Bradley M Lamm1, Kimona Issa1, Bhaveen H Kapadia1, Qais Naziri2, Lynne C Jones3, Michael A Mont1. 1. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for B.M. Lamm: blamm@lifebridgehealth.org. E-mail addresses for M.A. Mont: mmont@lifebridgehealth.org, rhondamont@aol.com. 2. SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 450 Clarkson Avenue, Box 30, Brooklyn, NY 11203. 3. The Johns Hopkins Medical Institution, 733 North Broadway, Baltimore, MD 21287.
Abstract
INTRODUCTION: The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising. STEP 1 PREOPERATIVE PLANNING FOR A LATERAL TALAR LESION: Obtain anteroposterior and lateral ankle radiographs as well as magnetic resonance imaging (MRI) studies of the ankle to evaluate the stage of the osteonecrotic disease. STEP 2 PERCUTANEOUS PIN INSERTION LATERAL TALAR LESION: Insert a 1.8-mm Steinmann pin or Ilizarov wire percutaneously under biplanar fluoroscopic visualization. STEP 3 PERCUTANEOUS DRILLING: Make one, two, or three passes with a 3.2-mm cannulated drill bit over the pin into the lesion(s). STEP 4 BACKFILLING THE BONE TUNNEL OPTIONAL: Infiltrate the defect with demineralized bone matrix to backfill the drill track and the deep necrotic bone defect. STEP 5 POSTOPERATIVE MANAGEMENT: The patient bears weight as tolerated in a removable short leg rigid boot for the first four weeks and avoids high-impact activities for at least ten months. RESULTS: In our study, there were significant improvements in the mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score (p = 0.001), University of California Los Angeles (UCLA) activity score (p = 0.025), and visual analog scale (VAS) pain score (p = 0.001) at a mean of five years (range, two to nine years) postoperatively.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising. STEP 1 PREOPERATIVE PLANNING FOR A LATERAL TALAR LESION: Obtain anteroposterior and lateral ankle radiographs as well as magnetic resonance imaging (MRI) studies of the ankle to evaluate the stage of the osteonecrotic disease. STEP 2 PERCUTANEOUS PIN INSERTION LATERAL TALAR LESION: Insert a 1.8-mm Steinmann pin or Ilizarov wire percutaneously under biplanar fluoroscopic visualization. STEP 3 PERCUTANEOUS DRILLING: Make one, two, or three passes with a 3.2-mm cannulated drill bit over the pin into the lesion(s). STEP 4 BACKFILLING THE BONE TUNNEL OPTIONAL: Infiltrate the defect with demineralized bone matrix to backfill the drill track and the deep necrotic bone defect. STEP 5 POSTOPERATIVE MANAGEMENT: The patient bears weight as tolerated in a removable short leg rigid boot for the first four weeks and avoids high-impact activities for at least ten months. RESULTS: In our study, there were significant improvements in the mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score (p = 0.001), University of California Los Angeles (UCLA) activity score (p = 0.025), and visual analog scale (VAS) pain score (p = 0.001) at a mean of five years (range, two to nine years) postoperatively.IndicationsContraindicationsPitfalls & Challenges.
Authors: German A Marulanda; Mike S McGrath; Slif D Ulrich; Thorsten M Seyler; Ronald E Delanois; Michael A Mont Journal: J Foot Ankle Surg Date: 2010 Jan-Feb Impact factor: 1.286