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Ankle-sparing bone transport effective for periarticular distal tibial nonunions
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The ankle-sparing bone transport approach was effective for the treatment of periarticular distal tibial nonunions and was considered safe for patients with infected nonunions that were close to the ankle joint.
“Prior to fusing ankles for these conditions, it may be worth seeking the opinion of an expert in external fixators for ankle conditions,” Ettore Vulcano, MD, assistant professor of orthopedics at the Icahn School of Medicine at Mount Sinai, told Healio.com/Orthopedics. “Despite being an excellent procedure, ankle fusions should be avoided whenever possible. Surgeons living in proximity to orthopedists trained in complex ankle reconstructions with external fixators should consider referring said patients.”
He added, “Nonetheless, the low availability (numerically and geographically speaking) of specialized orthopedic surgeons, as well as the difficulty of some patients to travel to the nearest specialist (which may be many hours away), can make access to care challenging.”
Researchers identified 21 patients who underwent ankle-sparing bone transport, with a man age of 48.6 years and 71% were men. On average, researchers followed the patients for 14.6 months. Time to union and the American Orthopaedic Foot and Ankle Society (AOFAS) score were among the primary endpoints. There were 13 patients with infected nonunions.
Results showed union was achieved in all fractures, with a mean time to union of 37.4 weeks. Investigators noted the mean AOFAS score was 86.3 points. One patient with preexisting Charcot foot had an AOFAS score of 37. At 6 months, the radiographic evaluation showed the mean lateral distal tibial angle and the mean anterior distal tibial angle was 89.2 degrees and 76 degrees, respectively. In all patients, the leg length discrepancy was less than 1.2 cm.
According to researchers, seven patients had superficial pin infection and three patients had operative wound infection at the level of bone resection. – by Monica Jaramillo
Disclosure: Vulcano reports no relevant financial disclosures.
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