Arthrodesis of the ankle joint by Ilizarov external fixator in patients with infection or poor bone stock

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Abstract

Background

Ankle arthrodesis is the most common surgical treatment for end stage ankle arthritis. Many surgical techniques have been described to achieve this purpose. The aim of the present study is to assess the results of the Ilizarov external fixator in performing ankle fusion in patients who have infection or poor bone stock at the region of the ankle joint.

Patients and methods

Twelve patients with secondary ankle arthritis were treated by ankle arthrodesis using the Ilizarov external fixator. Eight were males and four were females. The age ranged from 23 to 56 with an average of 42.8 years. Active infection was present in 7 cases and the bone stock was deficient in 5 cases. Bone lengthening was done in 4 cases to equalize the limb length.

Results

Sound fusion was achieved in all the cases except one. Infection was controlled in all the infected cases. Ten cases could walk without support, one could walk with a cane and one case required an ankle foot orthosis. All patients were satisfied with their results except one. The complications had included pin tract infection in 9 cases, varus deformity of about 15 degrees in 1 case and fibrous ankylosis in 1 case.

Conclusion

The Ilizarov technique is a good method for ankle fusion especially in presence of infection, bone defects or shortening.

Introduction

Secondary ankle arthritis may result from traumatic destruction of the articular cartilage, septic arthritis, inflammatory arthritis or avascular necrosis of the talus [1]. In its end stage, ankle arthritis may produce severe pain and marked disability similar to that of the end stage hip arthritis [2]. The treatment options range from medical treatment, physical therapy, orthotic management to surgical intervention [1]. Ankle arthrodesis remains the gold standard for surgical treatment of end stage ankle arthritis. Many surgical techniques have been described to achieve ankle fusion with varying degrees of success and failure. In case of infection or poor bone stock the chance of internal fixation to be successful is very limited and external fixation is the preferred method of treatment [3], [4]. Charnley was the first to describe compression ankle arthrodesis using a uniplanar external fixator. Since then many types of fixator have evolved to improve the stability of fixation [5], [6], [7]. The aim of the present study is to assess the results of the Ilizarov external fixator as a method for ankle arthrodesis in patients with ankle arthritis complicated by infection or poor bone stock.

Section snippets

Patients and methods

Between 2001 and 2005 twelve patients with secondary ankle arthritis were treated in our institution by ankle fusion using the Ilizarov external fixator. The age ranged from 23 to 56 years with an average of 42.8 years. Eight were males and 4 were females. The right side was affected in 7 cases and the left side in 5 cases. The initial diagnosis was pilon fracture in 4 cases, ankle fractures (malleolar fractures) in 2 cases, combined fractures of the distal tibia and talus in 1 case, open

Results

The follow up period ranged from 23 months to 52 months with an average of 29 months. The treatment time (from the index surgery till removal of the fixator) ranged from 3 months to 8 months with an average of 5 months. The longest time of treatment was observed in the cases that required lengthening beside ankle fusion (average 7 months). The treatment time was relatively short (average 4 months) in the cases in which only ankle fusion was done. Sound and painless fusion was achieved in all

Discussion

Ankle arthrodesis can be done by many techniques which include; conventional open surgery with internal fixation, arthroscopic approach with denuding the articular cartilage, interposition bone graft with screw fixation and intramedullary fixation [9], [10], [11], [12]. These methods are useful for patients with idiopathic, post-traumatic or post-rheumatic arthritis but they are contraindicated in presence of infection. Ankle arthrodesis by external fixation has been advocated by many authors

Conclusion

Ilizarov external fixator is a good method for ankle fusion in patients who have infection or poor bone stock. The thin tensioned wires allow for firm fixation in the small bone fragments or the osteoporotic bone. Any infected or dead tissues could be excised and the resultant defect can be treated by lengthening or bone transport.

Conflict of interest statement

The author has not received any benefit for personal or professional use from a commercial party related directly or indirectly to the subject of this article

References (20)

  • J.J. Rodrigo et al.

    Management of the arthritic joint

  • Glazebrook MA, Daniels TR, Younger AS, Penner MJ, Wing KJ, Lau JTC, et al. Patients with end stage ankle and hip...
  • O.A. Alade et al.

    What's new in foot and ankle surgery

    J Bone Joint Surg Am

    (2007)
  • R.M. Pickering

    Arthrodesis of ankle, knee, and hip

  • J. Charnley

    Compression arthrodesis of the ankle and shoulder

    J Bone Joint Surg Br

    (1951)
  • A.T. Berman et al.

    Compression arthrodesis of the ankle by triangular external fixation: an improved technique

    Orthopedics

    (1989)
  • R.F. Malarkey et al.

    Ankle arthrodesis with the calandruccio frame and bimalleolar onlay grafting

    Clin Orthop

    (1991)
  • H.B. Kitaoka et al.

    Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes

    Foot Ankle Int

    (1994)
  • R.A. Mann et al.

    Arthrodesis of the ankle: a critical analysis

    Foot Ankle Int

    (1998)
  • J.C. Cheng et al.

    The role of arthroscopy in ankle and subtalar degenerative joint disease

    Clin Orthop

    (1998)
There are more references available in the full text version of this article.

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