Introduction The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising.
Step 1: Preoperative Planning for a Lateral Talar Lesion Obtain anteroposterior and lateral ankle radiographs as well as magnetic resonance imaging (MRI) studies of the ankle to evaluate the stage of the osteonecrotic disease.
Step 2: Percutaneous Pin Insertion (Lateral Talar Lesion) Insert a 1.8-mm Steinmann pin or Ilizarov wire percutaneously under biplanar fluoroscopic visualization.
Step 3: Percutaneous Drilling Make one, two, or three passes with a 3.2-mm cannulated drill bit over the pin into the lesion(s).
Step 4: Backfilling the Bone Tunnel (Optional) Infiltrate the defect with demineralized bone matrix to backfill the drill track and the deep necrotic bone defect.
Step 5: Postoperative Management The patient bears weight as tolerated in a removable short leg rigid boot for the first four weeks and avoids high-impact activities for at least ten months.
Results In our study, there were significant improvements in the mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score (p = 0.001), University of California Los Angeles (UCLA) activity score (p = 0.025), and visual analog scale (VAS) pain score (p = 0.001) at a mean of five years (range, two to nine years) postoperatively.
Pitfalls & Challenges
The mid-term clinical, patient-reported, and radiographic outcomes of percutaneous drilling to treat early-stage osteonecrosis (without joint collapse) of the distal part of the tibia or of the talus are promising1. Atraumatic osteonecrosis is a devastating condition with an unclear pathogenesis2,3. The most prevalent locations of atraumatic osteonecrosis are the femoral head, knee, shoulder, and ankle4-7. At the ankle, lesions are most commonly localized in the …
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