Osteosynthesis and Trauma Care 2007; 15(4): 150-154
DOI: 10.1055/s-2008-1004793
Original Article

© Georg Thieme Verlag Stuttgart · New York

Stabilization of Ankle Fragility Fractures with a Transtibiocalcaneal Fusion Nail

T. T. Lögters1 , M. Hakimi1 , S. Thelen1 , J. Windolf1 , W. Linhart1
  • 1Department of Trauma- and Hand Surgery, University Hospital Düsseldorf, Germany
Further Information

Publication History

Publication Date:
11 June 2008 (online)

Abstract

Introduction: Incidence of ankle fractures in the elderly population increased for the last years. Osteoporosis, compromised soft tissue conditions, vascular supply, and systemic diseases enhance the high demands on fracture management. Here, early results of ankle fracture fixation with transtibiocalcaneal arthrodesis in elderly patients are reported. Patient and methods: Five patients with an unstable ankle fracture were included into this prospective study. All of them underwent closed reduction and transtibiocalcaneal arthrodesis by intramedullary nailing (Hindfoot Fusion Nail, Trigen, smith & nephew). Cartilage of tibiotalar and subtalar joint was left intact. Postoperatively early mobilisation with full weight bearing in a Vacoped® boot was allowed. Results: The mean age of patients was 76 ± 11 years (range: 74-87). There were no intraoperative complications. One patient showed postoperatively a heel ulcer with subsequent superficial infection at a screw entry point, which requires screw removal. Postoperative radiographics before and after mobilisation revealed satisfactory reduction results and sufficient arthrodesis without secondary dislocation for all patients. Conclusion: Arthrodesis of unstable ankle fractures with transtibiocalcaneal intramedullary nailing allows immediate return to full weight bearing and has a low risk of complications. Therefore Hindfoot nail arthrodesis of ankle fractures might be appropriate particularly for patients with severe comorbidities, poor bone stock, and reduced tissue conditions.

References

  • 1 Adams C J. Arthrodesis of the ankle joint.  J Bone Joint Surg [Br]. 1948;  30 506-511
  • 2 Amirfeyz R, Bacon A, Ling J, Blom A, Hepple S, Winson I, Harries W. Fixation of ankle fragility fractures by tibiotalocalcaneal nail.  Arch Orthop Trauma Surg. 2008;  ,  [Epub ahead of print]
  • 3 Anderson T, Linder L, Rydholm U, Montgomery F, Besjakov J, Carlsson A. Tibio-talocalcaneal arthrodesis as a primary procedure using a retrograde intramedullary nail: a retrospective study of 26 patients with rheumatoid arthritis.  Acta Orthop. 2005;  76 580-587
  • 4 Astion D J, Deland J T, Otis J C, Kenneally S. Motion of the hindfoot after simulated arthrodesis.  J Bone Joint Surg [Am]. 1997;  79 241-246
  • 5 Beauchamp C G, Clay N R, Thexton P W. Displaced ankle fractures in patients over 50 years of age.  J Bone Joint Surg [Br]. 1983;  65 329-332
  • 6 Boer R, Mader K, Pennig D, Verheyen C C. Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail.  Clin Orthop Relat Res. 2007;  463 151-156
  • 7 Buck P, Morrey B F, Chou E Y. The optimum position of arthrodesis of the ankle: a gait study of the knee and ankle.  J Bone Joint Surg [Am]. 1987;  69 1052-1062
  • 8 Childress H M. Vertical transarticular pin fixation for unstable ankle fractures: impressions after 16 years of experience.  Clin Orthop Relat Res. 1976;  120 164-171
  • 9 Cole P A, Craft J A. Treatment of osteoporotic ankle fractures in the elderly: surgical strategies.  Orthopedics. 2002;  25 427-430
  • 10 Court-Brown C, McQueen M, Tornetta P. Ankle fractures. In: Tornetta P, Einhorn T (eds). Trauma. Lippincott Williams and Wilkins, Philadelphia 2006; 366-382
  • 11 Court-Brown C, McBirnie J, Wilson G. Adult ankle fractures: an increasing problem.  Acta Orthop Scand. 1998;  69 43-47
  • 12 Faraj A A, Monkhouse R. Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age.  J Bone Joint Surg [Br]. 2002;  84 774-775
  • 13 Houshian S, Bajaj S K, Mohammed A M. Salvage of osteoporotic ankle fractures after failed primary fixation with an ankle arthrodesis nail: A report on four cases.  Injury. 2006;  37 791-794
  • 14 Kettunen J, Kröger H. Surgical treatment of ankle and foot fractures in the elderly.  Osteoporos Int. 2005;  16 Suppl 2 103-106
  • 15 Kitaoka H B, Anderson P J, Morrey B F. Revision of ankle arthrodesis with external fixation for non-union.  J Bone Joint Surg [Am]. 1992;  74 1191-1200
  • 16 Lauge-Pedersen H, Aspenberg P. Synovial fluid depletion: succesful arthrodesis ithout operative cartilage removal.  J Orthop Sci. 2003;  8 591-595
  • 17 Lemon M, Somayaji H S, Khaleel A, Elliott D S. Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail.  J Bone Joint Surg [Br]. 2005;  87 809-813
  • 18 Litchfield J C. The treatment of unstable fractures of the ankle in the elderly.  Injury. 1987;  18 128-132
  • 19 Mader K, Gausepohl T, Verheyen C, Pennig D. Ankle arthrodesis after failed fusion with retrograde locked nailing.  European J Trauma. 2002;  Suppl. 1 85
  • 20 Mader K, Pennig D, Gausepohl T, Patsalis T. Calcaneotalotibial arthrodesis with a retrograde posterior-to-anterior locked nail as a salvage procedure for severe ankle pathology.  J Bone Joint Surg [Am]. 2003;  85 Suppl 4 123-128
  • 21 Salem K H, Kinzl L, Schmelz A. Ankle arthrodesis using Ilizarov ring fixators: a review of 22 cases.  Foot Ankle Int. 2006;  27 764-770
  • 22 Scioscia T N, Ziran B H. Use of a vertical transarticular pin for stabilization of severe ankle fractures.  Am J Orthop. 2003;  32 46-48
  • 23 Simanski C J, Maegele M G, Lefering R, Lehnen D M, Kawel N, Riess P, Yücel N, Tiling T, Bouillon B. Functional treatment and early weightbearing after an ankle fracture: a prospective study.  J Orthop Trauma. 2006;  20 108-114
  • 24 Werner C M, Lorich D G, Gardner M J, Helfet D L. Ankle fractures: it is not just a “simple” ankle fracture.  Am J Orthop. 2007;  36 466-469

W. LinhartMD 

Department of Trauma and Hand Surgery · University Hospital Düsseldorf

Moorenstraße 5

40225 Düsseldorf

Germany

Email: Wolfgang.Linhart@uni-duesseldorf.de

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