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Functional outcome of knee arthrodesis with a monorail external fixator.

Roy AC, Albert S, Gouse M, Inja DB - Strategies Trauma Limb Reconstr (2016)

Bottom Line: We present salient advantages along with the radiological and functional outcome of twenty four patients treated with a single monorail external fixator.Improvements in functional outcome as assessed by the lower extremity functional score (LEFS), and the SF-36 was significant (p = 0.000).The outcome, though far from ideal, is definitely positive and predictable.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics Unit-1, CMC, Vellore, India.

ABSTRACT
Several methods for obtaining knee arthrodesis have been described in the literature and world; over, the commonest cause for arthrodesis is a failed arthroplasty. Less commonly, as in this series, post-infective or traumatic causes may also require a knee fusion wherein arthroplasty may not be indicated. We present salient advantages along with the radiological and functional outcome of twenty four patients treated with a single monorail external fixator. All patients went on develop fusion at an average of 5.4 months with an average limb length discrepancy of 3 cm (1.5-6 cm). Improvements in functional outcome as assessed by the lower extremity functional score (LEFS), and the SF-36 was significant (p = 0.000). Knee arthrodesis with a single monorail external fixator is a reasonable single-staged salvage option in patients wherein arthroplasty may not be the ideal choice. The outcome, though far from ideal, is definitely positive and predictable.

No MeSH data available.


Lateral plain radiograph at seven months showing good consolidation at the arthrodesis site
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Fig4: Lateral plain radiograph at seven months showing good consolidation at the arthrodesis site

Mentions: When the Orthofix monorail was employed anteriorly, the most proximal pin was inserted in the distal diaphysis of the femur ensuring central placement in the sagittal plane. The cut surfaces were then opposed to coapt bleeding surfaces of cancellous bone. The most distal pin on the tibial diaphysis was inserted along the sagittal plane just medial to the tibial crest. This ensured a slight valgus alignment and allowed for central and bicortical placement of the intervening pins. Such placement of the pins ensured positioning of a straight monorail across a slightly valgus knee. All pins (with a minimum of three on either side) were affixed to a single clamp. This facilitated compression when a compression device was utilized in the monorail. When the undersurface of the patella was prepared, the patella was allowed to fall back over the site of fusion with wound closure. Fixation with a screw or pin was not routinely required. Excision of the patella was done in a few cases to simplify closure in a scarred limb with poor soft tissue conditions. The wound was lavaged prior to closure under drains. An adequate distance between the rail and the skin allowed for wound closure and post-operative wound care. This was crucial as with the knee in flexion the monorail fixator was brought closer to the skin anteriorly. At the same time care was taken to avoid having the rail too far from the soft tissue thereby reducing biomechanical stability. There were occasions when additional soft tissue procedures were performed; medial or lateral gastrocnemius flaps served as work horses for defects surrounding the knee. Patients were encouraged to bear weight as tolerated. Partial weight bearing with support was continued for at least 3 months. Radiographs were obtained every 6 weeks for the first 3–6 months. The patients were educated and taught pin site care. Bridging trabeculae and sclerosis with blurring of the cut edges at the fusion site were signs of adequate fusion at which time the patient was usually able to ambulate full weight bearing without support. Frame removal was not routinely preceded by dynamization (Figs. 3, 4).Fig. 3


Functional outcome of knee arthrodesis with a monorail external fixator.

Roy AC, Albert S, Gouse M, Inja DB - Strategies Trauma Limb Reconstr (2016)

Lateral plain radiograph at seven months showing good consolidation at the arthrodesis site
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814381&req=5

Fig4: Lateral plain radiograph at seven months showing good consolidation at the arthrodesis site
Mentions: When the Orthofix monorail was employed anteriorly, the most proximal pin was inserted in the distal diaphysis of the femur ensuring central placement in the sagittal plane. The cut surfaces were then opposed to coapt bleeding surfaces of cancellous bone. The most distal pin on the tibial diaphysis was inserted along the sagittal plane just medial to the tibial crest. This ensured a slight valgus alignment and allowed for central and bicortical placement of the intervening pins. Such placement of the pins ensured positioning of a straight monorail across a slightly valgus knee. All pins (with a minimum of three on either side) were affixed to a single clamp. This facilitated compression when a compression device was utilized in the monorail. When the undersurface of the patella was prepared, the patella was allowed to fall back over the site of fusion with wound closure. Fixation with a screw or pin was not routinely required. Excision of the patella was done in a few cases to simplify closure in a scarred limb with poor soft tissue conditions. The wound was lavaged prior to closure under drains. An adequate distance between the rail and the skin allowed for wound closure and post-operative wound care. This was crucial as with the knee in flexion the monorail fixator was brought closer to the skin anteriorly. At the same time care was taken to avoid having the rail too far from the soft tissue thereby reducing biomechanical stability. There were occasions when additional soft tissue procedures were performed; medial or lateral gastrocnemius flaps served as work horses for defects surrounding the knee. Patients were encouraged to bear weight as tolerated. Partial weight bearing with support was continued for at least 3 months. Radiographs were obtained every 6 weeks for the first 3–6 months. The patients were educated and taught pin site care. Bridging trabeculae and sclerosis with blurring of the cut edges at the fusion site were signs of adequate fusion at which time the patient was usually able to ambulate full weight bearing without support. Frame removal was not routinely preceded by dynamization (Figs. 3, 4).Fig. 3

Bottom Line: We present salient advantages along with the radiological and functional outcome of twenty four patients treated with a single monorail external fixator.Improvements in functional outcome as assessed by the lower extremity functional score (LEFS), and the SF-36 was significant (p = 0.000).The outcome, though far from ideal, is definitely positive and predictable.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics Unit-1, CMC, Vellore, India.

ABSTRACT
Several methods for obtaining knee arthrodesis have been described in the literature and world; over, the commonest cause for arthrodesis is a failed arthroplasty. Less commonly, as in this series, post-infective or traumatic causes may also require a knee fusion wherein arthroplasty may not be indicated. We present salient advantages along with the radiological and functional outcome of twenty four patients treated with a single monorail external fixator. All patients went on develop fusion at an average of 5.4 months with an average limb length discrepancy of 3 cm (1.5-6 cm). Improvements in functional outcome as assessed by the lower extremity functional score (LEFS), and the SF-36 was significant (p = 0.000). Knee arthrodesis with a single monorail external fixator is a reasonable single-staged salvage option in patients wherein arthroplasty may not be the ideal choice. The outcome, though far from ideal, is definitely positive and predictable.

No MeSH data available.