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Outcomes after primary ankle arthrodesis in recent fractures of the distal end of the tibia in the elderly: a systematic review

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Abstract

Purposes

Management of distal tibia fractures in the elderly is complex. The results of conservative treatments may be disappointing and primary ankle arthrodesis is now regularly offered as an alternative. In this study, we aimed to review the outcomes of primary ankle arthrodesis for distal tibia fracture in the elderly.

Methods

We conducted a systematic review of the literature, from the Cochrane, MEDLINE, and Embase databases, on studies published in English and in French between 1950 and 2020. Only studies reporting the clinical results, the function, or the complications of primary ankle arthrodesis after ankle fracture in the elderly were included.

Results

We included nine studies. The total number of patients was 229: 21% of them (50/229) sustained open fractures and 41% (95/229) had three or more comorbidities. All the patients underwent a tibio-talo-calcaneal arthrodesis with a retrograde transplantar intramedullary nailing (TIMN): short nail in 52% (151/229) and long nail in 48% (78/229) of the cases. At a mean follow-up comprised between six and 21 months, 94.5% of patients (190/201) achieved bone union, 87% (123/140) recovered an ankle range of motion close to their pre-operative status, 19% (40/211) had a complication, and 11.3% (24/211) required a revision. The use of a short nail resulted in a higher rate of peri-implant complication (2%) as well as a higher rate of revision (12.4%).

Conclusion

Primary ankle arthrodesis in recent fractures of the distal end of the tibia in the elderly frequently results in satisfactory results. The use of a long nail may be associated with a lower rate of implant specific complications.

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Authors and Affiliations

  1. Department of Orthopaedic, Trauma and Reconstructive Surgery, Antoine Béclère Hospital, APHP, Paris Saclay University, 157 rue de la Porte de Trivaux, 92140, Clamart, France

    Wael Ben Fadhel, Léa Taieb, Benoît Villain, Nasser Mebtouche, Stéphane Levante, Thierry Bégué & Jean-Charles Aurégan

  2. Université Paris-Saclay CIAMS, 91405, Orsay, France

    Benoît Villain, Thierry Bégué & Jean-Charles Aurégan

  3. Université d’Orléans, CIAMS, 45067, Orléans, France

    Benoît Villain, Thierry Bégué & Jean-Charles Aurégan

Authors
  1. Wael Ben Fadhel
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  2. Léa Taieb
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  3. Benoît Villain
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  4. Nasser Mebtouche
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  5. Stéphane Levante
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  6. Thierry Bégué
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  7. Jean-Charles Aurégan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Wael Ben Fadhel and Léa Taieb. The first draft of the manuscript was written by Wael Ben Fadhel, Léa Taieb, and Thierry Bégué; then, all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jean-Charles Aurégan.

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This is a systematic review of the literature. The Local Research Ethics Committee has confirmed that no ethical approval is required.

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The authors declare no competing interests.

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Fadhel, W.B., Taieb, L., Villain, B. et al. Outcomes after primary ankle arthrodesis in recent fractures of the distal end of the tibia in the elderly: a systematic review. International Orthopaedics (SICOT) 46, 1405–1412 (2022). https://doi.org/10.1007/s00264-022-05317-0

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  • DOI: https://doi.org/10.1007/s00264-022-05317-0

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