Kae Sian Tay, Mickhael Langit, Carl Fenton, Rachael Grupping, Ross Muir, Elizabeth Moulder, Hemant Sharma
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Factors influencing radiologic and clinical outcomes were analyzed.</p><p><strong>Results: </strong>47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT.</p><p><strong>Conclusion: </strong>Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. 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引用次数: 0
摘要
背景:用于踝关节融合的圆形框架用于复杂的临床情况。文献是异质的和相互矛盾的。我们的目的是介绍该手术的适应症和结果。方法:回顾性队列研究基于前瞻性数据库框架手术在一所高等院校进行。纳入标准是2005年至2020年间接受环形框架复杂踝关节融合的患者，至少随访12个月。收集了患者人口统计学、手术指征、合并症、手术程序、外固定架时间(EFT)、住院时间(LOS)、放射学和临床结果以及不良事件的数据。分析影响放射学和临床结果的因素。结果:纳入47例患者，中位随访30个月(四分位数间距[IQR] 20-40)。手术时的中位年龄为63.5岁(IQR为58-71)。患者既往手术中位数为2次(IQR 1-3)。中位LOS为8.5天，中位EFT为237天(IQR 166-280)。11例患者同时行肢体延长术(中位3.3 cm, IQR 1.9-3.5)， EFT平均延长4个月。初愈合率91.5%，终愈合率95.7%。最后随访ASAMI骨评分优或良者占87.2%。ASAMI功能评分良好者占79.1%。患者满意度为83.7%。此外，97.7%的患者出现不良事件，最常见的是与针位相关，30.2%的患者出现严重并发症，60.5%的患者再次手术。有3例截肢。不良事件与年龄增加、软组织状况不佳、严重畸形、距下融合、周围神经病变、周围血管疾病和延长EFT有关。结论:使用圆形框架进行复杂踝关节融合可获得良好的效果，但可能会延长框架内的时间，并且不良事件发生率高。在患者咨询和预测时，应考虑已确定的不良预后风险因素。证据等级:III级，预后不良。
Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction.
Background: Circular frames for ankle fusion are reserved for complex clinical scenarios. The literature is heterogenous and conflicting. We aim to present the indications and outcomes of this procedure.
Methods: A retrospective cohort study based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow-up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiologic and clinical outcomes, and adverse events. Factors influencing radiologic and clinical outcomes were analyzed.
Results: 47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT.
Conclusion: Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. Identified risk factors for poorer outcomes should be considered in patient counselling and prognostication.
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
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