Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Mingyu , XIE Meiming , GONG Jicheng , ZHOU Binghua , MU Miduo , CHEN Yonghua ,  TANG Kanglai

Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China;

Corresponding author：

TANG Kanglai, Email: tangkanglai@hotmail.com

Keywords：

Tibio-talo-calcaneal arthrodesis; ankle; subtalar; full thread headless compression screw; minimal incision

DOI：

10.7507/1002-1892.201806048

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ObjectiveTo investigate the effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions.MethodsBetween January 2012 and December 2016, 36 patients (36 feet) with ankle diseases underwent tibio-talo-calcaneal arthrodesis with parallel double thread headless compression screws via minimal anterior and lateral oblique incisions. There were 14 males and 22 females with an average age of 53.8 years (range, 18-76 years). There were 19 cases of left feet and 17 cases of right feet. There were 21 cases of talar necrosis, 7 cases of post-traumatic arthritis, 3 cases of rheumatoid arthritis, 2 cases of tuberculosis infection (inactive), 1 case of talar absence, 1 case of Charcot’s disease, and 1 case of pigmented villonodular synovitis of ankle and subtalar joints. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were 53.7±2.5 and 5.9±0.2, respectively. The operation time was recorded and the wound healing and complications were observed. The bone healing was assessed by X-ray film and CT scanning. The function and pain of joint were evaluated by AOFAS and VAS scores.ResultsThe mean operation time was 49.8 minutes (range, 33-82 minutes). Incision infection occurred in 1 patient (2.8%) at 3 weeks after operation, and recovered after debridement. The other incisions healed by first intention without complications. Thirty-five patients were followed up with an average of 18.5 months (range, 12-29 months). Imaging examination showed fusion of the ankle and subtalar joints with an average fusion time of 10.9 weeks (range, 8-15 weeks). After 1 year, the AOFAS score (84.7±0.6) and VAS score (0.3±0.1) were significantly higher than preoperative scores (t=12.596, P=0.000; t=30.393, P=0.000).ConclusionIt is an effective surgical method of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions for end-stage ankle disease because of the less complications incidence and the higher postoperative fusion rate.

Citation： YANG Mingyu, XIE Meiming, GONG Jicheng, ZHOU Binghua, MU Miduo, CHEN Yonghua, TANG Kanglai. Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1297-1301. doi: 10.7507/1002-1892.201806048 Copy

1.	Franceschi F, Franceschetti E, Torre G, et al. Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1316-1325.
2.	Shah AB, Jones C, Elattar O, et al. Tibiotalocalcaneal arthrodesis with intramedullary fibular strut graft with adjuvant hardware fixation. J Foot Ankle Surg, 2017, 56(3): 692-696.
3.	Taylor J, Lucas DE, Riley A, et al. Tibiotalocalcaneal arthrodesis nails: A comparison of nails with and without internal compression. Foot Ankle Int, 2016, 37(3): 294-299.
4.	Richter M, Zech S. Tibiotalocalcaneal arthrodesis with a triple-bend intramedullary nail (A3)-2-year follow-up in 60 patients. Foot Ankle Surg, 2016, 22(2): 131-138.
5.	Gong JC, Zhou BH, Tao X, et al. Tibiotalocalcaneal arthrodesis with headless compression screws. J Orthop Surg Res, 2016, 11(1): 91.
6.	Arno F, Roman F. The influence of footwear on functional outcome after total ankle replacement, ankle arthrodesis, and tibiotalocalcaneal arthrodesis. Clin Biomech (Bristol, Avon), 2016, 32: 34-39.
7.	吴本文, 黄国锋, 丁真奇. 踝及后足关节融合术应用进展. 中国修复重建外科杂志, 2016, 30(4): 514-517.
8.	冯骏, 俞光荣. 髓内钉胫距跟融合术并发症的研究进展. 中国修复重建外科杂志, 2015, 29(9): 1173-1176.
9.	Rausch S, Loracher C, Frober R, et al. Anatomical evaluation of different approaches for tibiotalocalcaneal arthrodesis. Foot Ankle Int, 2014, 35(2): 163-167.
10.	Carranza-Bencano A, Tejero S, Del Castillo-Blanco G, et al. Minimal incision surgery for tibiotalocalcaneal arthrodesis. Foot Ankle Int, 2014, 35(3): 272-284.
11.	Lui TH. Tibiotalocalcaneal arthrodesis with combined retrograde intramedullary nail and lateral L-plate. J Foot Ankle Surg, 2012, 51(5): 693-695.
12.	Peterson KS, Chapman WD, Hyer CF, et al. Short-term radiographic results and technique of tibiotalocalcaneal arthrodesis with a posterior anatomic locking plate. J Foot Ankle Surg, 2016, 55(5): 906-909.
13.	Kitaoka HB, Anderson PJ, Morrey BF. Revision of ankle arthrodesis with external fixation for non-union. J Bone Joint Surg (Am), 1992, 74(8): 1191-1200.
14.	Mückley T, Klos K, Drechsel T, et al. Short-term outcome of retrograde tibiotalocalcaneal arthrodesis with a curved intramedullary nail. Foot Ankle Int, 2011, 32(1): 47-56.
15.	Richter M, Evers J, Waehnert D, et al. Biomechanical comparison of stability of tibiotalocalcaneal arthrodesis with two different intramedullary retrograde nails. Foot Ankle Surg, 2014, 20(1): 14-19.
16.	Hyer CF, Cheney N. Anatomic aspects of tibiotalocalcaneal nail arthrodesis. J Foot Ankle Surg, 2013, 52(6): 724-727.
17.	Flock TJ, Ishikawa S, Hecht PJ, et al. Heel anatomy for retrograde tibiotalocalcaneal roddings: a roentgenographic and anatomic analysis. Foot Ankle Int, 1997, 18(4): 233-235.
18.	谢美明, 潘显明, 范凌, 等. Acutrak 无头加压螺钉治疗第五跖骨基底部骨折. 中华创伤杂志, 2014, 30(10): 1005-1008.
19.	张建, 吴克俭, 张伟佳, 等. 全螺纹加压无头空心螺钉经皮固定骨盆骨折. 中国修复重建外科杂志, 2012, 26(1): 91-96.

1. Franceschi F, Franceschetti E, Torre G, et al. Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1316-1325.
2. Shah AB, Jones C, Elattar O, et al. Tibiotalocalcaneal arthrodesis with intramedullary fibular strut graft with adjuvant hardware fixation. J Foot Ankle Surg, 2017, 56(3): 692-696.
3. Taylor J, Lucas DE, Riley A, et al. Tibiotalocalcaneal arthrodesis nails: A comparison of nails with and without internal compression. Foot Ankle Int, 2016, 37(3): 294-299.
4. Richter M, Zech S. Tibiotalocalcaneal arthrodesis with a triple-bend intramedullary nail (A3)-2-year follow-up in 60 patients. Foot Ankle Surg, 2016, 22(2): 131-138.
5. Gong JC, Zhou BH, Tao X, et al. Tibiotalocalcaneal arthrodesis with headless compression screws. J Orthop Surg Res, 2016, 11(1): 91.
6. Arno F, Roman F. The influence of footwear on functional outcome after total ankle replacement, ankle arthrodesis, and tibiotalocalcaneal arthrodesis. Clin Biomech (Bristol, Avon), 2016, 32: 34-39.
7. 吴本文, 黄国锋, 丁真奇. 踝及后足关节融合术应用进展. 中国修复重建外科杂志, 2016, 30(4): 514-517.
8. 冯骏, 俞光荣. 髓内钉胫距跟融合术并发症的研究进展. 中国修复重建外科杂志, 2015, 29(9): 1173-1176.
9. Rausch S, Loracher C, Frober R, et al. Anatomical evaluation of different approaches for tibiotalocalcaneal arthrodesis. Foot Ankle Int, 2014, 35(2): 163-167.
10. Carranza-Bencano A, Tejero S, Del Castillo-Blanco G, et al. Minimal incision surgery for tibiotalocalcaneal arthrodesis. Foot Ankle Int, 2014, 35(3): 272-284.
11. Lui TH. Tibiotalocalcaneal arthrodesis with combined retrograde intramedullary nail and lateral L-plate. J Foot Ankle Surg, 2012, 51(5): 693-695.
12. Peterson KS, Chapman WD, Hyer CF, et al. Short-term radiographic results and technique of tibiotalocalcaneal arthrodesis with a posterior anatomic locking plate. J Foot Ankle Surg, 2016, 55(5): 906-909.
13. Kitaoka HB, Anderson PJ, Morrey BF. Revision of ankle arthrodesis with external fixation for non-union. J Bone Joint Surg (Am), 1992, 74(8): 1191-1200.
14. Mückley T, Klos K, Drechsel T, et al. Short-term outcome of retrograde tibiotalocalcaneal arthrodesis with a curved intramedullary nail. Foot Ankle Int, 2011, 32(1): 47-56.
15. Richter M, Evers J, Waehnert D, et al. Biomechanical comparison of stability of tibiotalocalcaneal arthrodesis with two different intramedullary retrograde nails. Foot Ankle Surg, 2014, 20(1): 14-19.
16. Hyer CF, Cheney N. Anatomic aspects of tibiotalocalcaneal nail arthrodesis. J Foot Ankle Surg, 2013, 52(6): 724-727.
17. Flock TJ, Ishikawa S, Hecht PJ, et al. Heel anatomy for retrograde tibiotalocalcaneal roddings: a roentgenographic and anatomic analysis. Foot Ankle Int, 1997, 18(4): 233-235.
18. 谢美明, 潘显明, 范凌, 等. Acutrak 无头加压螺钉治疗第五跖骨基底部骨折. 中华创伤杂志, 2014, 30(10): 1005-1008.
19. 张建, 吴克俭, 张伟佳, 等. 全螺纹加压无头空心螺钉经皮固定骨盆骨折. 中国修复重建外科杂志, 2012, 26(1): 91-96.

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Effectiveness of tibio-talo-calcaneal arthrodesis with full thread headless compression screws via combined minimal incisions

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