Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia

Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint d...

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Autores principales:	Nicolas Haelewijn, Sebastien Lobet, An Van Damme, Pierre-Louis Docquier, Maarten Eerdekens, Kevin Deschamps
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	ankle arthropathy haemophilia joint distraction Medicine R
Acceso en línea:	https://doaj.org/article/e4f7aab0300c45a7b48da14522943447
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spelling	oai:doaj.org-article:e4f7aab0300c45a7b48da145229434472021-11-11T16:30:57ZClinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia10.3390/ijerph1821114051660-46011661-7827https://doaj.org/article/e4f7aab0300c45a7b48da145229434472021-10-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/21/11405https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients’ physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema.Nicolas HaelewijnSebastien LobetAn Van DammePierre-Louis DocquierMaarten EerdekensKevin DeschampsMDPI AGarticleanklearthropathyhaemophiliajoint distractionMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 11405, p 11405 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ankle arthropathy haemophilia joint distraction Medicine R
spellingShingle	ankle arthropathy haemophilia joint distraction Medicine R Nicolas Haelewijn Sebastien Lobet An Van Damme Pierre-Louis Docquier Maarten Eerdekens Kevin Deschamps Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia
description	Ankle joint distraction (AJD) has been described to be a valuable joint-sparing alternative to arthrodesis or arthroplasty; however, clinical endpoints associated to this surgical intervention are lacking. The current case report describes clinical and biomechanical outcome measures of ankle joint distraction in a 14-year-old patient with severe haemophilia A. Because of persistent and incapacitating pain and the poor response to conservative and invasive treatment options, ankle joint distraction was performed in this 14-year-old patient using an external fixator encompassing two Ilizarov full rings in the tibia and a foot ring fixed to the foot by four K-wires. State-of-the-art medical imaging and non-invasive skin marker-based 3D multi-segment foot modelling were performed in a pre- and post-operative stage. From a structural viewpoint, this AJD was a success since it improved and stabilised the osteo-cartilaginous lesions of the ankle. Biomechanical outcome measures associated with the 18-month follow-up were found to be suboptimal, showing an early plantarflexion pattern at the ankle joint during midstance and a tendency towards increased power absorption at the midfoot with peak power absorption being almost two times higher when compared to boys of the same age. From a functional viewpoint, we observed a clear reduction in the patients’ physical activities until one year after AJD. Despite these functional and structural improvements, recurrent painful phenomena, including the development of a complex regional pain syndrome (CRPS) and a stress fracture of the third metatarsal bone, were observed which are probably related with the development of recurrent subchondral oedema.
format	article
author	Nicolas Haelewijn Sebastien Lobet An Van Damme Pierre-Louis Docquier Maarten Eerdekens Kevin Deschamps
author_facet	Nicolas Haelewijn Sebastien Lobet An Van Damme Pierre-Louis Docquier Maarten Eerdekens Kevin Deschamps
author_sort	Nicolas Haelewijn
title	Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia
title_short	Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia
title_full	Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia
title_fullStr	Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia
title_full_unstemmed	Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia
title_sort	clinical and biomechanical progression after ankle joint distraction in a young adolescent patient with haemophilia
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/e4f7aab0300c45a7b48da14522943447
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Clinical and Biomechanical Progression after Ankle Joint Distraction in a Young Adolescent Patient with Haemophilia

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