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Sourougeon Y, Barzilai Y, Haba Y, Spector B, Prat D. Outcomes following minimally invasive plate osteosynthesis (MIPO) application in tibial pilon fractures - A systematic review. Foot Ankle Surg 2023; 29:566-575. [PMID: 37532663 DOI: 10.1016/j.fas.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND This systematic review evaluates postoperative complications and functional outcomes of minimally invasive plate osteosynthesis (MIPO) for distal tibial pilon fractures. This paper aims to fill a key literature gap, as no previous reviews have specifically addressed MIPO for tibial pilon fractures or fractures other than those involving the humeral shaft. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was done using PubMed, Embase, Web of Science, and Scopus databases from 2000 to 2022. Inclusion criteria were MIPO treatment in skeletally mature patients, while exclusion criteria were non-English papers, conference abstracts, papers with multiple treatment modalities that didn't analyze MIPO outcomes separately, skeletally immature patients, case reports, and cohorts smaller than five patients. Unpublished papers were also searched using Clinical Trials. Data extraction included general study information, injury specification, outcome measures, and complications. Finally, a risk of bias assessment (RoB) was performed. RESULTS A total of 1732 studies were identified, of which 23 were included in this review, with 673 patients and 678 fractures analyzed. The mean follow-up ranged from 6 to 62.53 months, with most studies representing intermediate to long-term follow-up. Primary outcome measures showed that 87.33% achieved 'excellent to good' results, 8.67% achieved 'fair' results, and 4% achieved 'poor' results. Stratified by fracture type, 76.47%, 80.05%, and 76.92% of AO/OTA type A, B, and C fractures, respectively, achieved 'excellent to good' results. 35.06% of cases reported complications (236 in total). These included one case of deep infection (0.148%), 28 superficial wound infections (4.16%), 4 nonunion cases (0.59%), and 22 malunion instances (3.27%). RoB assessment showed that 52.17% had a moderate overall risk of bias, 39.13% had a serious overall risk of bias, and 8.7% had a critical overall risk of bias. CONCLUSION MIPO technique for pilon fractures showed good functional outcomes and reliability, with low complication rates and should be considered in cases where proper indirect reduction is possible. However, while the evidence is promising, further high-quality studies with larger sample sizes, longer-term follow-up, and comparison to other techniques are needed to evaluate the efficacy and safety of this technique. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yosef Sourougeon
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Derech Sheba 2, Ramat Gan, Israel.
| | - Yuval Barzilai
- Chaim Sheba Medical Center at Tel Hashomer, Derech Sheba 2, Ramat Gan, Israel.
| | - Yahav Haba
- Israeli Defense Forces Medical Corps, Israel.
| | - Barak Spector
- Sackler Faculty of Medicine, Tel Aviv University, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dan Prat
- Department of Orthopedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Derech Sheba 2, Ramat Gan, Israel.
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Wu J, Chen Y, Zhu Y, Wu X, Ren P, Cao F. Clinical efficacy of internal fixation with locking compression plates in the treatment of patients with extremity fractures and the effect on the recovery of limb function. Medicine (Baltimore) 2023; 102:e35884. [PMID: 38050232 PMCID: PMC10695631 DOI: 10.1097/md.0000000000035884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 12/06/2023] Open
Abstract
The purpose of this study was to evaluate the clinical efficacy of internal fixation with locking compression plates (LCP) in the treatment of patients with extremity fractures and the effect on the recovery of limb function. A total of 488 patients with extremity fractures admitted to our hospital from June 2019 to December 2022 were retrospectively analyzed and divided into open reduction and internal fixation (ORIF) group (n = 236) and internal fixation with LCP group (n = 252) according to the surgical procedure. Outcome indicators included intraoperative bleeding, operative time, length of hospital stay, pain duration, quality of life, healing time of the fracture, postoperative complications, and restoration of limb function as per the X-ray examination results and Johner-Wruhs criteria. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the changes of patients' negative emotions before and after treatment. LCP group was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stays, and pain duration compared with ORIF group (P < .05). Compared with ORIF group, LCP group provided more rapid fracture healing in tibial fractures, ulnar fractures, radial fractures, and external ankle fractures (P < .05). Compared with the ORIF group, patients in the LCP group showed better quality of life in terms of physical, psychological and social functions after surgery (P < .05). The incidence of postoperative complications in the LCP group was significantly lower than that in the ORIF group (19.92% vs 7.14%, P < .001). The Self-rating Depression Scale and Self-rating Anxiety Scale scores of the LCP group were lower than those of the ORIF group (P < .05). The recovery of limb function was significantly better in the LCP group than in the ORIF group (97.22% vs 85.17%, P < .001). The overall satisfaction rate of treatment in the LCP group was higher than that in the ORIF group (92.06% vs 81.90%, P < .001). Internal fixation with LCP in patients with extremity fractures can effectively promote the recovery of limb function, reduce the incidence of complications and improve the quality of life of patients.
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Affiliation(s)
- Jun Wu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Yang Chen
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Yin Zhu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Xiaodong Wu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Pengpeng Ren
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Feng Cao
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
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Xie W, Li H, Zhang C, Cui X, Zhang S, Rui Y, Chen H. Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture-dislocations. BMC Musculoskelet Disord 2023; 24:880. [PMID: 37951888 PMCID: PMC10638746 DOI: 10.1186/s12891-023-07020-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023] Open
Abstract
PURPOSE Ankle fracture-dislocations are among the most severe injuries, and the use of an external fixator as a recommended fixation method has some disadvantages. The aim of this study was to compare the clinical outcomes and complication rates of external and K-wire fixations in the treatment of ankle fracture dislocations. METHODS A total of 67 patients with ankle fracture-dislocations requiring temporary external or percutaneous K-wire fixation were included. The exclusion criteria were pilon fractures, open fractures, and those who required acute open reduction internal fixation (ORIF). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a 10-point visual analog scale (VAS) score (range 0-10), and complications before and after the definitive surgery were recorded. RESULTS A significant difference between the two groups was not observed for age, sex, affected side, fracture type, smoking status, or diabetes. The average AOFAS scores were 83.2 and 83.3, the median VAS scores were 3 and 3, and the complication rates were 32.4% and 6.7% in the external and K-wire fixation groups, respectively (p = 0.010). However, skin necrosis, re-dislocation of the ankle, surgical wound infection, and posttraumatic ankle osteoarthritis frequency were not significantly different between the groups, except for pin-sites infection (p = 0.036). CONCLUSION Ankle fracture-dislocations using percutaneous k-wire fixation showed a low rate of complications and favorable clinical outcomes. This method could be a good alternative treatment option for ankle fracture-dislocations.
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Affiliation(s)
- Wenjun Xie
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - He Li
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Cheng Zhang
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Xueliang Cui
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Sheng Zhang
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Yunfeng Rui
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China
| | - Hui Chen
- Department of OrthopaedicsZhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
- Trauma Center, Zhongda Hospital, Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
- Orthopaedic Trauma Institute (OTI), Southeast University, 87 Ding Jia Qiao, Nanjing, Jiangsu, 210009, PR China.
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Shafiq B, Zhang B, Zhu D, Gupta DK, Cubberly M, Stepanyan H, Rezzadeh K, Lim PK, Hacquebord J, Gupta R. Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters. J Orthop Trauma 2023; 37:532-538. [PMID: 37226911 DOI: 10.1097/bot.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To correlate patient-specific and surgeon-specific factors with outcomes after operative management of distal intra-articular tibia fractures. DESIGN Retrospective cohort study. SETTING 3 Level 1 tertiary academic trauma centers. PATIENTS/PARTICIPANTS The study included a consecutive series of 175 patients with OTA/AO 43-C pilon fractures. MAIN OUTCOME MEASUREMENTS Primary outcomes included superficial and deep infection. Secondary outcomes included nonunion, loss of articular reduction, and implant removal. RESULTS The following patient-specific factors correlated with poor surgical outcomes: increased age with superficial infection rate ( P < 0.05), smoking with rate of nonunion ( P < 0.05), and Charlson Comorbidity Index with loss of articular reduction ( P < 0.05). Each additional 10 minutes of operative time over 120 minutes was associated with increased odds of requiring I&D and any treatment for infection. The same linear effect was seen with the addition of each fibular plate. The number of approaches, type of approach, use of bone graft, and staging were not associated with infection outcomes. Each additional 10 minutes of operative time over 120 minutes was associated with an increased rate of implant removal, as did fibular plating. CONCLUSIONS While many of the patient-specific factors that negatively affect surgical outcomes for pilon fractures may not be modifiable, surgeon-specific factors need to be carefully examined because these may be addressed. Pilon fracture fixation has evolved to increasingly use fragment-specific approaches applied with a staged approach. Although the number and type of approaches did not affect outcomes, longer operative time was associated with increased odds of infection, while additional fibular plate fixation was associated with higher odds of both infection and implant removal. Potential benefits of additional fixation should be weighed against operative time and associated risk of complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Babar Shafiq
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Bo Zhang
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Diana Zhu
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Deven K Gupta
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Mark Cubberly
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Hayk Stepanyan
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Kevin Rezzadeh
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY
| | - Philip K Lim
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Jacques Hacquebord
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY
| | - Ranjan Gupta
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
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Ke C, Dong X, Xiang G, Zhu J. Risk factors and nomogram predictive model of surgical site infection in closed pilon fractures. J Orthop Surg Res 2023; 18:582. [PMID: 37553679 PMCID: PMC10408134 DOI: 10.1186/s13018-023-04058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES In this study, we try to investigate the risk factors of postoperative surgical site infection (SSI) in closed pilon fractures and establish a nomogram prediction model. METHODS From January 2012 to June 2021, 516 closed pilon fracture patients were included in this study. Of these, 387 patients were randomly assigned to the training group and 129 patients were assigned to the validation group (3:1). By univariate and multivariate Cox analysis, we identified independent risk factors for postoperative SSI after Pilon fracture. We established a nomogram model and used receiver operating characteristic (ROC) and calibration chart to evaluate its discriminant and calibration. RESULTS SSI occurred in 71 patients in the training group and 23 patients in the validation group. Ultimately, age, preoperative blood sugar, operative time, Tscherne classification and fracture classification were identified as independent risk factors for SSI. The AUC values for SSI of the training and validation group were 0.898 and 0.880, and the P value of the Hosmer-Lemeshow test was 0.125. We established a nomogram prediction model based on age, preoperative blood sugar, operative time, Tscherne classification and fracture classification. CONCLUSION Our nomogram model had good discrimination and calibration power, so it could be used to predict SSI risk in patients with pilon fracture.
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Affiliation(s)
- Chenrong Ke
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Xiaoyu Dong
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Guangheng Xiang
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Juanjuan Zhu
- Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China.
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Murawski CD, Mittwede PN, Wawrose RA, Belayneh R, Tarkin IS. Management of High-Energy Tibial Pilon Fractures. J Bone Joint Surg Am 2023; 105:1123-1137. [PMID: 37235679 DOI: 10.2106/jbjs.21.01377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
➤ Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.➤ Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.g., smoking) should be addressed perioperatively.➤ Delayed internal fixation with interval temporizing external fixation represents the preferred technique for managing most high-energy pilon fractures presenting with characteristically substantial soft-tissue trauma. In some cases, surgeons elect to utilize circular fixation for these scenarios.➤ Although there have been treatment advances, the results have been generally poor, with high rates of posttraumatic arthritis, despite expert care.➤ Primary arthrodesis may be indicated in cases with severe articular cartilage injury that, in the opinion of the treating surgeon, is likely unsalvageable at the time of the index management.➤ The addition of intrawound vancomycin powder at the time of definitive fixation represents a low-cost prophylactic measure that appears to be effective in reducing gram-positive deep surgical site infections.
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Affiliation(s)
- Christopher D Murawski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Incidence and risk factors of ankle fusion after pilon fracture: a retrospective review. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Legallois Y, Baudelle F, Lavignac P, Garcia M, Meynard P, Cadennes A, Ribes C, Fabre T. Tibial pilon fractures treated with a periarticular external fixator: Retrospective study of 47 cases. Orthop Traumatol Surg Res 2022; 108:103148. [PMID: 34785371 DOI: 10.1016/j.otsr.2021.103148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 02/25/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Tibial pilon fractures are a treatment challenge, since there is no true gold standard treatment, and because of potential skin complications. Periarticular external fixation (PAEF) appears to produce good results, but the outcomes with the TL-HEX Trauma™ (Orthofix®, Verona, Italy) have not yet been evaluated. We performed a study with the following objectives: 1) evaluate time to union and union rate; 2) determine clinical and radiological results; 3) detect complications. HYPOTHESIS PAEF will produce comparable fracture union to other external fixator techniques for tibial pilon fractures. METHODS A single center, retrospective study, was done between June 2016 and December 2018. Patients who had a tibial pilon fracture operated with a PAEF were included if they had a minimum of 12 months' follow-up. Forty-seven patients were included; the mean follow-up was 2.45 years (1.2-3.7). The primary endpoint was the time to union and union rate at the final assessment. The secondary endpoints were the joint range of motion, residual pain (VAS), functional scores (AOFAS and SF12) and complication rate. RESULTS The union rate was 70% (33/47) and the mean time to union was 201±79 days (89-369). The range of motion was significantly reduced relative to the contralateral side. Twenty patients had residual pain that averaged 2.9 (1-6) on the VAS. The mean AOFAS score was 74 points (51-95). Twenty patients (43%) suffered at least one complication. DISCUSSION While a PAEF helps to avoid skin complications, in our study, it was associated with a lower union rate and longer time to union than in other published studies. This difference is likely due to a higher rate of open fractures and high-energy trauma in our study, different protocol for return to weightbearing and a different external fixator than other studies. This is the first study reporting the results of the TL-HEX Trauma in this indication. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Yohan Legallois
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Fabien Baudelle
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Pierre Lavignac
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Matthieu Garcia
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Pierre Meynard
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Adrien Cadennes
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - Clément Ribes
- Service de chirurgie orthopédique, MSP de Bordeaux-Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - Thierry Fabre
- Service de chirurgie orthopédique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Liu K, Cai F, Liu Y, Abulaiti A, Ren P, Yusufu A. Risk factors of ankle osteoarthritis in the treatment of critical bone defects using ilizarov technique. BMC Musculoskelet Disord 2021; 22:339. [PMID: 33836698 PMCID: PMC8035717 DOI: 10.1186/s12891-021-04214-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/30/2021] [Indexed: 01/18/2023] Open
Abstract
Background Distraction osteogenesis using the Ilizarov external circular fixator has been applied in lower limb reconstructive surgery widely. The increasing ankle osteoarthritis (OA) progression and severity are often associated with the period of external fixator and the greater relative instability of the ankle joint, but few studies have quantified risk factors directly during this technique. Methods The study was conducted on 236 patients who underwent bone transport surgery for tibias using the Ilizarov external circular fixator from 2008 to 2018. The cumulative incidence of ankle OA diagnoses in patients after the Ilizarov technique treatment was calculated and stratified by risk factors from preoperative and postoperative management. After the data were significant through the Mann-Whitney U test analyzed, odds ratios were calculated using logistic regression to describe factors associated with the OA diagnosis including gender, age, BMI, location of bone defect, diabetes, hypertension, osteoporosis, the history of metal allergy and glucocorticoid intake, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-HF scale scores, defect size (DS), the type of bone transport, the bone union time, external fixator time (EFT), and external fixator index (EFI). Results There were 199 males and 37 females with a mean age of 47 years (range 28–59 years). Out of 236 patients, 49 had an additional treatment for ankle OA after the Ilizarov technique treatment of bone defects (average follow-up time 2.1 years, range 1.6–4.2 years). The incidence of postoperative ankle OA was 20.8 %, with 19 patients classified as K&L grade 3 and seven patients as grade 4. The top five risk factors included double-level bone transport (OR3.79, P = 0.005), EFI > 50days/cm (OR3.17, P = 0.015), age > 45years (OR2.29, P = 0.032), osteoporosis (OR1.58, P < 0.001), BMI > 25 (OR1.34, P < 0.001). Male, BMI > 25, diabetes, osteoporosis, and AOFAS ankle-HF scale scores are the independent risk factors. Conclusions Ilizarov external circular fixator is a safe and effective method of treatment for critical bone defects. The double level bone transport, EFI > 50days/cm, age > 45years, osteoporosis, BMI > 25 are the top five relevant risk factors of ankle OA. The probability of developing ankle OA among patients having three or more risk factors is 50–70 %.
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Affiliation(s)
- Kai Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China
| | - Feiyu Cai
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China
| | - Yanshi Liu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China
| | - Alimujiang Abulaiti
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China
| | - Peng Ren
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, 830054, Urumqi, Xinjiang, China.
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Abstract
OBJECTIVE To identify how diabetes impacts the risk of complications requiring further surgery (deep surgical site infection, nonunion, amputation, and arthrodesis) after pilon fracture fixation. DESIGN Retrospective cohort study. SETTING Level 1 academic trauma center. PATIENTS Two hundred seventy-nine pilon fractures (276 patients) were identified. A retrospective review was performed to find patients who presented for open reduction and internal fixation of a tibial pilon fracture (OTA/AO 43). Patient demographics, medical comorbidities, OTA/AO fracture type, and surgical outcomes were reviewed. INTERVENTION Patients were stratified into cohorts based on the presence or absence of diabetes at the time of surgery. MAIN OUTCOME MEASUREMENTS The complications of interest that proved significant during univariate analyses were then entered into a multivariable logistic regression model using a stepwise method to identify the independent predictors for complications. RESULTS There were 43 fractures (15.4%) in patients with diabetes mellitus; 17 (39.5%) of whom were insulin-dependent diabetics. Diabetic patients were significantly more likely to have a higher body mass index (34.81 vs. 29.57, P = 0.002) and be older (55.30 ± 16.3 years vs. 41.70 ± 14.05, P < 0.001) at the time of injury. Patients without diabetes were more likely to sustain an OTA/AO 43-C3 fracture (36.0% vs. 11.6%, P = 0.001). Diabetic patients were 5.5 times more likely to require an arthrodesis [95% confidence interval (CI) = 1.894-16.214; P = 0.001] and 2.7 times more likely to develop a deep infection (95% CI = 1.261-5.630; P = 0.008). CONCLUSIONS Overall, diabetic patients in this study were 3.64 times more likely (95% CI = 1.854-7.159; P < 0.001) to experience any complication, despite having less complex fractures. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lasun O Oladeji
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and
- Missouri Orthopaedic Institute, Columbia, MO
| | - Brooks Platt
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and
- Missouri Orthopaedic Institute, Columbia, MO
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO; and
- Missouri Orthopaedic Institute, Columbia, MO
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Mehraban N, Holmes GB, Lin J, Lee S, Hamid KS, Bohl DD. Skin Preparation Techniques for Orthopedic Foot and Ankle Surgery: A Current Concepts Review. Foot Ankle Int 2020; 41:1007-1016. [PMID: 32517493 DOI: 10.1177/1071100720925480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Surgical site infection (SSI) following orthopedic foot and ankle surgery is associated with morbidity, mortality, and cost to the healthcare system. The local anatomy and physiology predispose patients undergoing procedures to elevated risk. In particular, sterilizing of the webspaces, nailfolds, and subungual areas presents challenges, and the preferred skin antisepsis technique for foot and ankle procedures has not yet been defined. Skin antiseptic solutions (SASs) consist of 3 main categories: alcohol, chlorhexidine, and iodine-based solutions. This review of the literature supports a combined chlorhexidine and alcohol preparation technique; however, there are a number of studies that suggest otherwise. In addition, there is variable evidence for the use of alternatives to the standard soft sponge application technique, including immersion, bristled brush, and cotton gauze application. These alternatives may have a particular advantage in the forefoot. Most studies to date use growth from skin swab cultures after skin preparation as the primary outcome. Higher-level studies with large subject populations and more meaningful clinical outcomes will be required to solidify guidelines for preoperative skin antisepsis prior to foot and ankle procedures.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Nasima Mehraban
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - George B Holmes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Alt V, Giannoudis PV. Musculoskeletal infections - A global burden and a new subsection in Injury. Injury 2019; 50:2152-2153. [PMID: 31727403 DOI: 10.1016/j.injury.2019.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, Regensburg University Medical Center, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Peter V Giannoudis
- Academic Department of Trauma @ Orthopedic Surgery, School of Medicine, University of Leeds, Leeds, UK.
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Nwankwo EC, Labaran LA, Athas V, Olson S, Adams SB. Pathogenesis of Posttraumatic Osteoarthritis of the Ankle. Orthop Clin North Am 2019; 50:529-537. [PMID: 31466668 DOI: 10.1016/j.ocl.2019.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ankle osteoarthritis affects a significant portion of the global adult population. Unlike other joints, arthritis of the ankle often develops as a response to traumatic injury (intra-articular fracture) of the ankle joints. The full mechanism leading to posttraumatic osteoarthritis of the ankle (PTOAA) is poorly understood. These deficits in knowledge pose challenges in the management of the disease. Adequate surgical reduction of fractured ankle joints remains the gold standard in prevention. The purpose of this review is to thoroughly delineate the known pathogenesis of PTOAA, and provide critical updates on this pathology and new avenues to provide therapeutic management of the disease.
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Affiliation(s)
- Eugene C Nwankwo
- Department of Orthopedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA; Texas Tech University School of Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, USA
| | - Lawal A Labaran
- University of Illinois College of Medicine, 1200 Harrison Street, Chicago, IL 60607, USA
| | - Vincent Athas
- Texas Tech University School of Medicine, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, USA
| | - Steve Olson
- Department of Orthopedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA.
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