(s):

A. S. C. Bidwai ◽

F. Cashin ◽

A. Richards ◽

D. J. Brown

Keyword(s):

Rheumatoid Arthritis ◽

Pain Relief ◽

Surgical Intervention ◽

Case Series ◽

High Rate ◽

Wound Breakdown ◽

Radial Forearm ◽

Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

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Surgical management of superior petrosal sinus dural arteriovenous fistulae with dominant internal carotid artery supply

Interventional Neuroradiology ◽

10.1177/1591019917754038 ◽

2018 ◽

Vol 24 (3) ◽

pp. 331-338 ◽

Cited By ~ 4

Author(s):

Christopher J Stapleton ◽

Anoop P Patel ◽

Brian P Walcott ◽

Collin M Torok ◽

Matthew J Koch ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Surgical Intervention ◽

High Rate ◽

External Carotid ◽

Arteriovenous Fistulae ◽

Surgical Closure ◽

Superior Petrosal Sinus

Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.

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An analysis of tumor-related potential spinal column instability (Spine Instability Neoplastic Scores 7–12) eventually requiring surgery with a 1-year follow-up

Neurosurgical FOCUS ◽

10.3171/2021.2.focus201098 ◽

2021 ◽

Vol 50 (5) ◽

pp. E6

Author(s):

Enrique Vargas ◽

Dennis T. Lockney ◽

Praveen V. Mummaneni ◽

Alexander F. Haddad ◽

Joshua Rivera ◽

...

Keyword(s):

Logistic Regression ◽

San Francisco ◽

Surgical Intervention ◽

Nonoperative Management ◽

Multivariable Analysis ◽

Spinal Instability ◽

Karnofsky Performance Scale ◽

Surgery Group ◽

Increased Risk

OBJECTIVE Within the Spine Instability Neoplastic Score (SINS) classification, tumor-related potential spinal instability (SINS 7–12) may not have a clear treatment approach. The authors aimed to examine the proportion of patients in this indeterminate zone who later required surgical stabilization after initial nonoperative management. By studying this patient population, they sought to determine if a clear SINS cutoff existed whereby the spine is potentially unstable due to a lesion and would be more likely to require stabilization. METHODS Records from patients treated at the University of California, San Francisco, for metastatic spine disease from 2005 to 2019 were retrospectively reviewed. Seventy-five patients with tumor-related potential spinal instability (SINS 7–12) who were initially treated nonoperatively were included. All patients had at least a 1-year follow-up with complete medical records. A univariate chi-square test and Student t-test were used to compare categorical and continuous outcomes, respectively, between patients who ultimately underwent surgery and those who did not. A backward likelihood multivariate binary logistic regression model was used to investigate the relationship between clinical characteristics and surgical intervention. Recursive partitioning analysis (RPA) and single-variable logistic regression were performed as a function of SINS. RESULTS Seventy-five patients with a total of 292 spinal metastatic sites were included in this study; 26 (34.7%) patients underwent surgical intervention, and 49 (65.3%) did not. There was no difference in age, sex, comorbidities, or lesion location between the groups. However, there were more patients with a SINS of 12 in the surgery group (55.2%) than in the no surgery group (44.8%) (p = 0.003). On multivariate analysis, SINS > 11 (OR 8.09, CI 1.96–33.4, p = 0.004) and Karnofsky Performance Scale (KPS) score < 60 (OR 0.94, CI 0.89–0.98, p = 0.008) were associated with an increased risk of surgery. KPS score was not correlated with SINS (p = 0.4). RPA by each spinal lesion identified an optimal cutoff value of SINS > 10, which were associated with an increased risk of surgical intervention. Patients with a surgical intervention had a higher incidence of complications on multivariable analysis (OR 2.96, CI 1.01–8.71, p = 0.048). CONCLUSIONS Patients with a mean SINS of 11 or greater may be at increased risk of mechanical instability requiring surgery after initial nonoperative management. RPA showed that patients with a KPS score of 60 or lower and a SINS of greater than 10 had increased surgery rates.

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Mortality and morbidity in patients with spontaneous intracerebral hemorrhage: A single-center experience

Current Journal of Neurology ◽

10.18502/cjn.v20i1.6377 ◽

2021 ◽

Author(s):

Morteza Faghih-Jouybari ◽

Mohammad Taghi Raof ◽

Sina Abdollahzade ◽

Sanaz Jamshidi ◽

Tahereh Padegane ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Status ◽

Surgical Intervention ◽

High Rate ◽

Term Outcome ◽

Mortality And Morbidity ◽

Single Center Experience ◽

Poor Functional Status ◽

Ich Score

Background: Intracerebral hemorrhage (ICH) is the most common cause of non-ischemic strokes. Considering high mortality and poor functional status following ICH, we investigated factors that can predict short-term outcome and affect recovery of these patients. Methods: In this prospective descriptive study, 100 patients with non-traumatic ICH were included. Clinical and radiographic data were collected and extent of disability was measured by modified Rankin Scale (mRS) at discharge, 1 week, 1 month, and 3 months after discharge. Results: 32 of 100 cases died at hospital and 6 more expired during 3-month follow-up. Risk factors of in-hospital mortality were warfarin use, surgical intervention, and high ICH score. Functional status of patients significantly improved 3 months after discharge. Factors associated with poor recovery were age older than 70, history of coronary artery disease (CAD), low Glasgow Coma Scale (GCS) at admission, elevated mean arterial pressure (MAP), longer hospitalization, and high ICH score. Conclusion: ICH was associated with high rate of mortality (36%). Warfarin use, surgical intervention, and high ICH score were predictive of mortality during hospitalization and 3-month follow-up. Improvement of functional status began after 1 month and significantly improved 3 months after discharge.

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Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

Asian Spine Journal ◽

10.4184/asj.2017.11.3.356 ◽

2017 ◽

Vol 11 (3) ◽

pp. 356-364 ◽

Cited By ~ 4

Author(s):

Carola Francisca van Eck ◽

Mitchell Stephen Fourman ◽

Amir Mohamad Abtahi ◽

Louis Alarcon ◽

William Fielding Donaldson ◽

...

Keyword(s):

Risk Factors ◽

Conservative Management ◽

Radiographic Progression ◽

Surgical Intervention ◽

Nonoperative Management ◽

Classification Systems ◽

Retrospective Clinical Study ◽

Radicular Symptoms ◽

Time Of Presentation

<sec><title>Study Design</title>Retrospective clinical study.</sec><sec><title>Purpose</title>The purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management.</sec><sec><title>Overview of Literature</title>According to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management.</sec><sec><title>Methods</title>A retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively.</sec><sec><title>Results</title>Seventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis.</sec><sec><title>Conclusions</title>Patients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.</sec>

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Polished, Collarless, Tapered, Cemented Stems for Primary Hip Arthroplasty May Exhibit High Rate of Periprosthetic Fracture at Short-Term Follow-Up

The Journal of Arthroplasty ◽

10.1016/j.arth.2017.11.003 ◽

2018 ◽

Vol 33 (4) ◽

pp. 1120-1125 ◽

Cited By ~ 8

Author(s):

Trevor Scott ◽

Anthony Salvatore ◽

Pauline Woo ◽

Yuo-yu Lee ◽

Eduardo A. Salvati ◽

...

Keyword(s):

Hip Arthroplasty ◽

Periprosthetic Fracture ◽

High Rate ◽

Short Term ◽

Primary Hip Arthroplasty

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Periprosthetic Fracture following Partial Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1672204 ◽

2018 ◽

Vol 32 (10) ◽

pp. 947-952 ◽

Cited By ~ 1

Author(s):

Nicholas M. Brown ◽

Gerard Engh ◽

Kevin Fricka

Keyword(s):

Knee Arthroplasty ◽

Periprosthetic Fracture ◽

Flexion Contracture ◽

High Rate ◽

Ligament Injury ◽

Consecutive Series ◽

Complication Rates ◽

Partial Knee Arthroplasty ◽

Medial Collateral Ligament Injury

AbstractPartial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed. We identified 16 patients with early periprosthetic fracture, with an incidence of 0.6%. All of these were tibial fractures, which occurred at a mean of 35 days postoperatively. There were 5 males and 11 females, with an average age of 70 years at the time of surgery. Average follow-up was 62 months. Two patients had contralateral compartment insufficiency fractures that were successfully treated nonoperatively, five patients immediately underwent total knee arthroplasty (TKA), and nine patients underwent open reduction internal fixation (ORIF). Two of these cases had a failed ORIF and required conversion to TKA. Seven patients were successfully treated with a medial buttress plate in compression. Average Knee Society Score at final follow-up was 81, and average flexion was 115 degrees, with no patients having greater than 5-degree flexion contracture. Periprosthetic fracture following partial knee arthroplasty resulted in a high rate of conversion TKA. However, ORIF in select patients resulted in fracture healing and retention of the partial knee replacement. All patients were successfully treated with low complication rates, excellent range of motion, and acceptable knee scores at final follow-up.

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Midterm follow-up with modular fluted tapered stem in the management of Vancouver B3 femoral periprosthetic fracture

10.21203/rs.3.rs-17450/v1 ◽

2020 ◽

Author(s):

Qi Cheng ◽

Li Zheng ◽

Yunzhi Ding ◽

Fengchao Zhao

Keyword(s):

Periprosthetic Fracture ◽

Femoral Stem ◽

Good Choice ◽

Lower Limbs ◽

High Rate ◽

Harris Hip Score ◽

Bone Stock ◽

Stem Subsidence ◽

The Mean

Abstract BackgroundTo evaluate the technique and clinical results of the uncemented fluted, tapered, modular stems in treating Vancouver B3 periprosthetic femoral fractures. MethodsA retrospective study was carried out on 56 patients (56 hips) with the use of the modular femoral stem in revision of total hip arthroplasty between August 2007 and January 2009. The mean patient age was 73.4±6.6 years(rang, 62-82years). Bone defect was categorised as Paprosky types：32 Type IIIA , 20 Type IIIB, 4 Type Ⅳ. 28 hips had allograft struts placed around the fracture. 44 patients had concomitant revision of the acetabular component. The mean duration of follow-up was 102.1±12.2 months (rang, 84-120 months). Hip function and treatment outcome were assessed using Harris Hip Score System and Beals and Tower 's standard. Radiography were used to evaluate the implant stability, bone stock restoration, fracture healing, stem subsidence and complications. ResultsThe mean HHS improved from 45.6 ±5.4 points (range, 32-53 points) preoperatively to 86.3±8.4 points (range, 81-92 points) at the most recent follow-up. Radiographic review showed all fractures of patients united, with maintenance or improvement of bone stock in 96% of patients. The average value of the stem subsidence 4.9±1.5mm (rang, 0-9mm), happening mainly within the first six months after the operation. No implant had been revised because of aseptic loosening or dislocation. 8 of all the 28 allografts united to the host bone. In the last follow-up, 20 cases of treatment results were excellent, 36 cases were good. There were four patients occuring complications such as deep vein thrombosis of lower limbs or subcutaneous haematomas after surgery, all cured during hospitalization. There were no patients occurring the dislocation of hips after revision. ConclusionThe uncemented fluted, tapered, modular prosthesis is a good choice with a high rate of fracture union and implant osteointegration when the treatment of the Vancouver B3 femoral periprosthetic fracture.

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Outcomes of Vancouver B2 and B3 periprosthetic femoral fractures after total hip arthroplasty in elderly patients

Hip International ◽

10.1177/1120700018772163 ◽

2018 ◽

Vol 29 (2) ◽

pp. 184-190 ◽

Cited By ~ 9

Author(s):

Jesús Moreta ◽

Iker Uriarte ◽

Amaia Ormaza ◽

Javier Mosquera ◽

Kattalin Iza ◽

...

Keyword(s):

Elderly Patients ◽

Fracture Healing ◽

Femoral Fractures ◽

Functional Results ◽

High Rate ◽

Periprosthetic Fractures ◽

Harris Hip Score ◽

Periprosthetic Femoral Fractures ◽

The Mean

Introduction: The objective was to evaluate clinical and radiological outcomes of Vancouver B2 and B3 periprosthetic femoral fractures in patients older than 65 years treated at our institution from 2000 to 2014. We compared the most common methods of fixation: a modular tapered rectangular titanium stem versus a monoblock tapered stem. Methods: A retrospective review was performed with a minimum follow-up time of 2 years. Patient mobility in the period prior to the fracture and after fracture healing and functional results was assessed according to the Harris Hip Score. Results: A total of 43 Vancouver B2 and B3 periprosthetic fractures fulfilled the inclusion criteria (31 type B2 and 13 type B3). The mean age was 78 years old (66–88 years). The mean follow-up time was 5 years (range 2–12 years). A Wagner stem was used in 19 patients and a modular rectangular stem was implanted in 24 patients. Although fracture union was achieved in 93% of the cases, the mean Harris Hip Score was 73 (34–87) and 41.9% of the patients did not return to their previous ambulatory levels ( p = 0.0049). Dislocation was the most common complication (16.3%). We have found association ( p = 0.07) between subsidence with a mean of 4.14 mm and dislocation. No difference was observed between B2 and B3 fractures or between modular and monoblock stems. Discussion: Although we reported good results of fracture healing, there were functional impairment and a high rate of complications, especially dislocation, in Vancouver B2 and B3 periprosthetic fractures in elderly patients.

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