Algorithm for Management of Periprosthetic Ankle Fractures. (June 2019)

• Record Type: Journal Article
• Authors: Lazarides, Alexander L.; Vovos, Tyler J.; Reddy, Gireesh B.; DeOrio, James K.; Easley, Mark E.; Nunley, James A.; Adams, Samuel B.
• Is Part Of: Foot & ankle international. Volume 40:Number 6(2019)
• Page Start: 615
• Page End: 621
• Publication Date: 2019-06
• Subjects: trauma -- arthritis -- total ankle replacements -- periprosthetic fractures; Foot -- Abnormalities -- Periodicals; Ankle -- Abnormalities -- Periodicals; Orthopedics -- Periodicals; 617.585
• DOI: 10.1177/1071100719834542
• Languages: English
• ISSNs: 1071-1007

Abstract

Background: Evidence on the management of and outcomes from periprosthetic fractures about a total ankle replacement (TAR) are limited. The purpose of this study was to develop an algorithm for the management of patients with postoperative periprosthetic fractures about a TAR. Methods: This was a retrospective analysis of patients undergoing a TAR from 2007 through 2017 with a subsequent periprosthetic fracture >4 weeks from index surgery. Implant stability was defined radiographically and intraoperatively where appropriate. Univariate and multivariate analyses were used to identify differences in outcomes. Thirty-two patients were identified with a remote TAR periprosthetic fracture with an average follow-up of 26 months (range, 3-104 months). Results: Most fractures were located about the medial malleolus (62.5%); the majority of fractures (75%) were deemed to have stable implants. Fractures of the talus always had unstable implants and always required revision TAR surgery (100%, P = .0002). There was no difference in patient-reported outcomes between stable and unstable fractures at an average of 36 months. In a multivariate analysis, fracture location (talus), less time to fracture, and implant type were found to be predictive of unstable implants ( P < .001). Implant stability was independently associated with the need for revision surgery ( P < .049). Nonoperative treatment was independently associated with treatment failure ( P < .001). Conclusion: The majority of stable fractures about a TAR required operative fixation. Management with immobilization was fraught with a high rate of subsequent surgical intervention. We found that fractures about the talus required revision TAR surgery or arthrodesis. Level of Evidence: Level III, retrospective cohort study.