Tibiotalocalcaneal arthrodesis through retrograde nailing for the treatment of juxtaarticular distal tibia aseptic non-unions: A retrospective study at a minimum follow-up of 4 years

Mosca, Massimiliano; Caravelli, Silvio; Fuiano, Mario; Massimi, Simone; Censoni, Davide; Grassi, Alberto; Vocale, Emanuele; Ceccarelli, Francesco; Zaffagnini, Stefano

doi:10.1016/j.injury.2020.03.039

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…Due to the retrograde ILN implantation inherently no approach-related effects on the knee joint were observed in our patients. On the other hand, plantar nail entry carries the risk of approach-related problems such as painful soft tissue irritation or delayed wound healing (Mosca et al 2020). 3 of our patients had delayed plantar wound healing.…”

Section: Discussionmentioning

confidence: 78%

Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion

Vogt¹,

Roedl²,

Gosheger

et al. 2020

Acta Orthopaedica

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Background and purpose — Motorized intramedullary lengthening nails (ILNs) have been developed as an alternative to external fixators for long bone lengthening. The antegrade approach represents the standard method for tibial ILN insertion. In patients with preexisting ankle and hindfoot fusion a retrograde approach provides an alternative technique that has not been evaluated so far. We report the outcome of this method in 10 patients. Patients and methods — This retrospective study included 10 patients (mean age 18 years [13–25]) with preexisting ankle and hindfoot fusion who underwent tibial lengthening with a retrograde ILN (PRECICE). The mean leg length discrepancy (LLD) was 58 mm (36–80). The underlying conditions were congenital (n = 9) and post tumor resection (n = 1). The main outcome measures were: ILN reliability, distraction achieved, distraction index (DIX), time to bone healing, consolidation index (CIX), complications, and functional results. Results — All patients achieved the goal of lengthening (mean 48 mm [26–80]). Average DIX was 0.6 mm/day (0.5–0.7) and mean CIX was 44 days/cm (26–60). Delayed consolidation occurred in 2 patients and healed after ILN dynamization or nail exchange with grafting. Toe contractures in 2 other patients were resolved with physiotherapy or tenotomy. Until last follow-up (mean 18 months [12–30]) no true complications were encountered, knee motion remained unaffected, and full osseous consolidation occurred in all patients. Interpretation — In patients with LLD and preexisting ankle and hindfoot fusion distal tibial lengthening using a retrograde ILN is a reliable alternative to the standard approach with equivalent bone healing potential and low complication rates leaving the knee unaffected.

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Section: Discussionmentioning

confidence: 78%

Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion

Vogt¹,

Roedl²,

Gosheger

et al. 2020

Acta Orthopaedica

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Section: Study Populationmentioning

confidence: 99%

“…The subtalar joint was not approached and prepared. Arthrodesis of the subtalar joint was achieved by exploiting the mechanical action of the nail and fibrosis following bleeding in the subtalar joint itself [12]. The clinical outcomes were evaluated in all patients through the validated AOFAS ankle-hindfoot score (American Foot and Ankle Society) [13] and the Visual Analogue Scale (VAS).…”

Section: Study Populationmentioning

confidence: 99%

Custom-Made Implants in Ankle Bone Loss: A Retrospective Assessment of Reconstruction/Arthrodesis in Sequelae of Septic Non-Union of the Tibial Pilon

et al. 2022

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Background and Objectives: Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developing fracture-related infection with associated chronic osteomyelitis in patients. Segmental tibial and ankle bone loss have recently received new and improved treatments. Materials and Methods: Above all, 3D printing allows for the customization of implants based on the anatomy of each patient, using a personalized process through the layer-by-layer deposition of materials. Results: This article presents different cases from the authors’ experience. Specifically, four patients suffered tibia and ankle fractures and after radical surgery for chronic osteomyelitis combined with high-performance antibiotic therapy underwent ankle reconstruction/arthrodesis with custom-made tibial spacers. Conclusions: Thanks to 3D-printed patient-specific devices, it is possible to perform surgical procedures that, for anatomical reasons, would have been impossible otherwise. Moreover, an improvement in overall functionality and an important reduction in pain were shown in the last follow-up in all patients.

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“…47 Various studies have examined postoperative outcomes of these procedures using validated questionnaires, including the 36-Item Short Form Health Survey (SF-36), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, and the Musculoskeletal Functional Assessment; visual analog scale (VAS) for pain; subjective measures of pain and satisfaction; and rates of return to daily activity and return to work. 2,[5][6][7][8][9][10]13,18,20,21,24,31,[33][34][35]37,38,41,42,44,46,52,54 However, to our knowledge, no studies have thus far assessed patient-reported outcomes of these procedures using computer adaptive tests as with the Patient-Reported Outcome Measurement Information System (PROMIS).…”

Section: Introductionmentioning

confidence: 99%

Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis

Mehta

Sherman

et al. 2021

Foot & Ankle Orthopaedics

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Background: Hindfoot and ankle fusions are mechanically limiting procedures for patients. However, patient-reported outcomes of these procedures have not been well studied. This study assessed outcomes of hindfoot and ankle fusions by using Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) Computer Adaptive Tests (CATs). Methods: Between 2014 and 2018, 102 patients were prospectively enrolled after presenting to a tertiary care facility for ankle and hindfoot fusions, including tibiotalar, tibiotalocalcaneal, subtalar, and triple arthrodeses. Study participants completed preoperative and 12-month postoperative PF and PI CATs. The differences between mean 12-month postoperative and preoperative PROMIS PF and PI T scores were analyzed with paired t tests. The relationship between the 12-month PF and PI differences for the overall sample and patient factors was examined using multiple regression modeling. Results: The sample had mean age of 57.69 years; 48% were male, and 55% were obese. Patients who underwent ankle and hindfoot arthrodesis had statistically significant improvements from preoperative to 12 months postoperative in mean PF (36.26±7.85 vs 39.38±6.46, P = .03) and PI (61.07±7.75 vs 56.62±9.81, P = .02). Triple arthrodesis saw the greatest increases in physical function (▵PF = 7.22±7.31, P = .01) and reductions in pain (▵PI = –9.17±8.31, P = .01), achieving minimal clinically important difference (MCID). Patients who underwent tibiotalar fusion had significant improvement in physical function (▵PF = 4.18±5.68, P = .04) and pain reduction that approached statistical significance (▵PI = –6.24±8.50, P = .09), achieving MCID. Older age (≥60 years ) was associated with greater improvements in PF ( β = 0.20, P = .07) and PI ( β = –0.29, P = .04). Preoperative PF and PI T scores were significantly associated with the 12-month change in PF and PI T scores, respectively ( β = –0.74, P < .01; β = –0.61, P < .01). Conclusion: Hindfoot and ankle fusions are procedures with favorable patient outcomes leading to increased physical function and decreased pain at 12 months postoperation relative to preoperation. Level of Evidence: Level II, prospective comparative study.

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Tibiotalocalcaneal arthrodesis through retrograde nailing for the treatment of juxtaarticular distal tibia aseptic non-unions: A retrospective study at a minimum follow-up of 4 years

Cited by 5 publications

References 13 publications

Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion

Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion

Custom-Made Implants in Ankle Bone Loss: A Retrospective Assessment of Reconstruction/Arthrodesis in Sequelae of Septic Non-Union of the Tibial Pilon

Evaluating Prospective Patient-Reported Pain and Function Outcomes After Ankle and Hindfoot Arthrodesis

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