Factors Affecting the Outcomes of Uncomplicated Primary Open Ankle Arthrodesis

Chalayon, Ornusa; Wang, Bibo; Blankenhorn, Brad D.; Jackson, J. Benjamin; Beals, Timothy C.; Nickisch, Florian; Saltzman, Charles L.

doi:10.1177/1071100715587045

Cited by 83 publications

(72 citation statements)

References 28 publications

(33 reference statements)

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“…More investigation is necessary to determine if rhBMP-2 has a role in hindfoot and ankle fusion surgery. Previous arthrodesis of the adjacent joint is a risk factor for nonunion of the tibiotalar joint (with a previously fused subtalar joint) [7] or of the subtalar joint (with a previously fused tibiotalar joint) [12,26]. Easley et al [11], whose study included only patients who underwent revision arthrodesis, reported a union rate that was comparable to the rate in our patients.…”

Section: Discussionsupporting

confidence: 72%

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Gorman

Beals

Nickisch

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach. Questions/purposes We asked (1) what proportion of patients treated with this technique achieved osseous union; (2) what complications were observed; (3) were any patient-demographic or health-related factors associated with the likelihood that a patient would have a complication develop? Methods Between December 2001 and July 2014, 42 patients received a posterior blade plate. During the period in question, indications for hindfoot arthrodesis using posterior blade fixation were subtalar osteoarthritis below an ankle fusion, malunion or nonunion, failed tibiotalocalcaneal arthrodesis attributable to nonunion of the tibiotalar and/or subtalar joint; or tibiotalar and subtalar osteoarthritis in patients with impaired bone or soft tissue quality (particularly if the soft tissue problem was anterior). During that period, all patients who met those indications were treated with a posterior blade plate. Forty (95%) were included in this study, and two were lost to followup before the 1-year minimum required by the study. Demographics (age, gender, BMI, smoking status, and comorbidities) and surgical data (indication, previous treatment, and additional procedures) were analyzed. Of the 40 patients included, 27 (68%) were male and 13 (33%) were female, with a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). The mean age of the patients was 56 ± 13 years. Followup averaged 47 ± 28 months (range, 14-137

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Section: Discussionsupporting

confidence: 72%

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Gorman

Beals

Nickisch

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Generating compression across a fracture surface stabilises the fracture site by increasing the frictional contact between the opposed bone ends to neutralize micromotion and withstand bending, shearing & torsional stressors (Ashhurst 1986; Kaspar et al 2005). Rigid compression fixations with minimal interfragmentary movement as such, has been shown to be beneficial for primary bone healing (Chalayon et al 2015; Latt et al 2015; Mirhadi et al 2013). Promoting direct bone healing is especially critical to achieve successful union of ankle arthrodeses due to the lack of periosteal or endosteal joint coverage to facilitate secondary healing via callus formation (Kildow et al 2016; Yakacki et al 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Non-union of ankle arthrodesis in humans have been described to be between 9 and 17 %, with bone resorption attributed to be a major contributing factor especially in static fixation constructs (Chalayon et al 2015; Latt et al 2015). This is supported by a study conducted by Yakacki et al (2010) that demonstrated the inability of static internal fixations to provide sustained compression in the face of bone resorption.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical evaluation of shape-memory alloy staples for internal fixation—an in vitro study

et al. 2016

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BackgroundThe field of orthopaedics is a constantly evolving discipline. Despite the historical success of plates, pins and screws in fracture reduction and stabilisation, there is a continuing search for more efficient and improved methods of fracture fixation. The aim of this study was to evaluate shape-memory staples and to compare them to a currently used implant for internal fracture fixation. Multi-plane bending stability and interfragmentary compression were assessed across a simulated osteotomy using single and double-staple fixation and compared to a bridging plate.MethodsTransverse osteotomies were made in polyurethane blocks (20 × 20 × 120 mm) and repairs were performed with one (n = 6), or two (n = 6) 20 mm nitinol staples, or an eight-hole 2.7 mm quarter-tubular plate (n = 6). A pressure film was placed between fragments to determine contact area and compressive forces before and after loading. Loading consisted of multi-planar four-point bending with an actuator displacement of 3 mm. Gapping between segments was recorded to determine loads corresponding to a 2 mm gap and residual post-load gap.ResultsStaple fixations showed statistically significant higher mean compressive loads and contact areas across the osteotomy compared to plate fixations. Double-staple constructs were superior to single-staple constructs for both parameters (p < 0.001). Double-staple constructs were significantly stiffer and endured significantly larger loads before 2 mm gap formation compared to other constructs in the dorsoventral plane (p < 0.001). However, both staple constructs were significantly less stiff and tolerated considerably lower loads before 2 mm gap formation when compared to plate constructs in the ventrodorsal and right-to-left lateral loading planes. Loading of staple constructs showed significantly reduced permanent gap formation in all planes except ventrodorsally when compared to plate constructs.ConclusionsAlthough staple fixations were not as stable as plate fixations in particular loading planes, double-staple constructs demonstrated the most consistent bending stiffness in all planes. Placing two perpendicular staples is suggested instead of single-staples whenever possible, with at least one staple applied on the compression side of the anticipated loading to improve construct stability.

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“…The use of bone graft with internal or external compression will enhance the likelihood of a successful arthrodesis [31, 35–37]. In studies ranging in size from 12 to 101 patients, rates of successful primary ankle fusion of 80–100% have been reported.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic arthrodesis for ankle arthritis without bone graft

2016

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BackgroundAnkle arthrodesis is considered by many to be the standard operative treatment for end-stage ankle arthritis. The purpose of this study was to perform a new technique for ankle joint surface and determine the outcome for the union rates of ankle arthroscopic arthrodesis.MethodsA total of 68 patients with posttraumatic arthritis, primary osteoarthritis, and rheumatoid arthritis were treated by ankle arthroscopic arthrodesis between May 2007 and December 2012. Our surgical indication was deformity less than 15° measured by weight-bearing radiographs. Firstly, the remaining articular cartilage was removed with different curettes and shavers. Then, the new technique (microfracture) was done at tibiotalar surfaces. Finally, the ankle was fixed with two cannulated percutaneous screws. The wound healing, complications, postoperative radiographs, and American Orthopaedic Foot and Ankle Society (AOFAS) score were evaluated.ResultsThe average follow-up time was 32 months (range 25–58 months). There was no bone grafting, and a fusion rate of 100% was achieved. The average fusion time was 12.1 weeks. One patient developed superficial infection at 2 weeks postoperatively and was cured by nonsurgical treatment. No deep infections, deep venous thrombosis, or revision surgery were observed. Screws had been removed in four patients because of prominence. One patient had fusion in the subtalar joint because of arthritis at 5 years postoperatively. At the last follow-up, radiographic signs of developed or progressing arthritis were observed in nine patients at subtalar joint and in four patients at talonavicular joint. At 1-year follow-up, the mean AOFAS ankle/hindfoot score had increased to 84 from a mean preoperative value of 38 (P < 0.01).ConclusionsArthroscopic arthrodesis provides surgeons with an alternative to traditional open techniques for the management of severe ankle arthritis. Our data show that preparation of the joint surface with microfracture is an effective technique to increase the union rate of arthroscopic ankle arthrodesis, while bone graft and other promoting substances are not necessary to be routinely used.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-016-0490-y) contains supplementary material, which is available to authorized users.

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Factors Affecting the Outcomes of Uncomplicated Primary Open Ankle Arthrodesis

Abstract: Level III, retrospective comparative study.

Cited by 83 publications

References 28 publications

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Hindfoot Arthrodesis with the Blade Plate: Increased Risk of Complications and Nonunion in a Complex Patient Population

Biomechanical evaluation of shape-memory alloy staples for internal fixation—an in vitro study

Arthroscopic arthrodesis for ankle arthritis without bone graft

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