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Fracture Reduction and Primary Ankle Arthrodesis: A Reliable Approach for Severely Comminuted Tibial Pilon Fracture

  • Symposium: 2013 Limb Lengthening and Reconstruction Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns.

Questions/purposes

(1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used?

Methods

During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6–22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation.

Results

All of the ankle arthrodeses healed at an average of 4.4 months (range, 3–5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion.

Conclusions

Primary ankle arthrodesis combined with fracture reduction for the severely comminuted tibial pilon fracture reliably healed and restored acceptable function in this highly selective patient group. Ring external fixation may be a useful adjunct to internal fixation, and this concept should be further studied.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Kari Komloske FNP, and Paula Kupier PA, for their assistance in patient contact and data collection and Paxton Gehling for editorial assistance.

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Authors and Affiliations

  1. Summit Orthopaedics, 501 North Graham, Suite 250, Portland, OR, 97227, USA

    Douglas N. Beaman MD & Richard Gellman MD

Authors
  1. Douglas N. Beaman MD
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  2. Richard Gellman MD
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Correspondence to Douglas N. Beaman MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Beaman, D.N., Gellman, R. Fracture Reduction and Primary Ankle Arthrodesis: A Reliable Approach for Severely Comminuted Tibial Pilon Fracture. Clin Orthop Relat Res 472, 3823–3834 (2014). https://doi.org/10.1007/s11999-014-3683-x

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  • DOI: https://doi.org/10.1007/s11999-014-3683-x

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