Algorithm for Management of Periprosthetic Ankle Fractures

• Published in: Foot & ankle international 2019-06, Vol.40 (6), p.615-621
• Main Authors: Lazarides, Alexander L., Vovos, Tyler J., Reddy, Gireesh B., DeOrio, James K., Easley, Mark E., Nunley, James A., Adams, Samuel B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Algorithms; Analysis of Variance; Ankle Fractures - diagnostic imaging; Ankle Fractures - surgery; Arthroplasty, Replacement, Ankle - adverse effects; Arthroplasty, Replacement, Ankle - methods; Cohort Studies; Female; Fracture Fixation, Internal - methods; Fracture Healing - physiology; Humans; Injury Severity Score; Joint Instability - prevention & control; Male; Middle Aged; Multivariate Analysis; Periprosthetic Fractures - diagnostic imaging; Periprosthetic Fractures - surgery; Prognosis; Radiography - methods; Reoperation - methods; Retrospective Studies; Risk Assessment; Treatment Outcome
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100719834542

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.