{"title":"Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients","authors":"","doi":"10.1016/j.otsr.2024.103901","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population.</div></div><div><h3>Methods</h3><div>All patients were obese (BMI<!--> <!-->><!--> <!-->30<!--> <!-->kg/m<sup>2</sup>) and presented ankle osteoarthritis with<!--> <!-->><!--> <!-->10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score.</div></div><div><h3>Results</h3><div>Group S presented 31% non-union (10/32) and group P 0% (0/10) (<em>p</em> <!--><<!--> <!-->0.05). Postoperative AOFAS score was significantly higher in group P: 67.8<!--> <!-->±<!--> <!-->10.4 [range, 40–92] vs. 83.1<!--> <!-->±<!--> <!-->8.0 [range, 64–92] (<em>p</em> <!--><<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity<!--> <!-->><!--> <!-->10°, to limit the risk of non-union.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1877056824001427","RegionNum":3,"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
Introduction
Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population.
Methods
All patients were obese (BMI > 30 kg/m2) and presented ankle osteoarthritis with > 10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score.
Results
Group S presented 31% non-union (10/32) and group P 0% (0/10) (p < 0.05). Postoperative AOFAS score was significantly higher in group P: 67.8 ± 10.4 [range, 40–92] vs. 83.1 ± 8.0 [range, 64–92] (p < 0.05).
Conclusion
The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity > 10°, to limit the risk of non-union.
期刊介绍:
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.