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Algorithm for Management of Periprosthetic Ankle Fractures.

Publication ,  Journal Article
Lazarides, AL; Vovos, TJ; Reddy, GB; DeOrio, JK; Easley, ME; Nunley, JA; Adams, SB
Published in: Foot Ankle Int
June 2019

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.

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Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2019

Volume

40

Issue

6

Start / End Page

615 / 621

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Assessment
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Prognosis
  • Periprosthetic Fractures
  • Orthopedics
  • Multivariate Analysis
  • Middle Aged
 

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Lazarides, A. L., Vovos, T. J., Reddy, G. B., DeOrio, J. K., Easley, M. E., Nunley, J. A., & Adams, S. B. (2019). Algorithm for Management of Periprosthetic Ankle Fractures. Foot Ankle Int, 40(6), 615–621. https://doi.org/10.1177/1071100719834542
Lazarides, Alexander L., Tyler J. Vovos, Gireesh B. Reddy, James K. DeOrio, Mark E. Easley, James A. Nunley, and Samuel B. Adams. “Algorithm for Management of Periprosthetic Ankle Fractures.Foot Ankle Int 40, no. 6 (June 2019): 615–21. https://doi.org/10.1177/1071100719834542.
Lazarides AL, Vovos TJ, Reddy GB, DeOrio JK, Easley ME, Nunley JA, et al. Algorithm for Management of Periprosthetic Ankle Fractures. Foot Ankle Int. 2019 Jun;40(6):615–21.
Lazarides, Alexander L., et al. “Algorithm for Management of Periprosthetic Ankle Fractures.Foot Ankle Int, vol. 40, no. 6, June 2019, pp. 615–21. Pubmed, doi:10.1177/1071100719834542.
Lazarides AL, Vovos TJ, Reddy GB, DeOrio JK, Easley ME, Nunley JA, Adams SB. Algorithm for Management of Periprosthetic Ankle Fractures. Foot Ankle Int. 2019 Jun;40(6):615–621.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2019

Volume

40

Issue

6

Start / End Page

615 / 621

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Assessment
  • Retrospective Studies
  • Reoperation
  • Radiography
  • Prognosis
  • Periprosthetic Fractures
  • Orthopedics
  • Multivariate Analysis
  • Middle Aged