The total ankle replacement system shown is the Stryker STAR. The system is identified by the tibial tray double barrel configuration seen on the AP, and the large covering component of the talus with a longer lateral-sided border and central keel. The system is mobile-bearing (3-component) where the polyethylene articular component does not lock into either the tibial or talar component.
An evidence-based algorithm was made regarding the treatment of periprosthetic fractures of the ankle. The main determinants are stability of the implant and location of the fracture. Radiographically, implant instability was considered for fractures with associated osteolysis about an implant or evidence of loosening and/or subsidence related to the fracture. Where appropriate, implant stability can be confirmed intraoperatively.
Implant stability was found to be an important predictor of the need for revision TAR or arthrodesis. Stable implants with associated fractures at the medial malleolus, tibia shaft, and fibula require open reduction internal fixation. Unstable implants with associated fractures at the medial malleolus, tibia shaft, and fibula require revision or fusion.
All fractures about the talus were found to have an associated unstable implant and required revision surgery or arthrodesis. Finally, nonoperative treatment of fractures with stable implants was an independent predictor of treatment failure. Therefore, operative treatment of all periprosthetic TAR fractures is recommended.
In addition to arthrodesis, a single stage revision would also be appropriate. 2-stage revisions are performed in the setting of periprosthetic joint infection.
Citation:
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Lazarides AL. Algorithm for Management of Periprosthetic Ankle Fractures. Foot Ankle Int. 2019;40(6):615-621.
Photo credit by Dr. Eric So, DPM
Photo credit by Dr. Eric So, DPM