Lamm BM, Issa K, Kapadia BH, Naziri Q, Jones LC, Mont MA. Percutaneous Drilling for Early-Stage Osteonecrosis About the Ankle.
JBJS Essent Surg Tech 2014;
4:e21. [PMID:
30775128 DOI:
10.2106/jbjs.st.m.00069]
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Abstract
Introduction
The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising.
Step 1 Preoperative Planning for a Lateral Talar Lesion
Obtain anteroposterior and lateral ankle radiographs as well as magnetic resonance imaging (MRI) studies of the ankle to evaluate the stage of the osteonecrotic disease.
Step 2 Percutaneous Pin Insertion Lateral Talar Lesion
Insert a 1.8-mm Steinmann pin or Ilizarov wire percutaneously under biplanar fluoroscopic visualization.
Step 3 Percutaneous Drilling
Make one, two, or three passes with a 3.2-mm cannulated drill bit over the pin into the lesion(s).
Step 4 Backfilling the Bone Tunnel Optional
Infiltrate the defect with demineralized bone matrix to backfill the drill track and the deep necrotic bone defect.
Step 5 Postoperative Management
The patient bears weight as tolerated in a removable short leg rigid boot for the first four weeks and avoids high-impact activities for at least ten months.
Results
In our study, there were significant improvements in the mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score (p = 0.001), University of California Los Angeles (UCLA) activity score (p = 0.025), and visual analog scale (VAS) pain score (p = 0.001) at a mean of five years (range, two to nine years) postoperatively.IndicationsContraindicationsPitfalls & Challenges.
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