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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Traumatic Periprosthetic Fractures Following Total Ankle Replacement: A Systematic Review and Proposed

Zachary P Hill1, Joseph R Brown1, Daniel DeGenova2

  • 1Grant Medical Center Foot and Ankle Surgery, OhioHealth, Columbus, Ohio.

Foot & Ankle Specialist
|September 23, 2024
PubMed
Summary

Traumatic periprosthetic fractures after total ankle replacement (TAR) are rare but serious. A new classification system helps guide treatment based on fracture location, implant stability, and bone quality for better outcomes.

Keywords:
ankle fractureminimally invasive osteosynthesisperiprostheticperiprosthetic fracturetotal ankle arthroplastytotal ankle replacement

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Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Trauma surgery

Background:

  • Total ankle replacement (TAR) is increasingly common.
  • Periprosthetic fractures are a rare but challenging complication.
  • Existing literature lacks a standardized classification system for these fractures.

Purpose of the Study:

  • To propose a comprehensive classification system for traumatic periprosthetic fractures following total ankle replacement.
  • To analyze fracture characteristics, implant stability, and bone quality.
  • To guide treatment strategies for these complex injuries.

Main Methods:

  • Systematic review of 13 cases from 9 studies.
  • Fracture categorization using the proposed Hill-Brown classification (Type A, B, C).
  • Subclassification of Type B fractures based on implant stability and bone stock (B1, B2, B3).

Main Results:

  • Most fractures involved the distal tibial component (Type B).
  • Implant stability was influenced by fracture location and bone quality.
  • Minimally invasive plate osteosynthesis (MIPO) was effective for stable fractures; unstable fractures often required revision or arthrodesis.
  • Bone quality significantly impacted treatment decisions, especially in patients with rheumatoid arthritis or osteoporosis.

Conclusions:

  • The proposed Hill-Brown classification system provides a framework for managing periprosthetic ankle fractures.
  • Fracture location, implant stability, and bone quality are critical factors in treatment planning.
  • Surgical intervention is recommended for all traumatic periprosthetic ankle fractures.
  • Further multicenter studies are needed to validate the classification and refine treatment protocols.