Primary Arthrodesis with Retrograde Hindfoot Nail for Elderly Patients with Tibia Pilon Fractures and Psychiatric Illness.

IF 0.5 4区 医学 Q4 ORTHOPEDICS Journal of the American Podiatric Medical Association Pub Date : 2024-05-01 DOI:10.7547/22-048
Yen-Chun Chiu, Chin-Hsien Wu, Kun-Ling Tsai, I-Ming Jou, Yuan-Kun Tu, Ching-Hou Ma
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Abstract

Background: Management of tibial pilon fracture in elderly patients with psychiatric illness remains challenging for orthopedic doctors because of patients' poor bone quality and inability for self-care. This study aimed to ascertain the viability and reliability of primary arthrodesis by using retrograde hindfoot nail for these difficult cases.

Methods: We retrospectively reviewed eight elderly consecutive patients (age older than 65 years) with tibial pilon fractures and psychiatric illness from January of 2012 to December of 2019 in our institute. Primary tibiotalocalcaneal arthrodesis with retrograde hindfoot nail was used as a definitive procedure. The bone union time, wound complication rate, ankle alignment, necessity for narcotic agents, and ambulation status were evaluated.

Results: The average length of follow-up was 22.25 months (range, 15-36 months). Additional bone grafting surgery was performed for one patient because of fusion-site nonunion 6 months postoperatively. Another patient required debridement and removal of posterior calcaneal screw because of implant prominence and local infection. Osseous union with angular deformity less than 10° was achieved in all patients finally. The average bone union time was 6.6 months (range, 4-12 months). In terms of walking ability, six patients were capable of outdoor ambulation (classes 2 and 3). Two patients required oral pain medication at the final visit.

Conclusions: The current study involved only a small number of patients, and two of the eight cases encountered undesired complications (one local infection and one bone nonunion); however, we believe that our method may serve as a valuable alternative for the treatment of tibial pilon fractures in elderly patients with psychiatric illness, considering the specificity of this fragile population.

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用逆行后足钉为胫骨尖骨折并患有精神疾病的老年患者进行初级关节固定术。
背景:由于老年精神病患者骨质差、生活不能自理,胫骨Pilon骨折的治疗对骨科医生来说仍具有挑战性。本研究旨在确定在这些疑难病例中使用逆行后足钉进行初次关节置换术的可行性和可靠性:我们回顾性分析了我院自2012年1月至2019年12月连续收治的8例胫骨腓骨骨折合并精神疾病的老年患者(年龄大于65岁)。原发性胫骨-腓骨-胫骨关节置换术(Primary tibiotalocalcaneal arthrodesis with retrograde hindfoot nail)作为最终手术。评估了骨结合时间、伤口并发症发生率、踝关节对齐情况、使用麻醉剂的必要性以及行走状况:平均随访时间为 22.25 个月(15-36 个月)。一名患者在术后 6 个月因融合部位未愈合而进行了额外的植骨手术。另一名患者由于植入物突出和局部感染,需要进行清创并移除后方小腿螺钉。最终,所有患者都实现了角畸形小于10°的骨结合。平均骨结合时间为 6.6 个月(4-12 个月)。在行走能力方面,6 名患者能够在户外行走(2 级和 3 级)。两名患者在最后就诊时需要口服止痛药:目前的研究仅涉及少数患者,8 例患者中有 2 例出现了不良并发症(1 例局部感染,1 例骨不愈合);但考虑到老年精神病患者这一脆弱群体的特殊性,我们认为我们的方法可作为治疗老年精神病患者胫骨皮隆骨折的一种有价值的替代方法。
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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
128
审稿时长
6-12 weeks
期刊介绍: The Journal of the American Podiatric Medical Association, the official journal of the Association, is the oldest and most frequently cited peer-reviewed journal in the profession of foot and ankle medicine. Founded in 1907 and appearing 6 times per year, it publishes research studies, case reports, literature reviews, special communications, clinical correspondence, letters to the editor, book reviews, and various other types of submissions. The Journal is included in major indexing and abstracting services for biomedical literature.
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