A fibular notch approach for the treatment of ankle fractures involving the distal tibial plafond

Abstract BACKGROUND: Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes.METHODS: Twenty two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.RESULTS: All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3±3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last followup.CONCLUSIONS: The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

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A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

10.21203/rs.3.rs-129852/v1 ◽

2020 ◽

Author(s):

Tong Liu ◽

Yiheng Cheng ◽

Wenqing Qu

Keyword(s):

Articular Surface ◽

Clinical Results ◽

Ankle Fractures ◽

Ct Scans ◽

Lateral Stability ◽

Aofas Score ◽

Radiographic Outcomes ◽

Tibial Plafond ◽

Operative Notes ◽

Traditional Approaches

Abstract BACKGROUND: Although several approaches have been used for the treatment of complex ankle fractures, there are still some ankle fractures which can not obtain ideal intraoperative exposure with these traditional approaches. The purpose of this study was to present an innovative fibular notch approach in detail for the treatment of ankle fractures involving the distal tibial plafond and to present a series of patients with either functional or radiographic outcomes.METHODS: Between March 2015 and October 2018, 22 patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.RESULTS: All surgeries were successfully performed via the fibular notch approach as the primary approach. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis; however, CT scans showed mild malreduction with a gap of less than 2 mm in 4 fractures and a step-off of less than 2 mm in 1 fracture. No significant soft tissue complications occurred except for one case of delayed wound healing. All fractures healed with an average time of 17.3±3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. All patients achieved lateral stability of the ankle except one patient with distal syndesmosis instability. The average ankle range of motion was 55.0 degrees. The average AOFAS score was 88.8.CONCLUSIONS: The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

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Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2932-2 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Maxim Privalov ◽

Finn Euler ◽

Holger Keil ◽

Benedict Swartman ◽

Nils Beisemann ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Joint Surface ◽

Intraoperative 3D Imaging ◽

Tibial Plafond ◽

Sf 36 ◽

Surface Irregularities ◽

Tibial Plafond Fractures

Abstract Background The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p = 0.001) and the PCS domain of the SF-36 score (p = 0.018). Significant differences with regard to O & M score (p = 0.000), SF-36 score (p = 0.001 to p = 0.02; without MCS domain), movement deficit (p = 0.001), grade of osteoarthritis (p = 0.005) and pain (p = 0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.

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Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study

10.21203/rs.2.12099/v3 ◽

2019 ◽

Author(s):

Maxim Privalov ◽

Finn Euler ◽

Holger Keil ◽

Benedict Swartman ◽

Nils Beisemann ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Joint Surface ◽

Intraoperative 3D Imaging ◽

Tibial Plafond ◽

Sf 36 ◽

Surface Irregularities ◽

Tibial Plafond Fractures

Abstract Background: The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods: A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results: 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p=0.001) and the PCS domain of the SF-36 score (p=0.018). Significant differences with regard to O & M score (p=0.000), SF-36 score (p=0.001 to p=0.02; without MCS domain), movement deficit (p=0.001), grade of osteoarthritis (p=0.005) and pain (p=0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions: Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.

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Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study

10.21203/rs.2.12099/v4 ◽

2019 ◽

Author(s):

Maxim Privalov ◽

Finn Euler ◽

Holger Keil ◽

Benedict Swartman ◽

Nils Beisemann ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Joint Surface ◽

Intraoperative 3D Imaging ◽

Tibial Plafond ◽

Sf 36 ◽

Surface Irregularities ◽

Tibial Plafond Fractures

Abstract Background: The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods: A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results: 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p=0.001) and the PCS domain of the SF-36 score (p=0.018). Significant differences with regard to O & M score (p=0.000), SF-36 score (p=0.001 to p=0.02; without MCS domain), movement deficit (p=0.001), grade of osteoarthritis (p=0.005) and pain (p=0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions: Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.

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Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study

10.21203/rs.2.12099/v2 ◽

2019 ◽

Author(s):

Maxim Privalov ◽

Finn Euler ◽

Holger Keil ◽

Benedict Swartman ◽

Nils Beisemann ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Joint Surface ◽

Intraoperative 3D Imaging ◽

Tibial Plafond ◽

Sf 36 ◽

Surface Irregularities ◽

Tibial Plafond Fractures

Abstract Background: The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods: A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results: 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p=0.001) and the PCS domain of the SF-36 score (p=0.018). Significant differences with regard to O & M score (p=0.000), SF-36 score (p=0.001 to p=0.02; without MCS domain), movement deficit (p=0.001), grade of osteoarthritis (p=0.005) and pain (p=0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions: Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.

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Predisposing Factors for Posttraumatic Osteoarthritis After Malleolus Fracture Fixation in Patients Younger Than 50 Years

Foot & Ankle International ◽

10.1177/10711007211050039 ◽

2021 ◽

pp. 107110072110500

Author(s):

Jong Seok Beak ◽

Yeong Tae Kim ◽

Sung Hyun Lee

Keyword(s):

Risk Factors ◽

Articular Surface ◽

Binary Logistic Regression ◽

Ankle Fractures ◽

Fracture Dislocation ◽

Posttraumatic Arthritis ◽

Level Of Evidence ◽

Posttraumatic Osteoarthritis ◽

Posterior Malleolus

Background: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group ( P < .05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. Level of Evidence: Level III, case control study.

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Preliminary Experience Using Bioactive Glass Wedges for Cotton Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418796861 ◽

2018 ◽

Vol 3 (4) ◽

pp. 247301141879686

Author(s):

Tood Borenstein ◽

Tyler Gonzalez ◽

Janet Krevolin ◽

Bryan Den Hartog ◽

David Thordarson

Keyword(s):

Bioactive Glass ◽

Case Series ◽

Clinical Results ◽

Delayed Union ◽

Complication Rates ◽

Level Of Evidence ◽

Opening Wedge ◽

Radiographic Outcomes ◽

Initial Correction

Background: Medial cuneiform dorsal opening wedge (Cotton) osteotomy is often used for treating forefoot varus in patients undergoing surgery for stage II posterior tibialis tendon dysfunction. The goal of this study was to examine the radiographic outcomes of Cotton osteotomy with bioactive glass wedge to assess for both maintenance of correction and clinical results and complications. We hypothesized that bioactive glass wedges would maintain correction of the osteotomy with low complication rates. Methods: Between December 2015 and June 2016, the charts of 17 patients (10 female and 7 male) who underwent Cotton osteotomy using bioactive glass wedges were retrospectively reviewed. Patient age averaged 56.8 years (range, 16-84). The average follow-up was 6.5 months. Radiographs were reviewed to assess for initial correction and maintenance of correction of medial column sag as well as for union. Charts were reviewed for complications. Results: The medial column sag correction averaged 15.6% on the final postoperative lateral radiograph. Meary angle averaged 19 degrees (3.14-42.8 degrees) preoperatively and 5.5 degrees (0.4-20.7 degrees) at final follow-up. All patients achieved clinical and radiographic union. One patient developed neuropathic midfoot pain and was managed with sympathetic blocks. One patient had a delayed union that healed at 6 months without surgical intervention. No patients required the use of custom orthotics or subsequent surgical procedures. Conclusion: Cotton osteotomy with bioactive glass wedges produced consistent correction of the medial column with low risk. Level of Evidence: Level IV, case series.

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The Infinity Total Ankle System: Early Clinical Results With 2- to 4-Year Follow-up

Foot & Ankle Specialist ◽

10.1177/1938640018777601 ◽

2018 ◽

Vol 12 (2) ◽

pp. 159-166 ◽

Cited By ~ 11

Author(s):

Murray Penner ◽

W. Hodges Davis ◽

Kevin Wing ◽

Thomas Bemenderfer ◽

Feras Waly ◽

...

Keyword(s):

Prospective Observational Study ◽

Mobile Bearing ◽

Clinical Results ◽

Outcome Data ◽

Ankle Osteoarthritis ◽

Radiographic Outcomes ◽

Scale Scores ◽

Foot Function ◽

Component Revision

Aims. This study presents the first report of clinical and radiographic outcomes of the Infinity Total Ankle System (Wright Medical, Memphis, TN) with minimum 2-year follow-up. Patients and Methods. The first 67 consecutive patients who underwent primary total ankle arthroplasty (TAA) with the Infinity system at 2 North American sites between August 2013 and May 2015 were reviewed in a prospective, observational study. Demographic, radiographic, and functional outcome data were collected preoperatively, at 6 to 12 months postoperatively, and annually thereafter. Results. The overall implant survival rate was 97% (65 of 67 implants) at a mean follow-up of 35.4 months (27 to 47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a nonrevision reoperation. Mean Foot Function Index and Ankle Osteoarthritis Scale scores at latest follow-up improved from preoperative by 21.6 ( P < .0001) and 34.0 ( P < .0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 nonrevised cases. Conclusion. Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third-generation TAA designs, even when used in cases with deformity and increased case complexity. Levels of Evidence: Level IV

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Arthroscopic-Assisted Versus All-Arthroscopic Ankle Stabilization Technique

Foot & Ankle International ◽

10.1177/1071100720938672 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1360-1367 ◽

Cited By ~ 3

Author(s):

Matteo Guelfi ◽

Gustavo Araujo Nunes ◽

Francesc Malagelada ◽

Guillaume Cordier ◽

Miki Dalmau-Pastor ◽

...

Keyword(s):

Ankle Instability ◽

Clinical Results ◽

Pain Scale ◽

Chronic Ankle Instability ◽

Percutaneous Technique ◽

Aofas Score ◽

Level Of Evidence ◽

Vas Score ◽

The Mean

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

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