Blade Plate With Autogenous Bone Grafting to Salvage Peri Ankle Nonunions.

IF 2.4 2区医学 Q2 ORTHOPEDICS

Foot & Ankle International Pub Date : 2023-06-01 DOI:10.1177/10711007231165303

Mees Paulus Emmelot, Robert Kaspar Wagner, Stein Jasper Janssen, Peter Kloen

{"title":"Blade Plate With Autogenous Bone Grafting to Salvage Peri Ankle Nonunions.","authors":"Mees Paulus Emmelot, Robert Kaspar Wagner, Stein Jasper Janssen, Peter Kloen","doi":"10.1177/10711007231165303","DOIUrl":null,"url":null,"abstract":"Background: Salvage surgery for a nonunion around the ankle is challenging. Poor bone stock, stiffness, scarring, previous (or persistent) infection, and a compromised soft tissue envelope are common in these patients. We describe 15 cases that underwent blade plate fixation as salvage for a nonunion around the ankle, including patient/nonunion characteristics, Nonunion Scoring System (NUSS), surgical technique, healing rate, complications, and long-term follow-up with 2 patient-reported outcome measures.Methods: This is a retrospective case series from a level 1 trauma referral center. We included all patients that underwent blade plate fixation for a long-standing nonunion of the distal tibia, talus, or failed subtalar fusion. All patients had autogenous bone grafting, including 14 with posterior iliac crest grafts and 2 with femoral reamer irrigator aspirator grafting. Median follow-up was 24.4 months (interquartile range [IQR], 7.7-40). Main outcome measures were (time to) union, and functional outcomes using the 36-item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), and the Foot and Ankle Outcome Score (FAOS).Results: We included 15 adults with a median age of 58 years (IQR, 54-62). The median NUSS score at the time of index surgery was 46 (IQR, 34-54). Union was achieved after the index procedure in 11 of 15 patients. Additional surgery was performed in 4 of 15 patients. Union was achieved in all patients at a median of 4.2 months (IQR, 2.9-11). The median score for the PCS was 38 (IQR, 34-48, range 17-58, P = .009), for the MCS 52 (IQR, 45-60, range 33-62, P = .701), and for the FAOS 73 (IQR, 48-83).Conclusion: In this series, our use of blade plate fixation with autogenous grafting was an effective method for managing a nonunion around the ankle allowing for alignment correction, stable compression and fixation, union, and fair patient-reported outcome scores.Level of evidence: Level IV, therapeutic.","PeriodicalId":12446,"journal":{"name":"Foot & Ankle International","volume":"44 6","pages":"516-527"},"PeriodicalIF":2.4000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10248309/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foot & Ankle International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10711007231165303","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Salvage surgery for a nonunion around the ankle is challenging. Poor bone stock, stiffness, scarring, previous (or persistent) infection, and a compromised soft tissue envelope are common in these patients. We describe 15 cases that underwent blade plate fixation as salvage for a nonunion around the ankle, including patient/nonunion characteristics, Nonunion Scoring System (NUSS), surgical technique, healing rate, complications, and long-term follow-up with 2 patient-reported outcome measures.

Methods: This is a retrospective case series from a level 1 trauma referral center. We included all patients that underwent blade plate fixation for a long-standing nonunion of the distal tibia, talus, or failed subtalar fusion. All patients had autogenous bone grafting, including 14 with posterior iliac crest grafts and 2 with femoral reamer irrigator aspirator grafting. Median follow-up was 24.4 months (interquartile range [IQR], 7.7-40). Main outcome measures were (time to) union, and functional outcomes using the 36-item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), and the Foot and Ankle Outcome Score (FAOS).

Results: We included 15 adults with a median age of 58 years (IQR, 54-62). The median NUSS score at the time of index surgery was 46 (IQR, 34-54). Union was achieved after the index procedure in 11 of 15 patients. Additional surgery was performed in 4 of 15 patients. Union was achieved in all patients at a median of 4.2 months (IQR, 2.9-11). The median score for the PCS was 38 (IQR, 34-48, range 17-58, P = .009), for the MCS 52 (IQR, 45-60, range 33-62, P = .701), and for the FAOS 73 (IQR, 48-83).

Conclusion: In this series, our use of blade plate fixation with autogenous grafting was an effective method for managing a nonunion around the ankle allowing for alignment correction, stable compression and fixation, union, and fair patient-reported outcome scores.

Level of evidence: Level IV, therapeutic.

Abstract Image

查看原文本刊更多论文

钢板结合自体骨移植修复踝关节周围骨不连。

背景:踝关节周围骨不连的抢救手术具有挑战性。骨质疏松、僵硬、结疤、既往(或持续)感染和软组织包膜受损在这些患者中很常见。我们描述了15例接受钢板固定治疗踝关节周围骨不连的病例，包括患者/骨不连特征、骨不连评分系统(NUSS)、手术技术、治愈率、并发症和2例患者报告的长期随访结果。方法:这是一个来自一级创伤转诊中心的回顾性病例系列。我们纳入了所有因胫骨远端、距骨不愈合或距下融合失败而接受钢板固定的患者。所有患者均行自体骨移植术，其中髂骨后骨移植术14例，股骨铰刀灌洗器吸引器移植术2例。中位随访时间为24.4个月(四分位数间距[IQR]， 7.7-40)。主要结果测量是(愈合时间)，功能结果使用36项简短健康调查(SF-36)身体成分总结(PCS)和精神成分总结(MCS)，以及足和踝关节结局评分(FAOS)。结果:我们纳入了15名成年人，中位年龄为58岁(IQR, 54-62)。手术时NUSS评分中位数为46分(IQR, 34-54)。15例患者中有11例术后愈合。15例患者中有4例接受了额外手术。所有患者的中位愈合时间为4.2个月(IQR, 2.9-11)。PCS的中位数得分为38分(IQR, 34-48，范围17-58,P = 0.009)， MCS的中位数得分为52分(IQR, 45-60，范围33-62,P = .701)， FAOS的中位数得分为73分(IQR, 48-83)。结论:在本系列研究中，我们采用自体植骨钢板固定是治疗踝关节周围骨不连的有效方法，可实现对齐矫正、稳定的压迫和固定、骨愈合和公平的患者报告结果评分。证据等级:四级，治疗性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine