title: Use of a Proximal Humeral Locking Plate for Complex Ankle and Hindfoot Fusion.
abstract: Arthrodesis of the ankle and hindfoot in the setting of major deformity is challenging and associated with substantial risks. Patients often have significant comorbidities that lead to unforgiving soft tissues, poor vascularity, and poor bone quality. This creates the high-risk scenario of poor wound healing and poor implant fixation. Complications can be devastating, leading to loss of the limb and sepsis. The use of locking plate technology might provide biomechanical and operative technique advantages in such patients. We retrospectively assessed the results of the modified use of the PHILOS(™) (Synthes(®), Zuchwil, Switzerland) proximal humeral locking plate in 21 patients (11 males, 10 females; mean age 56.1 years, range 25 to 74 years) who had undergone complex fusions, including tibiotalar (n = 4), tibiocalcaneal (n = 7), or tibiotalocalcaneal (n =10) fusions. The average follow-up period was 14.6 (median 10, range 6 to 49) months. Of the 21 fusions, 18 achieved union (85.7%) at an average period of 4.8 (median 4.3, range 3 to 12) months. The overall deep infection rate was 14.3%. Overall, 17 of the 21 patients (81%) were satisfied with the result (good to excellent), 1 reported the result was fair (4.8%), and 3 patients developed nonunion and were dissatisfied with the procedure (14.3%). The present study is the largest series to date of patients undergoing complex ankle and hindfoot arthrodesis with the use of a proximal humeral locking plate and confirms previous findings that the technique is reliable with union, satisfaction, and complication rates comparable to those of other techniques.
authors.affiliation: Specialist Registrar, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom. Electronic address: ashearman@doctors.org.uk.
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Shearman
authors.affiliation: Consultant Orthopaedic Surgeon, Hippocrateon Private Hospital, Nicosia, Cyprus.
authors.forename: Kyriacos Iordanis
authors.initials: KI
authors.lastname: Eleftheriou
authors.affiliation: Specialist Registrar, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Akash
authors.initials: A
authors.lastname: Patel
authors.affiliation: Speciality Doctor, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Rajib
authors.initials: R
authors.lastname: Pradhan
authors.affiliation: Consultant Orthopaedic Surgeon, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Peter Francis
authors.initials: PF
authors.lastname: Rosenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001860:Bone Plates / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D006811:Humerus; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: PHILOS(™) plate; ankle fusion; arthritis; diabetes; hindfoot fusion