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Published on: January 24, 2018
Periprosthetic fractures in total ankle replacement: classification system and treatment algorithm.
Sebastian Manegold1, Norbert P Haas, Serafim Tsitsilonis
1Section for Foot and Ankle Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin 13353, Germany. sebastian.manegold@charite.de
Summary
Periprosthetic ankle fractures after total ankle replacement are uncommon. A new classification system aids in understanding causes and guiding treatment for these rare fractures.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Fracture Management
Background:
- Periprosthetic ankle fractures are an increasing concern following total ankle replacement.
- A standardized classification for treatment is currently lacking.
Purpose of the Study:
- To assess the prevalence, causes, and locations of periprosthetic fractures after total ankle replacement.
- To evaluate prosthetic component stability in these fractures.
- To develop a novel classification system for periprosthetic ankle fractures.
Main Methods:
- Retrospective review of 503 total ankle replacements with a mean follow-up of 14.7 months.
- Analysis of fracture prevalence, location, cause, and prosthesis stability.
- Development of a systematic classification based on these factors.
Main Results:
- Twenty-one periprosthetic fractures (4.2%) were identified.
- Fractures were intraoperative (2.2%) or postoperative (2.0%), including traumatic and stress fractures.
- Medial malleolus fractures were most common, accounting for two-thirds of cases.
Conclusions:
- The prevalence of periprosthetic fractures after primary total ankle replacement is relatively low.
- A proposed classification system, based on over 500 cases, aids in differential diagnosis.
- This classification facilitates therapeutic decision-making for operative and nonoperative management.
