SLR - May 2022 - Tiffany M. Chin, DPM
Reference: Fadhel, W. B., Taieb, L., Villain, B., Mebtouche, N., Levante, S., Bégué, T., & Aurégan, J. C. (2022). Outcomes After Primary Ankle Arthrodesis in Recent Fractures of the Distal End of the Tibia in the Elderly: A Systematic Review. International orthopaedics,10.1007/s00264-022-05317-0. Advance online publication. https://doi.org/10.1007/s00264-022-05317-0
Level of Evidence: IV
Scientific Literature Review
Reviewed By: Tiffany M. Chin, DPM
Residency Program: Cedars-Sinai Medical Center – Los Angeles, CA
Podiatric Relevance: Primary ankle arthrodesis is frequently offered to older patients after sustaining a distal tibia fracture, yet the elderly are known to have osteoporosis and generally have more comorbidities; which increases postoperative complications. Recovery and rehabilitation time for geriatric patients are also increased and surgical options should be carefully considered in efforts to minimize deconditioning in this patient population.
Methods: A systematic review was performed from 1950 to 2020 in English and French using three databases: Cochrane, MEDLINE and Embase. Studies involved primary ankle arthrodesis after distal tibia fractures in the elderly reporting clinical outcomes, function or complications.
Results: Nine studies were included with a total of 229 patients with ages between 63 and 84 years. Fifty patients had open fractures and 95 patients had three or more comorbidities. All patients had a tibiotalocalcaneal arthrodesis and were fixated with a transplantar intramedullary nail (78 patients with a long nail and 151 patients with a short nail) with a mean follow up between six to 21 months. A total of 94.5 percent of patients had unions, 87 percent displayed a mobility status similar to their preoperative status, 19 percent had a complication (most commonly failure of osteosynthesis) and 11.3 percent required revisions. Longer nails proved to have a lower rate of complications and revisions.
Conclusions: Primarily fusing the ankle joint in elderly patients after distal tibia fractures can provide adequate results and allow for early ambulation. Fixation with short nails should be reconsidered as they are associated with higher rates of complications.