FOOT AND ANKLE DEFORMITY CORRECTION IN ADULTS USING CIRCULAR EXTERNAL FIXATORS

Abstract

We report a series of sixty corrections in fifty-five adult patients performed from 1989 to 2001 for complex deformities of the foot and ankle, using circular external fixation, with a mean follow up of 4.4 years. We studied the aetiology, pathophysiology of injury, clinical and radiological evaluation, and the method and outcome of treatment. The patients mean age was 37 years (range 16–65). 37 male. 18 females. 44 deformities were sequel of severe lower limb trauma; the others were due to neurological, congenital and iatrogenic causes. 38 patients had associated proximal pathology including non-union, malunion, shortening and deformities. This required simultaneous correction. In most patients, conventional surgery had failed to achieve correction and many of them were considered for amputation. The aim of surgery was correction of deformity in forty-two occasions and correction of deformity with ankle fusion in eighteen occasions.

For each patient, specific treatment goals were delineated that were realistically achievable. Initial complete correction was achieved in fifty-two patients; there was recurrence of the deformity in fourteen. Forty patients needed corrective osteotomies (16 ankles, 24 tibia and fibula). The results were classified as excellent in six patients, good in thirty-five patients, fair in eight patients, poor in six patients, five of whom had a below-knee amputation. Complications were minor and all resolved with appropriate therapy.

Conclusion: Circular external fixation offer a versatile and effective method of treatment of a variety of complex foot and ankle deformities; however, the surgeon should be familiar with both, their application and subsequent management. If foot and leg deformities coexist consider simultaneous correction. Corrective osteotomies may lead to less recurrence than soft tissue correction alone. Fusion should be considered where muscular imbalance or severe degenerative changes exists. In some cases with severe pathology; the only other option may be amputation.