Ankle Arthrodesis with Cannulated Screw: Case Series

ABSTRACT Ankle osteoarthritis patients are young and lack of available long last treatment. Ankle arthrodesis remains the gold standard and is the procedure of choice for younger patients who are heavy laborers. These case series evaluate and report five patients undergone ankle arthrodesis at RSUD Dr. Soetomo Surabaya on 2012-2016. The data were collected from patient files, radiographs, and a recent physical examination. The outcome has been assessed with SF-36 score and clinical scoring system Ankle-Hind foot American Foot and Ankle Society. Three male patients and two female patients underwent ankle arthrodesis with cannulated screw, caused by neglected severe ankle dislocation. One patient had open dislocation. Based on SF-36 scoring, the five patients had average score 76,7 with highest and lowest score were 95,9 and 56,7. Based on clinical score ankle-hind foot American Ankle and Foot Society, the average score was 68(51 – 88). The scoring result includes general health, physic, emotional, and social. And clinical scoring ankle-hind foot American Foot and Ankle Society evaluation includes pain, function, and alignment. It shows that there was patient that gains an almost perfect result. Patient with the lowest score also had knee osteoarthritis contralateral from the operated ankle. Early weight bearing on ankle arthrodesis with cannulated screw was the major factor caused unsatisfactory result of this patient. Ankle arthrodesis with cannulated screw has satisfactory result eventhough remain complain on one patient. Nevertheless, ankle arthrodesis with cannulated screw still has an important role in the treatment of choice on ankle reconstruction.Keywords : Ankle arthrodesis, cannulated screw, ankle joint fusion

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Ilizarov Technique Combined with Additional Procedures for the Correction of Equinocavovarus Foot Deformity in Adults

10.21203/rs.3.rs-34937/v1 ◽

2020 ◽

Author(s):

Longbin Bai ◽

Peiting Liu ◽

Sihe Qin ◽

Zengtao Wang

Keyword(s):

Short Form ◽

Weight Bearing ◽

Case Series ◽

Foot Deformities ◽

Ilizarov Technique ◽

Foot Deformity ◽

Hindfoot Alignment ◽

Sf 36 ◽

Hind Foot

Abstract Background: The Ilizarov technique has been used to treat equinocavovarus foot deformity and has shown good results. However, these results were mostly observed in pediatric patients, and few reports involving only adult case series exist. The aim of this study was to evaluate the outcome of the Ilizarov technique combined with additional procedures for equinocavovarus deformities in adults. Methods: Total 28 adult patients (33 feet) who underwent equinocavovarus foot deformities correction using the Ilizarov technique combined with additional procedures between February 2013 and December 2017 were included. Clinical outcomes were assessed preoperatively and at final follow-up using the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, the Foot Ankle Ability Measure (FAAM) score, and the Short Form-36 (SF-36) questionnaire. The radiographic outcomes were measured using weight-bearing ankle and foot radiographs taken preoperatively and at the last follow-up visit.Results: The mean VAS, AOFAS ankle-hind foot scores, FAAM scores were significantly improved (P < 0.0001 for each) at a mean follow-up of 37.30 ±10.94 months. SF-36 scores increased postoperatively in terms of physical function, role-physical, body pain, general health, vitality, social function, role-emotional, mental health, and health transition (P < 0.0001 for each). Early complications were found in 19 feet (57.6%) and late complications were found in 7 feet (21.2%). Radiographs showed that the tibio-talar angle (p < 0.0001), tibial-sole angle (p < 0.0001), talus-first metatarsal angle (p = 0.0004), talo-calcaneal angle (p = 0.0002), and hindfoot alignment view angle (p < 0.0001) were significantly improved. Twenty-seven (97%) patients were satisfied with their outcomes and reported that they would undergo the same procedure if they had the same preoperative deformities.Conclusion: The combination of the Ilizarov technique and additional procedures provides an effective and reliable means of correcting equinocavovarus foot deformity, yielding high levels of patient satisfaction and a low incidence of recurrence. Studies with more cases are needed to assess the results because there are many different etiological mechanisms.

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Ankle Arthrodesis with Simultaneous Lengthening of the Lower Limb Using the Ilizarov Fixator

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0012.8393 ◽

2018 ◽

Vol 20 (6) ◽

pp. 441-450

Author(s):

Karol Mochocki ◽

Radosław Górski ◽

Sławomir Żarek ◽

Łukasz Szelerski ◽

Paweł Małdyk

Keyword(s):

Lower Limb ◽

Weight Bearing ◽

Kirschner Wire ◽

Ankle Arthrodesis ◽

Ilizarov Method ◽

Comprehensive Treatment ◽

Foot And Ankle ◽

Early Weight Bearing ◽

Ilizarov Fixator ◽

Tract Infections

Background. Patients with advanced ankle arthrosis or joint deformities and co-existing lower limb shortening present a complex therapeutic problem. This paper presents the Ilizarov treatment as a comprehensive method of simultaneous ankle arthrodesis and equalisation of lower limb length in 18 patients. Material and methods. Eighteen patients with arthrosis, deformities or other conditions of the ankle joint and ipsilateral lower limb shortening were treated with the Ilizarov method. The patients were assessed with the Foot and Ankle Outcomes Questionnaire before the treatment and one year after Ilizarov Fixator removal. Results. The Ilizarov Fixator allows early weight-bearing of the operated limb, which is undoubtedly convenient for the patient. The mean treatment duration was 8.2 months (range 4-18 months). Lower limb lengthening was 4.1 cm on average (range 2.5-8.5 cm). Bone union was achieved in all cases. Radiological and clinical outcomes were satisfactory in all 18 cases. Prolonged regenerate calcification was recorded in 1 patient. Ten patients developed soft tissue pin-tract infections and in 1 patient the Kirschner wire broke. According to the Foot and Ankle Outcomes Questionnaire, patients achieved a notable improvement in daily functioning and quality of life. Conclusions. The outcomes of a comprehensive treatment consisting of ankle arthrodesis and lower-leg lengthening using the Ilizarov method confirm its effectiveness. The Ilizarov Fixator allows early weight-bearing of the operated limb and evaluation at all treatment stages, creating an optimal biological environment for bone healing. The patient recovers functionally to allow satisfactory and pain-free functioning as well as resumption of daily responsibilities. The low incidence of complications adds to the attractiveness of the method.

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Effect of Weight-Bearing in Conservative and Operative Management of Fractures of the Base of the Fifth Metatarsal Bone

BioMed Research International ◽

10.1155/2017/1397252 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Jae-Yong Park ◽

Hyong-Nyun Kim ◽

Yoon-Suk Hyun ◽

Jun-Sik Park ◽

Hwan-Jin Kwon ◽

...

Keyword(s):

Bone Resorption ◽

Weight Bearing ◽

Operative Management ◽

Foot And Ankle ◽

Early Weight Bearing ◽

Group A ◽

Vas Scores ◽

American Orthopaedic ◽

Group B ◽

Underlying Diseases

Background. There is no established principle regarding weight-bearing in conservative and operative management of fifth metatarsal base fractures. Methods. We reviewed 86 patients with acute fifth metatarsal base fractures. Conservatively treated late or early weight-bearing patients were assigned to Group A or C, respectively. Operatively treated late or early weight-bearing patients were assigned to Group B or D, respectively. Results were evaluated by clinical union, bone resorption, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores. Results. All 4 groups had bone union at a mean of 6.9 weeks (range, 5.1–15.0). There were no differences between the groups in the AOFAS and VAS scores. In the early weight-bearing groups, there were fewer cases of bone resorption, and the bone unions periods were earlier. Conclusions. Early weight-bearing may help this patient population. Moreover, conservative treatment could be an option in patients with underlying diseases.

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Outcome of Ilizarov assisted ankle arthrodesis

International Surgery Journal ◽

10.18203/2349-2902.isj20180015 ◽

2018 ◽

Vol 5 (2) ◽

pp. 433

Author(s):

Priyajit Chattopadhyay ◽

Paras Kumar Banka ◽

Anindya Debnath ◽

Sanjay Kumar

Keyword(s):

Dynamic Compression ◽

Weight Bearing ◽

Major Complication ◽

Ankle Arthrodesis ◽

Time Interval ◽

Early Weight Bearing ◽

Ilizarov Fixator ◽

American Orthopaedic ◽

Second Procedure

Background: Among the various techniques used for ankle arthrodesis, Ilizarov technique has various advantages along with the potential for treating complex and failed cases.Methods: Eleven cases were undertaken for ankle arthrodesis using the Ilizarov fixator. Two rings were applied along the tibia and one at the talus/calcaneum. The articular cartilage was denuded, and dynamic compression applied. The clinical, functional and radiological outcome were evaluated. The goal was a stable fusion with a well aligned foot.Results: The mean follow-up period was 95 weeks. Fusion was achieved in all cases with no major complication. Only one case had a residual deformity. The average time interval for the ankle fusion was 140.8±25.7 days. The postoperative modified American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score was 67.5±9.6 points.Conclusions: Ilizarov assisted ankle arthrodesis aids in early weight bearing, better alignment, and has good functional outcomes even in cases with previously failed procedures. It has the advantage of postoperative readjustment of the arthrodesis without the need of any second procedure with no major complications.

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Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

Journal of Aging Research ◽

10.1155/2012/345237 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Beat Hintermann ◽

Markus Knupp ◽

Lukas Zwicky ◽

Alexej Barg

Keyword(s):

Elderly Patients ◽

Weight Bearing ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Long Term Results ◽

Postoperative Rehabilitation ◽

Early Weight Bearing ◽

Ankle Replacement ◽

First Choice ◽

End Stage

End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.

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Tibiotalar Arthrodesis Using a Hybrid Technique with a New Low-profile Anatomic Plate and Two Compression Screws: First One-year Results of Twenty Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001913010232 ◽

2019 ◽

Vol 13 (1) ◽

pp. 232-238

Author(s):

Christoph Eckstein ◽

Bernd Füchtmeier ◽

Franz Müller

Keyword(s):

Plate Fixation ◽

Weight Bearing ◽

Case Series ◽

Clinical Results ◽

Ankle Arthrodesis ◽

Implant Failure ◽

Full Weight Bearing ◽

Hybrid Technique ◽

Low Profile ◽

Tibiotalar Arthrodesis

Background: The aim of this prospective study was to evaluate and analyse the first clinical results of a recently developed low-profile anatomic plate in combination with two headless compression screws for tibiotalar arthrodesis. Methods: The case series involved 20 consecutive patients who underwent ankle arthrodesis using a hybrid technique. Radiographs were obtained at 6 and 12 weeks and 1 year postoperatively. The outcome was evaluated by using AOFAS and SF 12-questionnaire. Any complications related to the arthrodesis were recorded. Results: The follow-up rate was 100%. Patients mean age at the time of surgery was 60.1 years (range, 40-79). Arthrodesis with full weight-bearing occurred in every patient within 12 weeks postoperatively. There were no patients with delayed union, non-union, infection or implant failure. AOFAS Score and SF-12 scores increased considerably compared to preoperatively. Conclusion: The hybrid technique for ankle arthrodesis is a tibiotalar compression with screws in combination with rigid anterior plate fixation. Our clinical results demonstrated no implant failure, no infection and fusion in any of the 20 patients. Further studies are necessary to support our first results.

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Management of Long-Term Sequelae of Compartment Syndrome Involving the Foot and Ankle

Foot & Ankle International ◽

10.3113/fai.2009.0847 ◽

2009 ◽

Vol 30 (9) ◽

pp. 847-853 ◽

Cited By ~ 15

Author(s):

Francois Lintz ◽

Jean A. Colombier ◽

Joseph Letenneur ◽

Francois Gouin

Keyword(s):

Compartment Syndrome ◽

Case Series ◽

Personal Data ◽

Functional Results ◽

Ankle Arthrodesis ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Muscle Fibrosis

Background: Lower leg compartment syndrome can lead to severe sequelae affecting patient autonomy. Ischemic muscle fibrosis and retraction result in foot and ankle deformities ranging from claw toes to complex multiplanar dislocations with soft tissue impairment requiring amputation. Although these deformities have been reported in relation to compartment syndrome, they have rarely been discussed specifically in the light of a long term follow up. Materials and Methods: Between 1981 and 2006, 151 patients were treated in our hospital for compartment syndrome of the lower limb. Ten of them later required further surgery to treat sequelae on the foot and ankle and were followed up prospectively. Personal data and surgical events were recorded, as well as potential risk factors for sequelae and functional outcome. The data was analyzed and compared to that available in previous literature. We analyzed and describe the different surgical procedures available for the management of this condition including arthroscopic ankle arthrodesis which could be a less invasive and efficient technique in mild equinus deformities. Results: All ten patients were diagnosed late for compartment syndrome. The anterior and lateral compartments were most often involved but rarely accounted for late sequelae. The deep posterior compartment seems to be the key element in generating after effects. Functional results were good in eight patients. Two required amputation after failed secondary surgery. Conclusion: The late, post-compartment syndrome affecting the foot and ankle can be treated efficiently provided surgery is performed acurately, taking into account the multiplanar deformity. However, the best treatment for this condition remains prevention. Level of Evidence: IV, Retrospective Case Series

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Augmentation of Internal Fixation With Multiplanar External Fixator in High Risk Hind Foot Fusion Patients

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00282 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0028

Author(s):

Meghan Kelly ◽

Scott R. Whitlow ◽

Spenser J. Cassinelli ◽

Gregory A. Lundeen

Keyword(s):

Internal Fixation ◽

Weight Bearing ◽

Hybrid Fixation ◽

Early Weight Bearing ◽

Non Union ◽

Irrigation And Debridement ◽

History Of ◽

Hind Foot ◽

Antibiotic Spacer ◽

The Mean

Category: Hindfoot; Ankle; Diabetes Introduction/Purpose: Achieving adequate fixation is a critical component for successful fusion. Internal fixation can be compromised in the setting of poor bone quality due to open trauma, infection, osteoporosis, neuropathic arthropathy resulting in published ankle non-union rates of 38% in high risk patients. These failures may be magnified by weightbearing non-compliance. While the use of multiplanar external fixation (MEF) alone can be utilized - it can often require an extended period of time within the frame (mean 18 weeks, range 9-28 weeks) and complications such as pin site infections. We hypothesized that hybrid fixation, MEF in conjunction with internal fixation, will provide adequate stability elevating the fusion rates in complex fusion cases while allowing early weight bearing and reduces the MEF time and infection rate. Methods: Eleven patients were identified that demonstrate significant risk factors for a successful fusion (infection, charcot, neuropathy, smoking, history of non-union) that were treated with internal fixation augmented with MEF. Patients with an active infection underwent surgical irrigation and debridement, placement of an antibiotic spacer and a course of intravenous antibiotics six weeks prior to placement of internal fixation. In these cases, MEF was placed at the time of surgical irrigation and debridement to allow for stability. In those patient’s without an active fixation, both the internal fixation and MEF were placed at the same time. Internal fixation construct was based on surgeon preference. Patients were allowed to transfer weight bear at the time of surgery and could advance as tolerated after 2 weeks. CT was utilized to assess fusion. Outcomes measured were fusion rate and occurrence of internal fixation infection. Results: The mean age of patients was 55 (range 26-75), eight patients had diabetes, three were current smokers, two were former smokers, two patients had open trauma, one patient had peripheral neuropathy and one patient had a history of a non- union with known non-compliance. Six patients had an active infection and underwent irrigation and debridement, placement of antibiotic spacer and MEF during antibiotic treatment. Seven patients underwent intramedullary nail fixation, three patients underwent plate and screw constructs and one patient underwent screw only fixation. CT demonstrated fusion in all patients (100%). The mean time for external fixation was 72 days (range 41-111). There were no cases of infected internal fixation. Conclusion: The findings of the current study suggest high rates of hind foot fusion with the use of internal fixation augmented with MEF in a complex patient group with identified high non-union risk factors. Using internal fixation, patients time in the frame is much reduced than published studies evaluating MEF alone for fusion fixation. MEF did not result in any cases of infected internal fixation. Patients with hybrid fixation also benefit from early weight bearing. We emphasize the importance of good surgical technique and infection management using this technique.

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Early Weight-Bearing Does Not Compromise Postoperative Healing in Jones Fracture ORIF

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00312 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0031

Author(s):

Leonardo V. M. Moraes ◽

Stéfani C. Kelly ◽

James R. Jones ◽

Haley McKissack ◽

Aaradhana J. Jha ◽

...

Keyword(s):

Postoperative Complications ◽

Weight Bearing ◽

Case Series ◽

Wound Dehiscence ◽

Fracture Treatment ◽

Retrospective Case ◽

Early Weight Bearing ◽

Non Union ◽

Jones Fracture ◽

Radiographic Union

Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Several controversies persist regarding fracture treatment of the fifth metatarsal base. Due to its low blood supply, Jones fracture has an inherent difficulty of consolidation, and may devolop complications such as delayed union, non- union and refracture. Usually the Jones fracture treatment is done with extended period of non-weightbearing with either nonoperative or operative treatment. The surgery is indicated particularly in athletes or in the setting of nonunion or fracture displacement. The purpose of the present retrospective case series is to assess postoperative outcomes among patients who weight bear earlier than standard practice. Methods: We performed a retrospective analysis of the medical and radiographic records from patients who had undergone operative IM fixation of an acute isolated Jones fracture from May 2013 and August 2018. Patients were permitted to weight- bear as tolerated. Demographic information, such as age, gender, body mass index, the use of tobacco, presence of medical comorbidities, and the time of radiographic union were evaluated. Standardized radiographs at 2 weeks, 6 weeks, 3 months and 6 months after surgeries were chosen for evaluation. Radiographic union was defined as bridging in 2 of 3 (medial, lateral, plantar) cortices. Results: Twenty one patients were included for analysis. Of these, 14 had at least one comorbidity present at time of operation. Average BMI was 37.6, and average age was 44.8. One patient (4.8%) was lost to follow up, and therefore did not have radiographic results available for review at any appointment. At 6 weeks, 16 of 21 patients showed signs of radiographic healing; 8 were completely healed, and 8 were incomplete. One patient (4.8%) had nonunion, which was documented at 6 week, 3 month, and 6 month readings. None of the 21 patients experienced any other postoperative complications, including infection, wound dehiscence, sepsis, DVT, implant failure, or need for revision surgery. Conclusion: Patients who were subjected to early weight-bearing after fifth metatarsal Jones fracture surgery had satisfactory fusion rates with no additional postoperative complications, even despite having high average BMI and multiple comorbidities. We believe that patients can be treated with early weightbearing as tolerated after operative fixation of an acute Jones fracture, and achieve satisfactory outcomes comparable those associated with traditional postoperative protocols.

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Arthroscopic Tibiotalar Arthrodesis versus Open Arthrodesis with Anterior Locking Plate: A Retrospective Case Series

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00273 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0027

Author(s):

Benjamin Y. Jong ◽

John E. Femino ◽

Cesar de Cesar Netto ◽

Phinit Phisitkul

Keyword(s):

Locking Plate ◽

Screw Fixation ◽

Weight Bearing ◽

Case Series ◽

Fusion Rate ◽

Ankle Arthrodesis ◽

Ankle Arthritis ◽

Retrospective Case ◽

Tibiotalar Arthrodesis ◽

Open Versus

Category: Ankle; Ankle Arthritis; Arthroscopy Introduction/Purpose: Tibiotalar arthrodesis is a common procedure for the treatment of ankle arthritis. Arthroscopic arthrodesis with screw fixation has become increasingly popular with reported shorter hospital stays, shorter time to fusion, and equivalent patient reported outcomes to open arthrodesis with screw fixation. However, there is limited research comparing arthroscopic arthrodesis to open arthrodesis with a modern anterior locking plate. The aim of this study was to determine if the use of a modern anterior locking plate in primary ankle arthrodesis would have a similar time to fusion versus arthroscopic arthrodesis with screw fixation. Methods: We performed a retrospective case review of primary ankle arthrodesis cases from 2009 to 2018 that utilized either an open approach with an anterior locking plate or an arthroscopic approach with screw fixation. All open cases were performed by a single surgeon using an anterior locking plate; all arthroscopic cases were performed by another surgeon using cannulated screw fixation. Post-operative protocol was similar for both patient groups, with at least 6 weeks of casting and protected weight- bearing followed by a transition to removable cast-boot and progressive weight-bearing. Exclusion criteria included combined tibiotalar/subtalar arthrodesis, hindfoot arthrodesis, cases where infection was suspected pre-operatively, and revision arthrodesis for any reason (IE, infection, failed total ankle arthroplasty, prior nonunion). Time to fusion was based on evaluation of post- operative radiographs performed at six and ten weeks. Results: 28 open and 25 arthroscopic arthrodesis cases met inclusion criteria. The fusion rate at six weeks was 82.1% (open) versus 72% (arthroscopic). At ten weeks the fusion rate was 100% (open) versus 91% (arthroscopic). 4/28 open arthrodesis cases experienced continued pain versus 8/25 arthroscopic. For the open procedure, one patient required reoperation for skin grafting away from the incision due to a poor-fitting workboot. Two patients had removal of painful hardware; one of these patients required a second reoperation for symptomatic neuroma resection. For arthroscopic cases, two patients had removal of hardware and one patient had an elective below-knee amputation for intractable pain. Average patient age was 53.3 years (open) versus 48.4 (arthroscopic). Average length of hospital admission was 2.3 days (open) versus 0.9 (arthroscopic). Conclusion: Open tibiotalar arthrodesis with a modern anterior locking plate resulted in faster time to radiographic fusion and a lower incidence of continued pain compared to arthroscopic arthrodesis in this study. The faster time to fusion may be due to the superior biomechanical stability of a locking construct. Arthroscopic arthrodesis resulted in shorter hospital admissions, and neither group had any incision-related complications. In this case series, open and arthroscopic fusion had comparable outcomes.

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