Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Eur J Orthop Surg Traumatol. 2022 Jan;32(1):37-46. doi: 10.1007/s00590-021-02898-1. Epub 2021 Mar 9.
Secondary displacement of traumatic ankle fractures with subsequent soft-tissue breakdown is a troublesome issue after inappropriate conservative treatment among non-compliant diabetic patients with severe peripheral neuropathy. This study was conducted to evaluate the results of a less-invasive arthrodesis procedure as an alternative to osteosynthesis in these complex scenarios.
A total of 46 diabetics, who underwent fluoroscopy-assisted trans-calcaneal retrograde nailing-based ankle arthrodesis between 2012 and 2018 for salvaging secondary-displaced diabetic ankle fractures in their insensate feet, were evaluated in this retrospective study. All fractures were associated with uninfected mechanical ulcers overlying malleoli, without Charcot changes, after failed conservative cast immobilization. The patients (mean age: 52.52 ± 3.70 years; 18 males; 46 feet) were evaluated radiologically for union and clinically for limb salvage, modified American Orthopedic Ankle and Foot Scale (AOAFS), and the overall subjective patients' satisfaction.
The mean follow-up was 29.5 ± 3.1 months. All ulcers have healed with local care only with 100% limb salvage. Four patients experienced minor wound healing problems at posterior heel, and another one developed acute Charcot changes that was successfully managed by offloading and repeat surgery. Forty patients (86.96%) had fully consolidated fusions with a mean time to fusion 15.78 ± 2.58 weeks, while the other six cases had stable fibrous-union. At the final follow-up, the mean modified-AOFAS was 76.85 ± 6.0 from 86 total points. All, but four patients (91.30%) were completely satisfied while the other four patients were partially satisfied.
The presented less-invasive arthrodesis technique is reproducible and effective alternative for salvaging unstable diabetic ankle fractures in the insensate feet when standard surgical procedures would be more risky.
IV, retrospective case series.
在不合规的伴有严重周围神经病变的糖尿病患者中，不当的保守治疗后创伤性踝关节骨折继发的软组织破裂和再次移位是一个棘手的问题。本研究旨在评估一种微创关节融合术作为这些复杂情况下骨内固定术替代方法的结果。
回顾性研究分析了 2012 年至 2018 年间，46 例糖尿病患者因感觉丧失足部的二次移位糖尿病踝关节骨折，接受了经跟骨逆行顺行透视辅助下跟骨钉钉踝关节融合术。所有骨折均与未感染的机械性溃疡相关，这些溃疡位于外踝上方，无夏科氏关节改变，且在失败的保守石膏固定后。对患者进行了影像学（愈合）和临床（保肢、改良美国矫形足踝外科协会评分（AOAFS）和总体主观患者满意度）评估。
平均随访 29.5 ± 3.1 个月。所有溃疡仅通过局部护理即可愈合，保肢率为 100%。4 例患者后跟后部有轻微伤口愈合问题，另 1 例发生急性夏科氏关节改变，通过减压和重复手术成功治疗。40 例（86.96%）患者完全融合，平均融合时间为 15.78 ± 2.58 周，而另外 6 例为稳定的纤维性融合。最终随访时，改良 AOFAS 平均为 76.85 ± 6.0 分（总分 86 分）。除 4 例（91.30%）患者完全满意外，其余 4 例患者部分满意。
当标准手术程序风险更高时，本研究所提出的微创关节融合技术是一种可复制且有效的治疗感觉丧失的不稳定糖尿病踝关节骨折的替代方法。
IV，回顾性病例系列。
