Ankle Fusion Rates with Anterior Lock Plates : Is there a Difference Between Plating Systems?

Transcription

1 Ankle Fusion Rates with Anterior Lock Plates : Is there a Difference Between Plating Systems? G. Alex Simpson, DO 1 Sean A. Sutphen, DO 2 Mark A. Prissel, DPM 3 Kyle S. Peterson, DPM 4 Christopher Hyer, DPM 5 Gregory C. Berlet, MD 5 1. Attending Physician, Front Range Orthopedics, Colorado Springs, CO 2. Orthopedic Surgery Resident, Dept. of Orthopedics, Doctors Hospital, Columbus, OH 3. Fellow, Orthopedic Foot & Ankle Center, Westerville, OH 4. Attending Physician, Suburban Orthopaedics, Bartlett, IL 5. Attending Physician, Orthopedic Foot & Ankle Center, Westerville, OH

2 G. Alex Simpson, DO Augmented Ankle Fusion Rates with Anterior Lock Plates: Is there a Difference Between Plating Systems? My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Ankle Arthrodesis Bony consolidation of tibia & talus Eliminate pain in endstage arthritis Arthroplasty salvage

4 Fixation Methods Plate and screw combination Plates Anterior Anterolateral Posterior Lateral Screws only

5 Ankle arthrodesis Objective: Describe Fusion rates: Anterior locking plates Superior to screws alone (50-80%) Compare designs Integra vs. Wright

6 Retrospective Study IRB- approved chart and radiograph review ( ) Inclusion: Adult patients with ankle arthritis requiring primary ankle fusion. Lag screw + anterior locking plate fixation Integra and Wright Medical Technologies plates Exclusion: Concomitant subtalar joint fusion, lateral approach, fibular onlay technique, external fixation, revision surgery, minors.

7 Methods & Materials Clinical measures Days to full weight bearing Time to regular shoe wear Time to physical therapy Complication rates Hardware removal rates Radiographic measures Bony consolidation (3 cortices) Date of consolidation Fusion positioning Talocrural angle Tibial axis-talar ratio Lateral dorsiflexion angle

8 98% Union Rate 47 out of 48 total cases Results No difference between plating groups regarding Time to fusion Days to WB Time to shoe wear Time to P.T. Joint positioning Normal Talocrural angle= 66% Normal dorsiflexion angle= 87.2% Normal Tibial axis-talar ratio= 42.6

9 Results Complications Non-union (1 pt./ WMT plate) Required revision Hardware removal (10 pts.) Neurosensory disturbance (4 pts.) Infection ( 4 pts.)

10 Discussion Locked plating yields successful fusion rates Limited comparison studies Multiple fixation options Largest reported cohort of ankle arthrodesis with anterior locking plate fixation to date.

11 Conclusion Ankle fusion rates are enhanced with the use of an anterior locked plate when compared to screw fixation alone. No difference in outcomes between WMT and Integra brand plates.

12 References 1. Agel J; Coetzee JC; Sangeorzan BJ; Roberts MM; Hansen ST Jr. Functional limitations of patients with end-stage ankle arthrosis. Foot Ankle Int Jul;26( 7): Haddad SL; Coetzee JC; Estok R; Fahrbach K; Banel D; Nalysnyk L. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am. 2007;89: AaronAD. Ankle fusion: a retrospective review. Orthopedics,1990;13: KitaokaHB. Arthrodesis of the ankle: technique, complications, and salvage treatment. Instr Course Lect,1999;48: MoeckelBH, Patterson BM, Inglis AE,Sculco TP. Ankle arthrodesis. A comparison of internal and external fixation. Clin Orthop,1991;268: CoesterLM, Saltzman CL, Leupold J,Pontarelli W. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am,2001;83: FriedmanRL, Glisson RR,Nunley JA 2nd. A biomechanical comparative analysis of two techniques for tibiotalar arthrodesis. Foot Ankle Int,1994;15: ChenYJ, Huang TJ, Shih HN, Hsu KY,Hsu RW. Ankle arthrodesis with cross screw fixation. Good results in 36/40 cases followed 3-7 years. Acta Orthop Scand,1996;67: MonroeMT, Beals TC,Manoli A 2nd. Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws. Foot Ankle Int,1999;20: Technique and short-term results of ankle arthrodesis using anterior platingaly Mohamedean, Hatem G. Said, Mohammad El-Sharkawi, Wael El-Adly, Galal Z. Said Int Orthop August; 34(6): Published online 2009 September Tochigi Y, Suh JS, Saltzman CL, Pedersen, DR Amendola A. Ankle Alignment on Lateral Radiographs: Part 1: Sensitivity of Measures to Perturbations of Ankle Positioning. Foot Ankle Int February; 27(2): Veljkovic A, Norton A, Salat P, Saltzman C, Femino J, Phisitkul P, Amendola A.Lateral Talar Station: A Clinically Reproducible Measure of Sagittal Talar Position. Foot Ankle Int Aug Tochigi Y, Suh JS, Amendola A, Saltzman CL. Ankle Alignment on Lateral Radiographs: Part 2: Reliability and Validity of Measures.Foot Ankle Int February; 27(2):