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Promising results seen with circular external fixation for correction of ankle soft tissue contractures
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Circular external fixation was effective for gradual correction of ankle soft tissue contractures, according to a presentation at the Limb Lengthening and Reconstruction Society Annual Scientific Meeting.
“The technique of using circular external fixation for gradual correction of ankle soft tissue contractures is a safe and effective method to correct deformity,” Rachael Da Cunha, MD, FRCSC, an orthopedic surgery fellow in limb lengthening and complex deformity reconstruction at Hospital for Special Surgery, told Healio.com/Orthopedics. “It should be considered in patients who are not amenable to acute correction due to soft tissue compromise and the risk of complication, or the severity of deformity and inability to achieve full correction.”
De Cunha and colleagues used prospectively collected registry data to perform a retrospective chart review of 42 ankles in 38 consecutive patients who underwent gradual correction of an ankle contracture with circular or hexapod external fixation. The contracture type, etiology, degree of severity, deformity duration, correction achieved, concomitant procedures, complications and recurrences were determined. Twenty-nine cases had complete charts that could be reviewed, and 31 cases were included in the radiographic analysis. The Foot and Ankle Outcome Score was used to evaluate clinical outcomes at a minimum 1-year follow-up.
Results showed equinovarus deformity in 12 patients and pure equinus deformities in 17 patients. Equinus contractures significantly improved preoperatively to post-fixator removal from a mean of 33.9° to 1.4°. All varus contractures also significantly improved preoperatively to post-fixator removal from 20° to 0°. Based on radiographs, equinus contractures significantly improved preoperatively to post-fixator removal from mean of 32.8° to 0.5°. Subsequent procedures such as ankle arthrodesis, posterior tibial tendon transfer and total ankle replacement were needed in 11 patients.
According to researchers, three patients had recurrence of equinus and all patients with recurrence had post-traumatic etiology with prior fracture fixation. Investigators found no significance between etiology, patient age, deformity severity or deformity duration and recurrence or incomplete deformity correction. – by Monica Jaramillo
Reference:
Fragomen AT, et al. The use of circular external fixation for gradual correction of ankle contractures. Presented at: Limb Lengthening and Reconstruction Society Annual Scientific Meeting; July 13-14, 2018; San Francisco.
Disclosure: Da Cunha reports no relevant financial disclosures.