Does the Subtalar or Tibiotalar Joint Need Fused in Primary Retrograde Tibiotalocalcaneal Nailing for Fragility Ankle Fractures?

Daniel T DeGenova, Zachary P Hill, Adam D Hoffman, Avery R Taylor, Boston Dues, Mallory Faherty, Benjamin C Taylor
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Abstract

Background: As an alternative to traditional open reduction internal fixation of ankle fragility fractures, primary retrograde tibiotalocalcaneal (TTC) nailing has been investigated as a treatment option. These results suggest that this treatment is an acceptable alternative treatment option for these injuries. There are still questions about the need for formal joint preparation at the subtalar or tibiotalar joint when performing primary TTC nailing for fragility fractures.

Methods: In this study, we retrospectively evaluated 32 patients treated with primary retrograde TTC nail without subtalar or tibiotalar joint preparation for a mean of 2.4 years postoperatively. We specifically reviewed the charts for nail breakages at either joint, patients developing subtalar or tibiotalar joint pathology requiring additional treatment, including return to the operating room for formal joint preparation.

Results: Fracture union occurred in 100% of patients. There were 3 cases (10.0%) of hardware failure, and 2 of these cases were asymptomatic and did not require any treatment. One patient (3.3%) developed hardware failure with nail breakage at the subtalar joint. This patient developed progressive pain and symptoms requiring revision surgery with formal arthrodesis of the subtalar and tibiotalar joint.

Conclusions: This study shows that retrograde hindfoot nailing without formal subtalar or tibiotalar joint preparation is an acceptable potential treatment option in ankle fragility fractures. Mid-term follow-up demonstrates favorable outcomes without the need for formal joint preparation in this high-risk population. Comparative studies with higher patient numbers and long-term follow-up are needed to confirm the results of this study.Levels of Evidence: Level IV.

原发性胫骨踝关节逆行钉治疗脆性踝关节骨折时,需要融合胫骨下关节还是胫骨踝关节?
背景:作为传统的踝关节脆性骨折切开复位内固定术的替代方案,研究人员对胫骨踝关节(TTC)原发性逆行钉进行了研究。这些结果表明,这种治疗方法是可以接受的替代治疗方案。在对脆性骨折进行原发性 TTC 钉治疗时,是否需要在距骨下或胫骨关节处进行正式的关节准备仍存在疑问:在这项研究中,我们回顾性评估了 32 例接受原发性逆行 TTC 钉治疗的患者,这些患者术后平均 2.4 年未进行踝关节或胫骨关节准备。我们特别查看了病历,以确定是否有钉子在任一关节处断裂,是否有患者出现了需要额外治疗的距骨下或胫骨关节病变,包括返回手术室进行正式的关节准备:100%的患者骨折愈合。有3例患者(10.0%)出现硬件故障,其中2例患者无症状,无需任何治疗。一名患者(3.3%)出现了硬件故障,钉子在踝关节处断裂。这名患者出现了进行性疼痛和症状,需要进行翻修手术,并在距骨下关节和胫骨小关节处进行正式的关节固定术:这项研究表明,对于踝关节脆性骨折,不进行正式的踝关节或胫骨关节准备的逆行后足钉是一种可接受的潜在治疗方案。中期随访结果表明,在这一高风险人群中,无需进行正式关节准备即可获得良好疗效。需要进行更多患者人数和长期随访的比较研究,以证实本研究的结果:证据等级:IV 级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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