Postoperative Complications of Posterior Ankle and Hindfoot Arthroscopy

Nickisch, Florian; Barg, Alexej; Saltzman, Charles L.; Beals, Timothy C.; Bonasia, Davide Edoardo; Phisitkul, Phinit; Femino, John E.; Amendola, Annunziato

doi:10.2106/jbjs.k.00069

Cited by 141 publications

(121 citation statements)

References 42 publications

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“…Our technique described above also allows for safe placement of internal fixation by using established portals within anatomic safe locations 2 with a low rate of major complications. 3 This technique provides several advantages over standard open reduction internal fixation. The primary advantage is the limited soft tissue disruption.…”

Section: Discussionmentioning

confidence: 99%

Posterior Ankle Arthroscopic Reduction With Internal Fixation

Martin

Unangst

Englert

2016

Arthroscopy Techniques

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Current surgical techniques in ankle fracture management now include arthroscopic-assisted reduction and internal fixation. The need for minimally invasive fracture reduction techniques, which preserve soft tissue envelops and assists in overall anatomic reduction, can be refined and improved. The ankle is an ideal anatomic location for arthroscopic-assisted reduction and internal fixation due to the high incidence of intra-articular pathology and the poor long-term sequela of nonanatomic reduction. Thus, we propose using prone posterior ankle arthroscopic reduction internal fixation for posterior ankle fracture variants.A nkle fractures are among the most commonly treated fractures, but surgeons have been slow to accept arthroscopic assistance in treating these fractures. The thin rigid articular surfaces of the tibiotalar joint and the high incidence of traumatic osteochondral lesions produce small fragments and often loose bodies that are difficult to assess with standard open techniques. Standard anterior ankle arthroscopy is ideal for anterior pathology and syndesmosis reduction, but puts posterior pathology out of reach.1 Posterior ankle arthroscopy puts the posterior malleolus and pilon variants and their associated pathology within reach, making loose body removal and direct visualization of fracture reduction possible, while avoiding extensive posterior lateral dissection. Thus, we purpose using prone posterior arthroscopic reduction and internal fixation for posterior ankle fracture variants. Surgical Technique Preoperative SetupThe patient is positioned prone taking care to prevent hyperextension of the cervical spine and padding all bony prominences. We also recommend placing a thigh tourniquet before rolling the patient into the prone position ensuring that the feet are off the end of the bed. An external positioning arm (Trimano; Arthrex, Naples, FL) is applied to the ipsilateral side on the most distal end of the operating table rail. The operative leg is then prepped and draped in the standard fashion. We then apply a standard padded ankle distraction strap positioned around the end of the external position arm with gentle traction applied. The gentle traction serves 2 purposes: helps with reduction and holds the ankle in place as we operate. The anatomic landmarks (medial/lateral malleolus, Achilles tendon, and sural nerve) are marked and identified. Portal PlacementWe use the tip of the lateral malleolus to gauge the location of the posterior portals, which are established tangential to the Achilles tendon. The posteromedial portal is initially established using the nick-and-spread technique. Then a Stryker (Kalamazoo, MI) 4.0-mm 30 arthroscope is introduced. The posterolateral portal is then established in the same manner using a straight hemostat to create a working space and help with triangulation.

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Section: Discussionmentioning

confidence: 99%

Posterior Ankle Arthroscopic Reduction With Internal Fixation

Martin

Unangst

Englert

2016

Arthroscopy Techniques

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“…By not using the well-leg holder, the potential neurovascular injury from sustained pressure on the popliteal fossa is also eliminated. 3,4,7 Moreover, this method removes all reprocessed sterile equipment, thus cutting costs and the burden regarding the sterilization process and operating room staff. The external positioning arm is commonplace in operating rooms in which shoulder arthroscopy is performed; in most cases the burden of purchasing the equipment has already been met.…”

Section: Discussionmentioning

confidence: 99%

“…6 These techniques decreased the iatrogenic complication rate to 8% but required lengthy setup times and several pieces of sterilely processed equipment. 7 Thus we propose a 1-step simple ankle arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of any reprocessed sterile equipment (Table 1).…”

mentioning

confidence: 99%

Simple 1-Step Ankle Arthroscopy Distraction

Unangst

Martin

2015

Arthroscopy Techniques

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Ankle arthroscopy has emerged as a viable treatment option for multiple ankle pathologies and continues to have expanding indications as technology and techniques improve. Historically, ankle arthroscopy used skeletal traction, and it has transitioned to noninvasive soft-tissue distraction because of high rates of iatrogenic complications. Although soft-tissue distraction has decreased complications, it continues to be both cumbersome and time-consuming. Thus we propose a 1-step simple ankle arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of any reprocessed sterile equipment.

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“…Dancers returned to sport faster with arthroscopic management as well at 6 to 8 weeks versus 8 to 24 weeks with open techniques. 54 The largest and most comprehensive study looking at complications after posterior arthroscopy was reported by Nickisch and colleagues 55 and demonstrated a complication rate of 8.5%. Open surgery complication rates have been reported between 10% and 24% (Fig.…”

Section: Clinical Outcomesmentioning

confidence: 99%