Radiological evaluation of ankle arthrodesis with Ilizarov fixation compared to internal fixation

IntroductionWe asked whether the type of ankle joint arthrodesis stabilization will affect: (1) rate of union, (2) rate of adjacted-joint arthritis, (3) malalignment of the ankle joint.Material and methodsWe retrospectively radiological studied 62 patients who underwent ankle arthrodesis with Ilizarov external fixator stabilization (group 1,n = 29) or internal stabilization (group 2,n = 33) from 2006 to 2015. Radiologic outcomes were mesure by: (1) rate of union, (2) rate of adjacent-joint arthritis, (3) malalignment of the ankle joint. The Levene’s test,Mann–Whitney U test and Students t-test were used to the statistical analyses.ResultsAnkle fusion was achieved in 100% of patients treated with external fixation and in 88% with internal stabilization. Desired frontal plane alignment was achieved in 100% of patients with external fixation and 76% with internal stabilization. Desired sagittal plane alignment was achieved in 100% of external fixation and 85% of internal stabilization. A total of 14 (48.3%) patients from group 1 showed a radiographic evidence of pre-existing adjacent-joint OA. The radiographic evidence of pre-existing adjacent-joint OA was also found in 27(81.8%) subjects from group 2. Alterations of adjacent joints were also found on postoperative radiograms of 19 (65.5%) patients subjected to Ilizarov fixation and in all 33 patients from group 2.DiscusionIlizarov fixation of ankle arthrodesis is associated with lower prevalence of adjacent-joint OA and ankle joint misalignment,and with higher fusion rates than after internal fixation.Although achieving a complex ankle fusion is generally challenging,radiological outcomes after fixation with the Ilizarov apparatus are better than after internal stabilization.     

Transfibular ankle arthrodesis with use of sagitally split fibula as a biological plate leads to excellent outcome: A retrospective analysis

BackgroundWe studied ankle arthrodesis with a transfibular approach using sagitally spilitted fibula as a biological plate (onlay grafting) as well as other half of fibula as morcellised local interpositional graft (inlay grafting) to achieve bony union.Material and methodsRetrospective clinico-radiological evaluation of 36 operated cases was done at 3, 6, 12 and 30 months follow-ups. Clinically union was considered once ankle became pain free on full weight bearing. Pain assessment was done by using VAS (visual analogue scale) score and functional evaluation was done by AOFAS (American Orthopaedic Foot & Ankle Society) hind foot score preoperatively and at different follow ups. Radiologically, sagittal plane ankle alignment and fusion status was determined at each follow up.ResultsMean age of patients was 40.36 ± 10.56 years (range 18–55), who were evaluated for mean duration of 33.32 ± 11.25 months (range 24–65). Thirty-three (91.7%) ankles were fused adequately and mean duration to achieve bony union was 5.09 ± 1.3 months (range 4–9 months). Mean post-operative AOFAS score at final follow up was 76.65 ± 4.87 in comparison to 45.76 ± 3.38, preoperatively. VAS score improved significantly from 7.8 (pre-operative) to 2.3 (final follow-up). Non-union in three patients (8.3%) and ankle malalignment in one patient was observed.ConclusionTransfibular ankle arthrodesis achieves excellent bony unions and functional outcomes in severe ankle arthritis. Biologically incompetent fibula that to be judged individually by the operating surgeon to use it as a graft. Patients having inflammatory arthritis have more dissatisfaction than other aetiologies.     

External versus internal fixation for arthrodesis of chronic ankle joint infections — A comparative retrospective study

BackgroundArthrodesis of the ankle is a salvage procedure in case of chronic ankle joint infection. External fixation still is the gold standard.We compared the outcome of external fixator versus intramedullary nailing for arthrodesis of the infected ankle joint.MethodsAll patients with ankle joint infection who received arthrodesis with either external fixator or intramedullary nail between 08/2009 and 09/2017 were retrospectively analyzed. Endpoints were the successful control of infection, osseous fusion, and mobilization with full weightbearing.ResultsSeventy-one patients were included. Nineteen patients (27%) suffered reinfection. Patients with intramedullary nailing showed significantly fewer reinfections (p = 0.019), achieved full weightbearing significantly more often (p = 0.042) and faster and developed significantly fewer complications (p < 0.001). Forty-three patients showed bone fusion without significant differences between the groups.ConclusionsAnkle arthrodesis with intramedullary nailing appears to be a successful alternative to the established procedure of external fixation in cases of chronic ankle joint infection.     

Union Rates With the Use of Structural Allograft in Lapidus Arthrodesis: A Comparison Between Two Fixation Constructs

Although structural allograft has been previously described as acceptable practice for reconstructive foot and ankle surgery, results for an allograft bone wedge in Lapidus arthrodesis are unknown. Additionally, there is no consensus on the superiority of a single fixation construct in Lapidus cases. Our objective was (1) to report union rates for Lapidus arthrodesis with and without the use of an allograft bone wedge and (2) to determine if fixation construct impacts rates of union when using structural allograft. A review was performed for Lapidus cases with fixation constructs of 2 crossed compression screws (CS) and a medial locking plate with single transarticular screw (MPS), both with and without use of an allograft bone wedge. Inclusion required a CT scan to evaluate bony union. There was no significant difference in union rates (p = .41) between the use (90%) and the nonuse (97%) of an allograft bone wedge. Union rates were significantly different (p = .04) when comparing CS fixation (85%) and MPS fixation (98%). The comparative results between the fixation constructs highlight the importance of compression across the arthrodesis site as part of a robust fixation construct. Our findings demonstrate that the use of an allograft bone wedge in Lapidus arthrodesis may mitigate complications due to metatarsal shortening while providing satisfactory rates of union.     

踝关节融合术对足踝创伤性关节炎的治疗研究

目的：观察关节镜下微创踝关节融合术与开放式踝关节融合术治疗创伤性关节炎的疗效。方法：回顾性分析26例创伤性踝关节炎患者的临床资料,按治疗方法不同分为微创组和开放式组,对比两组骨性融合率及术后美国足踝外科协会踝-后足评分系统(AOFAS,Ankle Hindfoot Scale)评分。结果：术后6个月微创组骨性融合率为80.0%,高于开放式组的31.3%,两组比较差异有统计学意义(P<0.05);术后1年两组骨性融合率差异无统计学意义(P>0.05)。术后6个月两组AOFAS评分差异均无统计学意义(P>0.05),术后1年时微创组评分明显高于开放式组,差异有统计学意义(P<0.01)。结论：关节镜下踝关节融合术在提高早期骨性融合率及减轻疼痛方面较开放式踝关节融合术更具优势。     

Clinical outcomes in the surgical management of ankle fractures: A systematic review and meta-analysis of fibular intramedullary nail fixation vs. open reduction and internal fixation in randomized controlled trials

BackgroundWhat level I evidence exists to support the use of FNF for surgical management of ankle fractures in high risk patients? The purpose of this study was to compare clinical outcomes following fibular intramedullary nail fixation (FNF) and open reduction and internal fixation (ORIF) of ankle fractures.MethodsA systematic review of the current literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Certainty of evidence reported according to GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Our primary hypothesis was that patients undergoing FNF procedures to manage an ankle fracture would have significantly higher patient reported outcome scores (PROs) than patients undergoing ORIF. Primary study outcome measures were validated PROs. Secondary outcome measures included complication rate, secondary surgery rate, and bony union.ResultsThe primary outcome analysis revealed no evidence of a significant effect difference on Olerud and Molander Ankle Score (OMAS) PRO and no evidence of statistical heterogeneity. Secondary outcome analysis revealed a significant 0.30 (0.12–0.74 95CI) relative risk reduction for complications in FNF (P = 0.008). No evidence of an effect difference for bony union. The GRADE certainty of the evidence was rated as low for bone union. No evidence of reporting bias was appreciated. Sensitivity analyses did not significantly alter effect estimates.ConclusionThis systematic review and meta-analysis restricted to evidence derived from RCTs revealed that the quality of evidence is reasonably strong and likely sufficient to conclude: (1) there is likely no clinically important difference between FNF and ORIF up to 12 months post-operatively, as defined by OMS (moderate certainty); (2) surgeons may reasonably expect reduced complications in 14 out of every 100 patients treated with FNF (moderate certainty); (3) there is likely no difference in bony union (low certainty). Future studies should investigate more patient-centered outcomes and if short-term findings are durable over time if these findings apply to lower risk populations.Level of EvidenceSystematic review and meta-analysis of level I evidence     

What is the best fixation technique for isolated talonavicular arthrodesis? – A systematic review

SummaryTalonavicular arthrodesis is associated with a rate of non-union that ranges from 3 % to 37 %. Various fixation devices have been reported for talonavicular arthrodesis including screws, staples, plates, K-wires and intraosseous fix systems, however there is no definitive gold standard. This systematic review aims to compare clinical outcomes between different fixation devices for talonavicular arthrodesis.MethodsMEDLINE, EMBASE, CENTRAL and Google Scholar were reviewed for studies reporting on outcomes of different fixation techniques for talonavicular arthrodesis indicated for osteoarthritis, inflammatory and post-traumatic arthritis from 1946 to 2021. The primary outcome measure was union rate. Secondary outcome measures included functional improvement, cost, quality of life and patient satisfaction.Results9 articles involving 141 cases of talonavicular arthrodesis were identified. Fusion rates were as follows: screw fixation (n = 75): 87.5 % to 100 %, staple fixation (n = 13): 100 %, intraosseous fix system (n = 16): 100 %, and K-wire fixation (n = 2): 100 %. One study utilised a dorsal locking plate with two supplemented compression screws (n = 9, fusion rate= 100 %) and two studies used a combination of screws with staples (n = 26, fusion rate= 96 %). 7 of 9 studies measured functional outcomes and pain relief with improvement demonstrated in all fixation techniques. Quality of life, satisfaction and cost were inadequately reported amongst the included studies. All studies were rated as serious risk of bias.ConclusionThis systematic review consolidates the evidence for outcomes of different fixation techniques for TN arthrodesis, however a definitive judgement regarding the best fixation technique is unobtainable from current clinical evidence, due to lack of high-quality studies.With review of biomechanical studies and the limited clinical data, fixation with plate plus screw is most promising and would warrant further comparative study.Level of evidenceIV.     

Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome

BACKGROUND: Transfibular ankle arthrodesis with internal fixation and fibular onlay grafting has resulted in acceptable fusion rates. This study analyzed the results of ankle arthrodesis using one operative technique in a large series of patients with high and low risks for nonunions. METHODS: Fifty consecutive patients had a transfibular ankle arthrodesis with rigid internal fixation and fibular onlay strut grafting from 1997 to 2004. Two patients were lost to followup. The remaining 48 patients had preoperative and postoperative clinical and radiographic examinations and then were stratified into high-risk and low-risk groups for ankle nonunions. Fifteen of 48 patients were considered at high risk for nonunion. Rate of osseous fusion, satisfaction with the procedure, correction of the deformity, and relief of pain were evaluated. Thirty-five of 48 patients were evaluated with the AOFAS ankle-hindfoot scale at an average 45 months after surgery. RESULTS: Forty-six of 48 patients had bony union (96% union rate). Fourteen of 15 (93%) high-risk patients had bony fusion in an average of 83 days. Thirty-two of 33 patients (97%) in the low-risk group had bony fusion at an average of 81 days. The AOFAS ankle-hindfoot score improved from 38 to 74 in 12 of 15 patients in the high-risk group and from 34 to 69 in 24 of 33 patients in the low-risk group from preoperative to postoperative scores. CONCLUSIONS: A transfibular ankle arthrodesis with rigid internal fixation and fibular onlay strut grafting can achieve a high rate of union in both a low-risk and high-risk patient populations. This technique can be an effective approach for most primary and revision cases with or without significant deformity. In addition the AOFAS ankle-hindfoot score improved significantly both in the high-risk and low-risk groups.     

Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot's neuroarthropathy

Background:

Charcot''s neuroarthropathy of ankle leads to instability, destruction of the joint with significant morbidity that may require an amputation. Aim of surgical treatment is to achieve painless stable plantigrade foot through arthrodesis. Achieving surgical arthrodesis in Charcot''s neuroarthropathy has a high failure rate. This is a retrospective nonrandomized comparative study assessing the outcomes of tibio-talar arthrodesis for Charcot''s neuroarthropathy treated by uniplanar external fixation assisted by external immobilization or retrograde intramedullary interlocked nailing.

Materials and Methods:

Records of the authors′ institution were reviewed to identify those patients who had undergone ankle fusion for diabetic neuroarthropathy from January 1998 to December 2008. A total of11 patients (six males and five females) with a mean age of 56 year and diabetes of a mean duration of 15.4 years with ankle tibio-talar arthrodesis using retrograde nailing or external fixator for Charcot''s neuroarthropathy were enrolled for the analysis. Neuropathy was clinically diagnosed, documented and substantiated using the monofilament test. All procedures were performed in Eichenholz stage II/III.Six patients were treated with uniplanar external fixator, while the remaining five underwent retrograde intramedullary interlocking nail. The outcomes were measured for union radiologically, development of complications and clinical follow-up, according to digital archiving systems and old case notes.

Results:

All five (100%) patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7%) and a delayed union which went on to full osseous union.

Conclusion:

The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot''s neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.     

Anterior ankle arthrodesis

Ankle arthrodesis is a common procedure that resolves many conditions of the foot and ankle; however, complications following this procedure are often reported and vary depending on the fixation technique. Various techniques have been described in the attempt to achieve ankle arthrodesis and there is much debate as to the efficiency of each one. This study aims to evaluate the efficiency of anterior plating in ankle arthrodesis using customised and Synthes TomoFix plates. We present the outcomes of 28 ankle arthrodeses between 2005 and 2012, specifically examining rate of union, patient-reported outcomes scores, and complications. All 28 patients achieved radiographic union at an average of 36 wk; the majority of patients (92.86%) at or before 16 wk, the exceptions being two patients with Charcot joints who were noted to have bony union at a three year review. Patient-reported outcomes scores significantly increased (P < 0.05). Complications included two delayed unions as previously mentioned, infection, and extended postoperative pain. With multiple points for fixation and coaxial screw entry points, the contoured customised plate offers added compression and provides a rigid fixation for arthrodesis stabilization.     

Subjective and Objective Outcomes of Ankle Joint Arthrodesis with Either Ilizarov or Internal Fixation

After arthroplasty, arthrodesis of the ankle joint is the most common method to treat advanced ankle osteoarthritis. The goal of the study was to assess the subjective and objective outcomes in 2 different types of fixation for ankle joint arthrodesis.We retrospectively assessed 47 patients who had undergone ankle joint arthrodesis with fixation either via an Ilizarov apparatus (group 1) (n = 21) or cannulated screws (group 2) (n = 26). The outcomes were measured by: (1) the quantity of analgesics administered, (2) the American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, (3) general patient satisfaction, (4) the patients’ decision to undergo the same procedure given another chance, and (5) the necessity of blood transfusion during hospitalization. Data was collected at the last postoperative follow-up visit. The AOFAS scores in group 1 and group 2 patients were 73.9 ± 13 and 72.7 ± 14.3, respectively. In group 1, 17 patients (81%) were very satisfied with the results, while in group 2, 19 patients (73%) were very satisfied with the results (p = .043). Two group 1 patients (10%) and four group 2 patients (15.3%) reported that they were satisfied with the outcomes (p = .035). Two patients (10%) from group 1 and three patients (11%) from group 2 were fairly satisfied. Seventeen patients (81%) after arthrodesis with Ilizarov fixation and 21 patients (81%) after arthrodesis with internal fixation would choose the same procedure given the opportunity to choose again. In group 1 there were no patients who required blood transfusion; in group 2 one patient (4%) required blood transfusion; the difference was statistically significant (p = .039). Nineteen group 1 patients (90%) were administered an analgesic preoperatively, while postoperatively only 6 (29%) required analgesics. In group 2, 24 patients (92%) were administered analgesics preoperatively, with 8 (31%) of them still requiring analgesics postoperatively. Ankle arthrodesis patients from both group 1 and group 2 achieved good subjective and objective results of treatment. We noted slightly better results in the Ilizarov apparatus group.     

Osteitis and Septic Arthritis after Tibial Head Fracture: Results of a Radical Treatment Regime

Abstract Objectives:  We report a series of 37 consecutive patients with both bone infection and septic arthritis of the knee following fracture of the proximal tibia. Aim of this study is to evaluate treatment results using a standardized treatment regime. The treatment regime consisted of an aggressive surgical approach to both the bone and the joint. In 61% the joint function was preserved, in the reminder an arthrodesis was required, there were no amputations. The difficulties in dealing with this condition are described as well as the clinical, radiological and occupational results. Design/Setting:  Data collection was prospective. Data gathered at follow up included clinical examination, radiographs and the Rassmussen scoring system. Setting is a bone and joint infection and reconstruction unit of a tertiary referral hospital. Patients/Methods:  Nine patients were female (24.3%). Mean age was 47.7 years (16.6–76.7 years). We classified fracture types according to Schatzker; ofwhich type VI fractures were the largest group with 13 cases. Results:  About 3.2 operations where required on average (1–7) for the treatment of infection. For 22 patients the joint function was salvaged. In the remaining cases an arthrodesis was required. Conclusions:  The reported treatment regime gives reliable results for the treatment of combined bone and joint infection of the knee after fracture. In a large group of cases it was possible to salvage joint function. Comparison to other forms of treatment is not possible as there are no reported results so far.     

Salvage arthrodesis for failed total ankle arthroplasty

Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease.

Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to union. Clinical outcome at latest follow-up was measured by the AOFAS score, the foot function index (FFI) and by VAS scores for pain, function, and satisfaction.

Results Blade plates were used in 7 ankles (4 IJD, 3 OA); all united. Nonunion developed in 7 of the 11 rheumatic ankles stabilized by other methods. 11 patients (8 fused ankles, 3 nonunions) were available for clinical evaluation. Their mean AOFAS score was 62 and mean overall FFI was 70. VAS score for pain was 20, for function 64, and for satisfaction 74. The scores were similar in united and non-united ankles.

Interpretation Blade plate fixation is successful in salvage arthrodesis for failed TAA. A high nonunion rate was found after salvage ankle arthrodesis in IJD with other methods of fixation. Clinical results were fair to good.     

Distal Tibial Fracture Fixation with Locking Compression Plate (LCP) Using the Minimally Invasive Percutaneous Osteosynthesis (MIPO) Technique

Abstract Background:   Treatment of distal tibial fractures has always been a challenge. Distal tibia is more superficial, with less soft tissue coverage and blood supply. Therefore, operative treatment can lead to complications. We aim to see the results of the distal tibial fracture fixation with LCP using MIPO. Patients and Methods:   Twenty-one consecutive patients were prospectively reviewed. AO types 43A, 43B and 43C were included. Fourteen male and seven female patients with a mean age of 51 years were included. Results:   Mean time to union was 5.5 months (range 3–13 months). Seventeen fractures healed with good functional outcome. One patient had delayed union. One patient had nonunion and underwent revision; the fracture ultimately healed with good functional outcome. Two patients developed superficial wound infections but the fractures united completely. Discussion:   The MIPO technique for distal tibia has shown good results with many additional advantages over the conventional methods. Early mobilization without risk of secondary displacement helps to prevent stiffness and contracture.     

Historical Treatment Results of Pelvic Ring Fractures: A 12-year Cohort Study

Abstract Background:   Since the Academic Medical Center Amsterdam was appointed as a level-1 trauma center in July 1997, the number of polytrauma patients who were presented has increased. This stimulated us to perform a retrospective analysis on the treatment results of patients with a pelvic ring fracture and to evaluate our treatment strategies. Materials and Methods:   A chart review of all patients with a partially stable fracture (Tile/AO type B) or an unstable fracture (Tile/AO type C) was performed. All patients presented between 1 January 1990 and 31 December 2001 were included. Two historical groups (1990–1997 and 1998–2001) were formed. General demographics, treatment method, complications, re-operations, length of hospital stay and anatomic results were recorded for all patients. Results:   Fifty-two patients were included in group 1 and 65 patients in group 2. There was a lower mortality in group 2. The B-fractures were treated either conservatively (group 1 83.3% vs. group 2 73.8%), by external fixation (16.7 vs. 9.5%) or by ORIF (0 vs. 16.7%). C-fractures were treated by ORIF in 32.1 versus 82.6%, by external fixation in 28.6 versus 4.4% and conservatively 39.3 versus 13.0%, respectively. Fracture healing with less than 10 mm displacement was achieved in 58.3 versus 78.6% for the B-fractures, while this was achieved in 42.9 versus 73.9% in the C-fractures. Group 2 showed significantly fewer complications. Conclusion:   Evaluating two consecutive patient groups shows an increase in the number of fractures. A more aggressive surgical treatment has lead to lower mortality, improved anatomical reduction, and lower rate of complications.     

Is there a role for low intensity pulsed ultrasound (LIPUS) in delayed or nonunion following arthrodesis in foot and ankle surgery?

BackgroundDelayed union and nonunion following foot and ankle arthrodesis is a disabling complication for patients. There are no clinical studies looking at whether there is a role for use of low-intensity pulsed ultrasound (LIPUS) following this. The aim of this study is to investigate the efficacy of LIPUS in this cohort of patients in our centre.MethodsThis was a retrospective observational study reviewing the use of LIPUS in patients who had arthrodesis of a number of different foot and ankle joints diagnosed with delayed or non-union.ResultsOver a 5 year period, 18 patients (71st MTPJ fusion, 2 subtalar joints, 2 triple fusion, 4 ankle fusions and 3 isolated midfoot joint) with radiologically confirmed delayed union, were treated with a standardised LIPUS therapy. Twelve patients (67%) were treated successfully with full radiological union confirmed. 4 patients required further surgical revision surgery while 2 were treated conservatively. Isolated small foot joints demonstrated a higher incidence of fusion (9/10; 90%) after LIPUS in comparison to larger or multiple joint arthrodesis (3/8; 38%).ConclusionsThere may be a role for the use of LIPUS as a treatment option in delayed union of isolated, small foot joint arthrodesis. However, we would not recommend its use in large or multiple F&A joint arthrodesis. Large multicentre series are required to confirm our findings.     

Functional Outcome after Operative Treatment of Displaced Fractures of the Acetabulum: A 12-month to 5-year Follow-up Investigation

Abstract Purpose:  To review our experience with 82 surgically treated displaced acetabular fractures over a 4-year period. Patients and Methods:  Ninety-three consecutive displaced acetabular fractures were consecutively operated on at Level I Trauma Center from January 1, 2000 through December 31, 2003, and 82 were available for review with a minimum of 12-month follow-up. Clinical (Merle D'Aubigné modified by Matta et al.) and radiographic (Matta) outcomes were evaluated. Complications and secondary operative procedures were documented. Results:  Anatomical reduction was achieved in 89% of the patients. At follow-up examination 12–60 months postoperatively (mean 32 months), clinical results were satisfactory in 65 patients (79.2% of the cases), with 14 excellent and 51 good results, and roentgenographic results were satisfactory in 70 patients (85.4% of the cases). Complications included a 12.2% incidence of sciatic nerve palsy (10 patients, two postoperative and eight posttraumatic), a 2.4% incidence of intraoperative vascular lesion (one external iliac artery and one external iliac vein), a 1.2% incidence of postoperative loss of reduction, a 1.2% incidence of infection, a 1.2% incidence of Brooker et al. class IV heterotopic ossification, a 2.4% incidence of posttraumatic osteoarthritis, and a 2.4% incidence of osteonecrosis of the femoral head. Conclusions:  Operative treatment is an effective method for the management of displaced acetabular fractures. Clinical and roentgenographic results correlate closely with an anatomic reduction. Low complication rate can be expected if adequate preoperative assessment and planning is performed. Strategies to minimize the risk of thromboembolism and heterotopic ossification on the basis of mechanical pneumatic compression and antiinflammatory nonsteroidal drugs, respectively, are reliable techniques for these injuries.     

Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy

Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those with IMN.     

Vergleich zwischen externer und interner Fixation bei Arthrodese des oberen Sprunggelenks

SUBJECT: This study evaluates the results of external and internal fixation techniques for arthrodesis of the ankle. METHODS: Perioperative and subjective, clinical, and radiological long-term results (average follow-up: 9 years) in 55 patients following arthrodesis of the ankle due to posttraumatic arthritis were compared in two groups with different fixation techniques--compression arthrodesis with external fixator (AO) or internal screw fixation. RESULTS: Patients with external fixation revealed a significantly higher deep infection rate, which was treated conservatively, while the rates of nounion, revision surgery due to infection, and total revision surgery did not show any difference in the two groups. CONCLUSION: Both surgical techniques applied mostly guarantee a safe and stabile fixation in arthrodesis of the ankle and provide convincing long-term results without showing a difference in comparing the outcome.