OTA 2006 Posters
Scientific Poster #45 Foot and Ankle
Limb Salvage Reconstruction of the Ankle with Simultaneous Arthrodesis
and Tibial Lengthening
Nazzar Tellisi, MD (a,b-EBI, Smith+Nephew);
Austin T. Fragomen, MD (a-EBI & Smith+Nephew);
Svetlana Ilizarov, MD (a-EBI, Smith+Nephew);
S. Robert Rozbruch, MD (a-EBI, Smith+Nephew);
Hospital for Special Surgery, New York, New York, USA
Purpose: Despite improving methods for the early treatment
of complex fractures involving the ankle joint, many patients develop debilitating
ankle arthritis often associated with deformity and bone loss. Osteonecrosis
of the talus, collapse of the plafond, and resection of nonviable bone cause
bone loss with significant leg-length discrepancy. The technique of ankle
arthrodesis combined with simultaneous proximal tibial lengthening using
circular external fixation has been very effective in providing patients
with an infection-free and functional limb.
Methods: 11 patients underwent staged ankle arthrodesis and proximal
tibial lengthening for limb salvage using the Ilizarov/Taylor Spatial Frame.
Preoperative diagnosis included ankle arthritis and bone loss from failed
previous arthrodesis for chronic pilon fracture (2), infected pilon nonunion
(3), traumatic talar osteonecrosis (4), failed total ankle replacement after
pilon fracture (1), and repetitive microfracture in a diabetic Charcot ankle
(1). Average age was 40years old (range, 10-59). Average number of previous
surgeries was 4 (range, 2-10). Six patients had osteomyelitis. Two patients
were smoking during treatment. In five patients, tibiocalcaneal fusion was
performed. Proximal tibial osteoplasty was performed 4 weeks (range, 3-6)
after the index arthrodesis surgery.
Results: Average time in the frame was 8 months (range, 5-23). Average
amount of lengthening was 6.6cm (range, 2-15 cm). Average AOFAS score was
72 (range, 55-100). Average ASAMI bone score was excellent and functional
score was good. SF-36 scores increased in all 8 categories. AAOS LLM score
increased an average of 7 points from preoperative scores. All osteotomy
sites healed. Both smoking patients had nonunions of the fusion site (P
= 0.03). One elected amputation; the other obtained union after revision
surgery. No other patients had nonunion or amputation. One patient developed
significant valgus deformity through the regenerate that required a corrective
osteotomy. One patient needed IV antibiotics for cellulites.
Conclusion: Despite modest increases in functional scores, 10 of
the 11 patients were very satisfied with their final result and would do
it again.
Significance: Ankle arthrodesis with proximal tibial lengthening
using the Ilizarov method and the Taylor Spatial Frame is well tolerated
and offers a reliable solution to very complex lower limb pathology. This
technique is effective for limb salvage in many patients whose only other
recourse is below-knee amputation.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.