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      The SIGN nail for knee fusion: technique and clinical results

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      1 , 2 , * , 2 , 1
      SICOT-J
      EDP Sciences
      Knee fusion, Intramedullary nail, SIGN nails

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          Abstract

          Purpose: Evaluate the efficacy of using the SIGN nail for instrumented knee fusion.

          Methods: Six consecutive patients (seven knees, three males) with an average age of 30.5 years (range, 18–50 years) underwent a knee arthrodesis with SIGN nail (mean follow-up 10.7 months; range, 8–14 months). Diagnoses included tuberculosis (two knees), congenital knee dislocation in two knees (one patient), bacterial septic arthritis (one knee), malunited spontaneous fusion (one knee), and severe gout with 90° flexion contracture (one knee). The nail was inserted through an anteromedial entry point on the femur and full weightbearing was permitted immediately.

          Results: All knees had clinical and radiographic evidence of fusion at final follow-up and none required further surgery. Four of six patients ambulated without assistive device, and all patients reported improved overall physical function. There were no post-operative complications.

          Conclusion: The technique described utilizing the SIGN nail is both safe and effective for knee arthrodesis and useful for austere environments with limited fluoroscopy and implant options.

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          Most cited references13

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          Arthrodesis of the knee after an infected arthroplasty using the Ilizarov method.

          We treated 15 patients by arthrodesis of the knee after removal of an infected total knee arthroplasty, using an Ilizarov ring fixator. Eight had a failed arthrodesis by another technique. The mean age of the patients was 75 years, the mean duration of retention of the frame was 28 weeks, the mean treatment time 51 weeks, and the mean follow-up 52 months. All but one knee fused at the first attempt, a rate of union of 93%. The incidence of complications related to treatment was 80%. The length of treatment and rates of complication were attributed to advanced age and the adverse local clinical factors in these patients. The Ilizarov method is a promising technique for achieving arthrodesis under these circumstances.
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            Knee arthrodesis.

            Arthrodesis is one of the last options available to obtain a stable, painless knee in a patient with a damaged knee joint that is not amenable to reconstructive measures. Common indications for knee arthrodesis include failed total knee arthroplasty, periarticular tumor, posttraumatic arthritis, and chronic sepsis. The primary contraindications to knee fusion are bilateral involvement or an ipsilateral hip arthrodesis. A variety of techniques has been described, including external fixation, internal fixation by compression plates, intramedullary fixation through the knee with a modular nail, and antegrade nailing through the piriformis fossa. Allograft or autograft may be necessary to restore lost bone stock or to augment fusion. For the carefully selected patient with realistic expectations, knee arthrodesis may relieve pain and obviate the need for additional surgery or extensive postoperative rehabilitation.
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              Comparison of intramedullary nailing and external fixation knee arthrodesis for the infected knee replacement.

              We analyzed knee arthrodesis for the infected total knee replacement (TKR) using two different fixation techniques. Patients undergoing knee arthrodesis for infected TKR were identified and rates of successful fusion and recurrence of infection were compared using Cox proportional hazard models. Eighty-five consecutive patients who underwent knee arthrodesis were followed until union, nonunion, amputation, or death. External fixation achieved successful fusion in 41 of 61 patients and was associated with a 4.9% rate of deep infection. Fusion was successful in 23 of 24 patients with intramedullary (IM) nailing and was associated with an 8.3% rate of deep infection. We observed similar fusion and infection rates with the two techniques. Thirty-four patients (40%) had complications. Knee arthrodesis remains a reasonable salvage alternative for the difficult infected TKR. Complication rates are high irrespective of the technique, and one must consider the risks of both nonunion and infection when choosing the fixation method in this setting. IM nailing appears to have a higher rate of successful union but a higher risk of recurrent infection when compared with external fixation knee arthrodesis. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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                Author and article information

                Journal
                SICOT J
                SICOT J
                sicotj
                SICOT-J
                EDP Sciences
                2426-8887
                2016
                05 February 2016
                : 2
                : ( publisher-idID: sicotj/2016/01 )
                : 6
                Affiliations
                [1 ] Soddo Christian Hospital Soddo Ethiopia
                [2 ] University of Utah Department of Orthopaedics Salt Lake City Utah USA
                Author notes
                [* ]Corresponding author: lucas.anderson@ 123456hsc.utah.edu
                Article
                sicotj150098 10.1051/sicotj/2015038
                10.1051/sicotj/2015038
                4849330
                27163095
                888eeb2d-399a-4885-b527-3da314b95a38
                © The Authors, published by EDP Sciences, 2016

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 May 2015
                : 30 November 2015
                Page count
                Figures: 5, Tables: 1, Equations: 0, References: 14, Pages: 6
                Categories
                Knee
                Original Article

                knee fusion,intramedullary nail,sign nails
                knee fusion, intramedullary nail, sign nails

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