MEDIAL COMPRESSION PLATE ARTHRODESIS OF THE ANKLE

Abstract

Numerous techniques of arthrodesis of the ankle have been described in the literature with variable results. Although arthrodesis achieves satisfying results in most cases, high complication rates have been reported. We utilized a medial compression T plate to achieve fusion and the aim of this study is to present the early to mid term results of this procedure at our institution.

20 patients (23 ankles) underwent ankle arthrodesis by a single surgeon using the same surgical technique. Under tourniquet control, a medial longitudinal incision centering on the medial malleolus was used. After osteotomising the medial malleolus to expose the ankle joint, chevron cuts were made in the tibia and the talus removing only enough bone. The cut surfaces are apposed and then compressed together by using a medial compression T plate. The excised medial malleolus was used as bone graft. The fixation was protected in a plaster cast and allowed only partial weight bearing for up to 10 weeks. The ankles were clinically assessed by Mazur ankle scoring system and radiologically assessed until fusion was solid.

The mean age at operation was 56 years (range 20–76) and the sex distribution was equal. Indication for surgery included either posttraumatic or rheumatoid arthritis. At a mean follow-up of 73 months (range 6–112), all the patients had complete pain relief. Complications included deep infection in two ankles (Rheumatoid patient, needed implant removal), subtalar pain in four and nonunion in one ankle. There was late loss of position in 2 ankles (same patient), who was later diagnosed with charcot’s joints. All the fusions occurred within 16 weeks.

The fusion rate with this technique was 96% with the medial T plate providing a stable internal fixation. Our experience suggests that medial compression arthrodesis of the ankle is a reliable and an easily reproducible technique with a very low incidence of complications.