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

摘要

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.