Indications for and Early Complications Associated With Use of Temporary Invasive Distraction for Osteochondral Graft Transfer Procedures for Treatment of Lateral Osteochondral Lesions of the Talus

Abstract

Background:

A recent cadaveric study demonstrated that a novel technique termed temporary invasive distraction (TID), which uses intraoperative external fixation, can improve lateral talar dome exposure for osteochondral graft transfer procedures for treatment of lateral osteochondral lesions of the talus (OCLTs). The current study was performed to report our early complications using TID during open treatment of lateral OCLTs to determine whether this technique poses any risk of increased short-term patient morbidity.

Methods:

Electronic and manual surgeon logs were searched for all cases of osteochondral graft procedures. Lateral lesions treated with TID were analyzed. Inpatient and outpatient medical records were reviewed for early complications associated with TID for this application to assess initial safety of this new technique. Complications were defined as pin tract infection, fracture, neurovascular injury, pin site pain, or pin site wound-healing problems. Complications were stratified into major and minor based on severity. Twelve consecutive patients had open osteochondral graft transfer procedures using temporary invasive distraction with and without fibular osteotomies. All patients were male, active-duty US military service members with an average age of 38.4 (range, 23.8-52.5) years.

Results:

Use of TID resulted in no early major complications and only 2 early minor complications. Minor complications included 2 cases of residual postoperative pin site pain that resolved completely at 12 weeks postoperatively. By 12 weeks postoperatively, no patients demonstrated any residual complications or symptoms related to the use of TID. At mean latest follow-up of 90.5 weeks (20.9 months), there were no residual complications directly associated with the use of the TID device.

Conclusions:

Temporary invasive distraction with use of intraoperative external fixation can be safely performed with minimal risk of increased morbidity and offers potential technical advantages during open osteochondral graft transfer procedures for treatment of lateral OCLTs.

Level of Evidence:

Level IV, retrospective chart study.

Keywords

osteochondral lesion talus temporary distraction external fixation autograft transfer allograft transfer

Get full access to this article

View all access options for this article.

References

Brooks

Burstein

Frankel

. The biomechanics of torsional fractures: the stress concentration effect of a drill hole. J Bone Joint Surg Am. 1970;52:507-514.

Casteleyn

Handelberg

. Distraction for ankle arthroscopy. Arthroscopy. 1995;11:633-634.

Chang

Lenczner

. Osteochondritis dissecans of the talar dome treated with an osteochondral autograft. Can J Surg. 2000;43:217-221.

Easley

Latt

Santangelo

Merian-Genast

Nunley

. Osteochondral lesions of the talus. J Am Acad Orthop Surg. 2010;18:616-630.

Econopouly

Perlman

Notari

Boiardo

. The use of an ankle joint distractor in ankle arthroscopy. J Foot Surg. 1992;31:96-99.

Flick

Gould

. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985;5:165-185.

Garras

Santangelo

Wang

Easley

. A quantitative comparison of surgical approaches for posterolateral osteochondral lesions of the talus. Foot Ankle Int. 2008;29:415-429.

Gautier

Kolker

Jakob

. Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br. 2002;84(2):237-244.

Juliano

Schneider

Jacobs

. Evaluation of fracture predilection in the calcaneus after external fixator pin removal. J Orthop Trauma. 1997;11:430-434.

10.

Kolker

Murray

Wilson

. Osteochondral defects of the talus treated with autologous bone grafting. J Bone Joint Surg Br. 2004;86(4):521-526.

11.

Kumar

Satku

. The A-O femoral distractor for ankle arthroscopy. Arthroscopy. 1994;10:118-119.

12.

Lamy

Stienstra

. Complications in ankle arthroscopy. Clin Podiatr Med Surg. 1994;11:523-539.

13.

Mendicino

Catanzariti

Hallivis

. Mosaicplasty for the treatment of osteochondral defects of the ankle joint. Clin Podiatr Med Surg. 2001;18:495-513.

14.

Mendicino

Hallivis

Cirlincione

Catanzariti

Krause

. Osteochondral autogenous transplantation for osteochondritis dissecans of the ankle joint. J Foot Ankle Surg. 2000;39:343-348.

15.

Muir

Saltzman

Tochigi

Amendola

. Talar dome access for osteochondral lesions. Am J Sports Med. 2006;34:1457-1463.

16.

Rush

Kirk

Kirby

Hsu

. Lateral talar dome access utilizing temporary invasive distraction. Foot Ankle Int. 2010;31(3):236-241.

17.

Tochigi

Amendola

Muir

Saltzman

. Surgical approach for centrolateral talar osteochondral lesions with an anterolateral osteotomy. Foot Ankle Int. 2002;23(11):1038-1039.

18.

Topp

Hayda

Benedetti

Twitero

. The incidence of neurovascular injury during external fixator placement without radiographic assistance for lower extremity diaphyseal fractures: a cadaveric study. J Trauma. 2003;55(5):955-958.