The Taylor Spatial Frame for Correction of Neglected Fracture Dislocation of the Ankle

Authors: Ravikiran Shenoy, George Kubicek, Michael Pearse

Journal:  JFAS Taylor Spatial Frame

Treatment of neglected fracture dislocations of the ankle poses a surgical challenge. Extensive open reduction can frequently be contraindicated because of local skin conditions and contractures. The Taylor Spatial Frame™ (TSF) has been used to reduce and maintain reduction of complex fractures. Its use in fracture dislocation of the ankle joint has not been described. We describe a case where a TSF was used to reduce and treat a 6-week-old fracture dislocation of the ankle. The TSF is a versatile device, which has a role in the management of both acute and neglected fractures.

Keywords: Ankle fracture, dislocation, neglected fracture dislocation, Taylor Spatial Frame

Medial Malleolar Fractures: A Biomechanical Study of Fixation Techniques

Authors: T. Ty Fowler, MD; Kevin J. Pugh, MD; Alan S. Litsky, MD, ScD; Benjamin C. Taylor, MD; Bruce G. French, MD

Journal: ORTHOPEDICS August 2011;34(8):349

Fracture fixation of the medial malleolus in rotationally unstable ankle fractures typically results in healing with current fixation methods. However, when failure occurs, pullout of the screws from tension, compression, and rotational forces is predictable. We sought to biomechanically test a relatively new technique of bicortical screw fixation for medial malleoli fractures. Also, the AO group recommends tension-band fixation of small avulsion type fractures of the medial malleolus that are unacceptable for screw fixation. A well-documented complication of this technique is prominent symptomatic implants and secondary surgery for implant removal. Replacing stainless steel 18-gauge wire with FiberWire suture could theoretically decrease symptomatic implants. Therefore, a second goal was to biomechanically compare these 2 tension-band constructs.

Using a tibial Sawbones model, 2 bicortical screws were compared with 2 unicortical cancellous screws on a servohydraulic test frame in offset axial, transverse, and tension loading. Second, tension-band fixation using stainless steel wire was compared with FiberWire under tensile loads. Bicortical screw fixation was statistically the stiffest construct under tension loading conditions compared to unicortical screw fixation and tension-band techniques with FiberWire or stainless steel wire. In fact, unicortical screw fixation had only 10% of the stiffness as demonstrated in the bicortical technique. In a direct comparison, tension-band fixation using stainless steel wire was statistically stiffer than the FiberWire construct.

Key words: Medial Malleolar Fractures, Ankle Fracture Fixation Techniques

Distal Femoral Locking Plates for Tibiotalocalcaneal Fusions in the Charcot Ankle: A retrospective study

Authors: Sarah Shogren, DPM , Sara Zelinskas, DPM , Byron Hutchinson, DPM , Vineet Kamboj, DPM

Journal: The Foot and Ankle Online Journal 4 (8): 3

This paper presents a retrospective case series with chart and radiographic review of four patients with Charcot neuroarthropathy and associated ankle valgus. All four patients underwent tibiotalocalcaneal (TTC) arthrodesis using a distal femoral locking plate combined with external ring fixation for rigid axial compression. A 12 month follow-up was obtained. All four TTC arthrodeses were performed by the same surgeon (BH) including preoperative and postoperative evaluation and care. Outcomes were deemed successful with evidence of radiographic consolidation across the fusion sites. Outcomes were considered failures in the presence of non-union or amputation. Three patients had satisfactory outcomes with only minor complications. One patient had failure of the procedure with development of osteomyelitis and ultimately had a below knee amputation. Although this was a small review, on average, osseous consolidation was appreciated in 77 days for those patients that had successful outcomes. Larger retrospective or even prospective studies are needed to confirm the use of tibiotalocalcaneal arthrodesis using a distal femoral locking plate and external ring fixation in Charcot arthropathy. This small case series shows promise to the efficacy of distal femoral locking plates for tibiotalocalcaneal fusions.

Key words: Tibiotalocalcaneal fusions, Charcot Ankle, distal femoral locking plates, ankle valgus

Current Concepts Review: Results of Total Ankle Arthroplasty

Authors: Mark E. Easley, MD; Samuel B. Adams, MD; W. Chad Hembree, MD; James K. DeOrio, MD

Journal: J Bone Joint Surg Am. 2011; 93: 1455-1468

Most published reports related to total ankle arthroplasty have a fair to poor-quality level of evidence.

Comparative studies with a fair to good-quality level of evidence suggest that total ankle arthroplasty provides equal pain relief and possibly improved function compared with ankle arthrodesis.

On the basis of the current literature, survivorship of total ankle arthroplasty implants, when measured as the retention of metal components, ranges from 70% to 98% at three to six years and from 80% to 95% at eight to twelve years.

Several investigators have argued that, in the evolution of total ankle arthroplasty, some obligatory reoperation without removal of the metal implants is anticipated; examples of reoperation include relief of osseous or soft-tissue impingement, improvement of alignment or stability of the foot and ankle, bone-grafting for cystic lesions, and/or polyethylene exchange.

A successful return to low-impact, recreational sporting activities is possible after total ankle arthroplasty.

Key words: N/A

Locked Versus Nonlocked Plate Fixation For Hallux MTP Arthrodesis

Authors: Kenneth J. Hunt, MD; J. Kent Ellington, MD, MS; Robert B. Anderson, MD; Bruce E. Cohen, MD.

Foot & Ankle International: July 2011 (Vol.32 #7)

Dorsal plate fixation is used commonly for arthrodesis of the hallux

first metatarsophalangeal (MTP) joint. Custom dorsal plates

incorporating locking technology have been developed recently for

applications in the foot to provide relative ease of application and

theoretically superior mechanical properties. The purpose of this study

is to compare the radiographic and clinical outcomes of patients

undergoing hallux MTP joint arthrodesis using a locked plate, or a

nonlocked plate. Materials and Methods: We compared consecutive

patients who underwent hallux MTP arthrodesis for a variety of

diagnoses with either a precontoured locked titanium dorsal plate

(Group 1) or a precontoured, nonlocked stainless steel plate (Group 2).

All patients were evaluated with radiographs, visual analog pain scale,

American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a

detailed patient satisfaction survey. Results: There were 73 feet in

Group 1 and 107 feet in Group 2. There was a trend toward a higher

nonunion rate in Group 1 compared to Group 2. When considering

only patients without rheumatoid arthritis (RA), the union rate was

significantly higher in Group 2 compared to Group 1. Hardware failure

and the overall complication rate was equivalent between the two

Groups. Conclusion: As locked plate technology continues to gain

popularity for procedures in the foot, it is important that clinical

outcomes are reported. Locked titanium plates were associated with

higher nonunion rates. Improved plate design, patient selection, and an

understanding of plate biomechanics in this unique loading environment

may optimize future outcomes for hallux MTP arthrodesis.

Level of Evidence: III, Retrospective Comparative Study

Key Words: Hallux Arthrodesis; Hallux Valgus; Hallux Rigidus; Locked

Plate; Arthritis

Lapidus Arthrodesis with a Single Lag Screw and a Locking H-Plate

Authors:  Christopher R.D. Menke, DPM; Michael C. McGlamry, DPM; Craig A. Camasta, DPM

The Journal of Foot and Ankle Surgery: Vol: 50, No. 4, 377-382. July 2011

The aim of this pilot study was to assess if using an interfragmental lag screw and a Darco® locking H-plate for the modified Lapidus arthrodesis in the treatment of hallux abducto valgus deformity (1) would allow for earlier weight bearing than previously described and (2) would indicate whether any changes would occur radiographically with the earlier weight bearing. Twenty-one metatarsocuneiform arthrodeses, in 18 patients, were retrospectively evaluated through chart review and postoperative radiographs. Original diagnoses included painful hallux abducto valgus and osteoarthritis of the first metatarsocuneiform joint. The mean age of the patients was 48 (range, 16 to 70) years. The mean follow-up duration was 38.5 (range, 29 to 60) months. The overall radiographic osseous union rate was 90.5% (19/21 feet), although there were 2 asymptomatic nonunions. There were no cases of fixation failure, and the surgical correction was preserved on follow-up radiographs. Overall, the mean time to full weight bearing was 4.7 (range, 3 to 7.5) weeks, and it was a mean of 8 (range, 7 to 10) weeks before the patient was back to wearing comfortable shoes. The authors concluded that metatarsocuneiform arthrodesis fixated with 1 interfragmentary lag screw and a Darco® locking H-plate provides sufficient stability to allow earlier weight bearing than has been previously described with other internal fixation constructs.

Level of Clinical Evidence: 4

Keywords: bunionectomy, fixation, foot, hallux abducto valgus, surgery

Posterior Approach Using Anterior Ankle Arthrodesis Locking Plate for Tibiotalocalcaneal Arthrodesis

Authors:  Lawrence A. DiDomenico, DPM; Paul Sann, DPM

 

The Journal of Foot and Ankle Surgery: Online Only July 8th, 2011

Tibiotalocalcaneal arthrodesis is a successful treatment for patients with severe pain and functional disability in the ankle and subtalar joint. Patients with post-traumatic ankle and subtalar joint arthritis, and/or Charcot deformity, often present with compromised skin and soft tissue structures. In the present report, we describe a technique using an anterior ankle arthrodesis locking plate placed posteriorly to obtain hindfoot and ankle fusion. This technique, which uses the well vascularized, thick, posterior soft tissue envelope, provides very good exposure of the articular surfaces for resection and tibiotalocalcaneal fusion. The technique provides a valuable option for patients with compromised skin and soft tissue structures over aspects of the ankle that make other approaches risky and complicated.