- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02051933
The Effect of Botulinum Toxin A Injections on Ankle Dorsiflexion Following Internal Fixation of Tibial Pilon Fractures (Botox)
The Effect of Botulinum Toxin A Injections on Ankle Dorsiflexion Following Internal Fixation of Tibial Plafond (Pilon) Fractures: A Pilot Study
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
To determine if the use of Botulinum toxin A intramuscular injections of the gastrocsoleus complex in patients with operatively treated tibial plafond fractures will result in:
- increased ankle dorsiflexion when compared to controls
- increased ankle functionality as measured by the FAAM, and quality of life as measured by the SF-36, when compared to controls
- a higher proportion of patients achieving at least 10 degrees of dorsiflexion when compared to controls
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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North Carolina
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Charlotte, North Carolina, United States, 28204
- Carolinas Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients 18 and older with a tibial plafond fracture to be treated by a staged protocol involving primary external fixation and definitive fixation within 3 weeks from the injury.
(Non-definitive, interval procedures such as repeat irrigation and debridement and fibular fixation are allowed.)
Exclusion Criteria:
- Younger than 18 years of age
- Significant traumatic brain injury or cognitive disability that would interfere with post-operative rehabilitation and study questionnaires
- Nerve, vascular, or tendon injury of the lower leg: injury to the tibial or peroneal motor nerves, injury to the posterior tibial artery requiring repair, or laceration of tendons that are involved in plantar flexion or dorsiflexion of the ankle which require repair
- History of prior lower extremity fracture to the tibia or ankle of the affected limb.
- Incarcerated patients.
- Patients unable or unwilling to return for follow-up examination.
- Pregnant or lactating patients.
- History of disease affecting the neuromuscular junction (ex: myasthenia gravis).
- Use of aminoglycoside antibiotics at the time of definitive fixation.
- Ipsilateral foot injury that will impair dorsiflexion exercises: Lisfranc injuries, fractures or dislocations of the talus, calcaneus, navicular, cuboid, cuneiforms, or metatarsals (phalanx fractures or dislocations will not be excluded).
- Patients receiving Botulinum Toxin A for other reasons.
- Patients with a known hypersensitivity to Botulinum toxin A.
- Gustilo Anderson type III B and C.
- Patients with a weight greater than 115 kg - to ensure proper injection locations
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Botox
Botox: At the time of definitive fixation, the hospital's investigational pharmacy will provide four syringes containing 0.5mL Botulinum toxin type A. The dose of botulinum toxin will be calculated based on the patient's weight in kilograms, such that a total dose of 200U of Botox will be used for a 70kg individual. The dosage will scale linearly in proportion to the patient's body weight, such that each kilogram change results in a 3U change in Botox (rounded to the nearest 30U interval change from 200U, with a maximum of 300U). 45-55 kg: 140U 55-65 kg: 170U 65-75 kg: 200U 75-85 kg: 230U 85-95 kg: 260U 95-105 kg: 290U 105-115 kg: 300U |
At the time of definitive fixation, the hospital's investigational pharmacy will provide four syringes containing 0.5mL Botulinum toxin type A. The dose of botulinum toxin will be calculated based on the patient's weight in kilograms, such that a total dose of 200U of Botox will be used for a 70kg individual. The dosage will scale linearly in proportion to the patient's body weight, such that each kilogram change results in a 3U change in Botox (rounded to the nearest 30U interval change from 200U, with a maximum of 300U). 45-55 kg: 140U 55-65 kg: 170U 65-75 kg: 200U 75-85 kg: 230U 85-95 kg: 260U 95-105 kg: 290U 105-115 kg: 300U
Other Names:
|
Placebo Comparator: Placebo
Placebo: At the time of definitive fixation, the hospital's investigational pharmacy will provide four syringes containing 0.5mL 0.9% sodium chloride solution . The dose of 0.9% sodium chloride will be calculated based on the patient's weight in kilograms, such that a total dose of 200U of Placebo will be used for a 70kg individual. The dosage will scale linearly in proportion to the patient's body weight, such that each kilogram change results in a 3U change in placebo(rounded to the nearest 30U interval change from 200U, with a maximum of 300U). 45-55 kg: 140U 55-65 kg: 170U 65-75 kg: 200U 75-85 kg: 230U 85-95 kg: 260U 95-105 kg: 290U 105-115 kg: 300U |
At the time of definitive fixation, the hospital's investigational pharmacy will provide four syringes containing 0.5mL 0.9% sodium chloride solution . The dose of 0.9% sodium chloride will be calculated based on the patient's weight in kilograms, such that a total dose of 200U of Placebo will be used for a 70kg individual. The dosage will scale linearly in proportion to the patient's body weight, such that each kilogram change results in a 3U change in placebo(rounded to the nearest 30U interval change from 200U, with a maximum of 300U). 45-55 kg: 140U 55-65 kg: 170U 65-75 kg: 200U 75-85 kg: 230U 85-95 kg: 260U 95-105 kg: 290U 105-115 kg: 300U
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ankle Dorsiflexion of Injured Extremity
Time Frame: 6 month follow-up visit
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The difference in ankle dorsiflexion between the injured and un-injured ankles as measured with goniometer 6 month from surgery.
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6 month follow-up visit
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Short Form-36 (SF-36)Health Related Quality of Life
Time Frame: 6 month follow-up visit
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The SF-36 is a patient reported survey of health.
Physical functioning, role functioning/physical and general health sub-scores ranges from 0 (worst)- 100 (best)
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6 month follow-up visit
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Short Form-36 (SF-36) Health Related Quality of Life
Time Frame: 12 month follow-up visits
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The SF-36 is a patient reported survey of health.
Physical functioning, role functioning/physical and general health sub-scores ranges from 0 (worst)- 100 (best)
|
12 month follow-up visits
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Ankle Pain at 6 Month
Time Frame: 6 month follow-up visit
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Brief pain inventory (BPI) severity subscale measures pain severity with a higher score indicates worse pain (10) and lower score of no pain (0).
The pain interference subscale of the BPI measures interference of pain on average of the 7 questions assessing the interference of pain for general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life.
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6 month follow-up visit
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Ankle Pain at 12 Month
Time Frame: 12 month follow-up visit
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Brief pain inventory (BPI) severity subscale measures pain severity with a higher score indicates worse pain (10) and lower score of no pain (0).
The pain interference subscale of the BPI measures interference of pain on average of the 7 questions assessing the interference of pain for general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life.
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12 month follow-up visit
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Functional Status of the Ankle at 6 Month
Time Frame: 6 month follow-up visit
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The Foot and Ankle Ability Measure (FAAM) will be obtained to assess the functional status of the affected ankle. Each item is scored on a 5-point Likert scale (4 to 0) from 'no difficulty at all' to 'unable to do'. Item score totals, which range from 0 to 84 for the ADL subscale and 0 to 32 for the Sports subscale, were transformed to percentage scores. Higher scores represent higher levels of function for each subscale, with 100% representing no dysfunction. |
6 month follow-up visit
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Functional Status of the Ankle at 12 Month
Time Frame: 12 month follow-up visit
|
The Foot and Ankle Ability Measure (FAAM) will be obtained to assess the functional status of the affected ankle.
A higher score represents a higher level of physical function.
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12 month follow-up visit
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Collaborators and Investigators
Investigators
- Principal Investigator: Madhav A Karunakar, MD, Wake Forest University Health Sciences
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Congenital Abnormalities
- Joint Diseases
- Musculoskeletal Diseases
- Muscular Diseases
- Musculoskeletal Abnormalities
- Limb Deformities, Congenital
- Foot Deformities
- Foot Deformities, Acquired
- Foot Deformities, Congenital
- Lower Extremity Deformities, Congenital
- Clubfoot
- Talipes
- Equinus Deformity
- Contracture
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Cholinergic Agents
- Membrane Transport Modulators
- Acetylcholine Release Inhibitors
- Neuromuscular Agents
- Botulinum Toxins
- Botulinum Toxins, Type A
- abobotulinumtoxinA
Other Study ID Numbers
- 03-12-19B
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