%0 Journal Article
%T Algorithm for Management of Periprosthetic Ankle Fractures
%A Alexander L. Lazarides
%A Gireesh B. Reddy
%A James A. Nunley
%A James K. DeOrio
%A Mark E. Easley
%A Samuel B. Adams
%A Tyler J. Vovos
%J Foot & Ankle International
%@ 1944-7876
%D 2019
%R 10.1177/1071100719834542
%X Evidence on the management of and outcomes from periprosthetic fractures about a total ankle replacement (TAR) are limited. The purpose of this study was to develop an algorithm for the management of patients with postoperative periprosthetic fractures about a TAR. This was a retrospective analysis of patients undergoing a TAR from 2007 through 2017 with a subsequent periprosthetic fracture >4 weeks from index surgery. Implant stability was defined radiographically and intraoperatively where appropriate. Univariate and multivariate analyses were used to identify differences in outcomes. Thirty-two patients were identified with a remote TAR periprosthetic fracture with an average follow-up of 26 months (range, 3-104 months). Most fractures were located about the medial malleolus (62.5%); the majority of fractures (75%) were deemed to have stable implants. Fractures of the talus always had unstable implants and always required revision TAR surgery (100%, P = .0002). There was no difference in patient-reported outcomes between stable and unstable fractures at an average of 36 months. In a multivariate analysis, fracture location (talus), less time to fracture, and implant type were found to be predictive of unstable implants (P < .001). Implant stability was independently associated with the need for revision surgery (P < .049). Nonoperative treatment was independently associated with treatment failure (P < .001). The majority of stable fractures about a TAR required operative fixation. Management with immobilization was fraught with a high rate of subsequent surgical intervention. We found that fractures about the talus required revision TAR surgery or arthrodesis. Level III, retrospective cohort study
%K trauma
%K arthritis
%K total ankle replacements
%K periprosthetic fractures
%U https://journals.sagepub.com/doi/full/10.1177/1071100719834542