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@#Introduction: The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection. Materials and methods: Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest. Results: All patients were followed-up for an average of 17.6 months (range 12.0 – 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united. Conclusions: The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.
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Objective To analyze the clinical and radiographic outcomes of staged reduction and fixation in a consecutive series of patients with the old Lisfranc injuries. Methods Fifty patients (16 feet) with Lisfranc injuries were treated with staged reduction. Mean duration between injury and surgery was 4. 8month ( 3 to 8 month) . In first stage an external fixator was applied across the Lisfranc joint and distraction was done at 1 milliliter per day to 2 milliliter per day. In the second staged the ORIF ( open reduction and internal fixation) was doneand we were able to reduce all the fractures and dislocations. Extra-Articular screws and staple fixation were used for fixation. We compared categorical variables using Fisher’ s exact test and continuous variables using paired t-test or Wilcoxon signed-rank test. Results All patients were followed up 1 to 3 years ( mean 2. 2 years) in the clinic. The visual analogue scale score averaged 3. 1 points at the final follow-up, the average AOFAS scores for these patients were 55. 8 points ( range, 43 to 98 points), with a significant increase than before surgery ( P=0. 001). The mean duration between two surgeries was 3. 2 weeks (range 2. 5-4. 5 weeks). Anatomic reduction was obtained in all 15 patients. At the last follow-up, 2 patients had lost reduction. Posttraumatic osteoarthritis was observed in 5 patients, and all of them were scheduled for arthrodesis because of persistent pain. Conclusions The study have displayed that staged reduction and Extra-Articular fixation should be considered for old Lisfranc injuries with a good reduction, the firm stability, low risk of intraoperative fracture. The short-term effectiveness is good, but the long-term effectiveness needs further follow-up.
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[Objective]Pilon fractures are often high-energy injuries.One third to half of these fractures are companied by other fractures or organs injuries.10%~30% Pilon injuries are open fractures.This study was aimed to evaluate the significance of external fixator in the multi-staged management of Pilon fractures.[Method]Ten patients(M=8,F=2) with high-energy Pilon fractures were managed from February 2004 to March 2007.Their average age was 56.2 yrs(range 22 to 72 yrs).All patients underwent external fixation of single-arm external fixator(Orthofix)or Hoffmann external fixator-II(Stryker) in the very early stage.Then it was replaced by strong internal fixation through open reduction or close reduction with the technique of minimally invasive percutaneous plate oesteosynthesis(MIPPO) when general conditions were controlled,the wound surface healed and the soft tissues improved.[Result]The mean duration of external fixation was 13.2 days(range 7-49 days).All the external fixations were changed to internal fixations.All the traumatic and operative wounds healed.All bone fractures united.No compartment syndrome or osteomyelitis occurred in this study.One case of open Pilon fracture was found infection after external fixation.It was changed to internal plate fixation after 7 weeks of anti-infection treatment.The infection was controlled and the bone reunited.[Conclusion]For high-energy Pilon fractures,multi-staged management,including correct evaluation of local soft tissue injuries and general conditions,proper damage control via external fixator,and right timing to change to internal fixator,is safe and effective.