Algorithm for Management of Periprosthetic Ankle Fractures.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Lazarides, AL; Vovos, TJ; Reddy, GB; DeOrio, JK; Easley, ME; Nunley, JA; Adams, SB

Published Date

  • June 2019

Published In

Volume / Issue

  • 40 / 6

Start / End Page

  • 615 - 621

PubMed ID

  • 30813821

Electronic International Standard Serial Number (EISSN)

  • 1944-7876

Digital Object Identifier (DOI)

  • 10.1177/1071100719834542


  • eng

Conference Location

  • United States