Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2021; 12(12): 1036-1044
Published online Dec 18, 2021. doi: 10.5312/wjo.v12.i12.1036
Intraosseous device for arthrodesis in foot and ankle surgery: Review of the literature and biomechanical properties
Biju Benjamin, Paul Ryan, Yulia Chechelnitskaya, Levent Bayam, Turab Syed, Efstathios Drampalos
Biju Benjamin, Paul Ryan, Yulia Chechelnitskaya, Turab Syed, Efstathios Drampalos, Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, Larbert FK54WR, Scotland, United Kingdom
Levent Bayam, Department of Orthopaedic, Sakarya University, Sakarya 54100, Turkey
Author contributions: Benjamin B, Ryan P, Chechelnitskaya Y and Syed T performed the preparation of manuscript; Ryan P performed the English language check; Bayam L and Drampalos E helped with collection of data and manuscript preparation.
Conflict-of-interest statement: We, the authors of this study declare that there is no financial conflicts of interest or other interests that may influence the manuscript. We have not received any funding for the work undertaken.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Efstathios Drampalos, MD, MSc, PhD, Surgeon, Department of Trauma and Orthopaedics, Forth Valley Royal Hospital, Stirling Road, Larbert FK54WR, Scotland, United Kingdom. efstathios.drampalos2@nhs.scot
Received: March 18, 2021
Peer-review started: March 18, 2021
First decision: July 18, 2021
Revised: August 1, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: December 18, 2021
Processing time: 270 Days and 21.9 Hours
Abstract
BACKGROUND

Arthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and stability. There have been numerous fixation devices described in literature for foot and ankle arthrodesis, each with their own benefits and drawbacks.

AIM

To review the use of intraosseous devices in foot and ankle surgery.

METHODS

There were 9 papers included in the review (6 clinical and 3 experimental studies) all evaluating arthrodesis in the foot and ankle using the IOFIX device (Extremity Medical™, Parsippany, NJ, United States). Outcome scores, union rates, as well as complications were analysed.

RESULTS

IOFIX appears to be safe and effective in achieving arthrodesis of the 1st metatarsophalangeal, and talonavicular joints with early rehabilitation. In comparison to plate/screw constructs there were fewer soft tissue complications and issues of metalwork prominence. Cadaveric and biomechanical studies on the use of intramedullary fixation for fusion of the tarsometatarsal and ankle joint showed decreased load to failure, cycles to failure and stiffness in comparison to traditional fusion methods using plates and screws, however IOFIX devices produced higher compressive forces at the joint.

CONCLUSION

We describe the reasons for which this biomechanical behavior of the intraosseous fixation may be favorable, until prospective and comparative studies with larger sample size and longer follow-up confirm the effectiveness and limitations of the method.

Keywords: Intra-osseous fixation; Foot; Ankle; Arthrodesis; Biomechanical; IOFIX

Core Tip: Numerous fixation devices have been described in literature for foot and ankle arthrodesis. This review article looked into the use of an intraosseous device IOFIX. Outcome scores, union rates, as well as complications described in 9 related publications were analysed. IOFIX appears to be safe and effective in achieving arthrodesis of the 1st metatarsophalangeal and talonavicular joints with early rehabilitation. However, cadaveric and biomechanical studies on the use in tarsometatarsal and ankle joint showed some concerns for which further clinical trials are required.