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Staged distraction osteogenesis followed by arthrodesis using internal fixation as a form of surgical treatment for complex conditions of the ankle.

Abstract Aims The aim of this study was to describe the technique of distraction osteogenesis followed by arthrodesis using internal fixation to manage complex conditions of the ankle, and to present the results of this technique. Patients and Methods Between 2008 and 2014, distraction osteogenesis followed by arthrodesis using internal fixation was performed in 12 patients with complex conditions of the ankle due to trauma or infection. There were eight men and four women: their mean age was 35 years (23 to 51) at the time of surgery. Bone healing and functional recovery were evaluated according to the criteria described by Paley. Function was assessed using the ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS). Results A solid fusion of the ankle and eradication of infection was achieved in all patients. A mean lengthening of 6.1 cm (2.5 to 14) was achieved at a mean follow-up of 25.2 months (14 to 37). The mean external fixation index (EFI) was 42 days/cm (33.3 to 58). The function was judged to be excellent in six patients and good in six patients. Bone results were graded as excellent in ten patients and good in two patients. The mean AOFAS score was 37.3 (5 to 77) preoperatively and 75.3 (61 to 82) at the final follow-up. Minor complications, which were treated conservatively, included pain, pin-tract infection, loosening of wires, and midfoot stiffness. Major complications, which were treated surgically included grade V pin-tract infection with inflammation and osteolysis, poor consolidation of the regenerate bone, and soft-tissue invagination. The reoperations required to treat the major complications included the exchange of pins and wires, bone grafting and invagination split surgery. Conclusion The technique of distraction osteogenesis followed by arthrodesis using internal fixation is an effective form of treatment for the management of complex conditions of the ankle. It offers a high rate of union, an opportunity to remove the frame early, and a reduced EFI without infection or wound dehiscence. Cite this article: Bone Joint J 2018;100-B:755-60.
PMID
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Authors

Mayor MeshTerms
Keywords

Ankle arthrodesis

Distraction osteogenesis

Staged technique

Journal Title the bone & joint journal
Publication Year Start




PMID- 29855238
OWN - NLM
STAT- MEDLINE
DCOM- 20180612
LR  - 20180612
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 6
DP  - 2018 Jun 1
TI  - Staged distraction osteogenesis followed by arthrodesis using internal fixation
      as a form of surgical treatment for complex conditions of the ankle.
PG  - 755-760
LID - 10.1302/0301-620X.100B6.BJJ-2017-1188.R1 [doi]
AB  - Aims The aim of this study was to describe the technique of distraction
      osteogenesis followed by arthrodesis using internal fixation to manage complex
      conditions of the ankle, and to present the results of this technique. Patients
      and Methods Between 2008 and 2014, distraction osteogenesis followed by
      arthrodesis using internal fixation was performed in 12 patients with complex
      conditions of the ankle due to trauma or infection. There were eight men and four
      women: their mean age was 35 years (23 to 51) at the time of surgery. Bone
      healing and functional recovery were evaluated according to the criteria
      described by Paley. Function was assessed using the ankle-hindfoot scale of the
      American Orthopedic Foot and Ankle Society (AOFAS). Results A solid fusion of the
      ankle and eradication of infection was achieved in all patients. A mean
      lengthening of 6.1 cm (2.5 to 14) was achieved at a mean follow-up of 25.2 months
      (14 to 37). The mean external fixation index (EFI) was 42 days/cm (33.3 to 58).
      The function was judged to be excellent in six patients and good in six patients.
      Bone results were graded as excellent in ten patients and good in two patients.
      The mean AOFAS score was 37.3 (5 to 77) preoperatively and 75.3 (61 to 82) at the
      final follow-up. Minor complications, which were treated conservatively, included
      pain, pin-tract infection, loosening of wires, and midfoot stiffness. Major
      complications, which were treated surgically included grade V pin-tract infection
      with inflammation and osteolysis, poor consolidation of the regenerate bone, and 
      soft-tissue invagination. The reoperations required to treat the major
      complications included the exchange of pins and wires, bone grafting and
      invagination split surgery. Conclusion The technique of distraction osteogenesis 
      followed by arthrodesis using internal fixation is an effective form of treatment
      for the management of complex conditions of the ankle. It offers a high rate of
      union, an opportunity to remove the frame early, and a reduced EFI without
      infection or wound dehiscence. Cite this article: Bone Joint J 2018;100-B:755-60.
FAU - Lou, T-F
AU  - Lou TF
AD  - Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's
      Hospital, Shanghai, China.
FAU - Hamushan, M
AU  - Hamushan M
AD  - Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's
      Hospital, Shanghai, China.
FAU - Li, H
AU  - Li H
AD  - State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute,
      Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
FAU - Wang, C-Y
AU  - Wang CY
AD  - Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's
      Hospital, Shanghai, China.
FAU - Chai, Y
AU  - Chai Y
AD  - Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's
      Hospital, Shanghai, China.
FAU - Han, P
AU  - Han P
AD  - Orthopaedic Department, Shanghai Jiao Tong University Affiliated Sixth People's
      Hospital, Shanghai, China.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Adult
MH  - Ankle Joint/pathology/*surgery
MH  - Arthrodesis/adverse effects/*methods
MH  - Female
MH  - Fracture Fixation/adverse effects/*methods
MH  - Humans
MH  - Joint Diseases/*surgery
MH  - Male
MH  - Middle Aged
MH  - Orthopedic Fixation Devices/adverse effects
MH  - Osteogenesis, Distraction/adverse effects/*methods
MH  - Recovery of Function
MH  - Reoperation/statistics & numerical data
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Ankle arthrodesis
OT  - Distraction osteogenesis
OT  - Staged technique
EDAT- 2018/06/02 06:00
MHDA- 2018/06/13 06:00
CRDT- 2018/06/02 06:00
PHST- 2018/06/02 06:00 [entrez]
PHST- 2018/06/02 06:00 [pubmed]
PHST- 2018/06/13 06:00 [medline]
AID - 10.1302/0301-620X.100B6.BJJ-2017-1188.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Jun 1;100-B(6):755-760. doi:
      10.1302/0301-620X.100B6.BJJ-2017-1188.R1.