OUR EXPERIENCE IN ANKLE ARTHRODESIS WITH ILIZAROV TECHNIQUE

Abstract

Purpose: Our aim was to evaluate the use of Ilizarov external fixator for ankle arthrodesis in severe post-traumatic or other ankle arthritis.

Patients and Methods: In the period of 8 years, 19 patients underwent ankle arthrodesis with the Ilizarov external fixator for severe ankle arthritis. In four patients the indication for arthrodesis was infection following failed surgical management of tibia plafond fractures, four patients had failed prior ankle arthrodesis and the rest suffered severe ankle arthritis. Eleven patients were male, eight female, with a mean age of 52 years (range 30–71 years). Seven patients had deformities greater then 10°. All had painful stiff ankle joints and 12 patients had disorder of ankle joint anatomy with significant limp. Anterior approach to the ankle joint was preferred, associated with distal fibular osteotomy. Secondary gradual corrections of postoperative deformity and additional compression at the arthrodesis site were performed with the Ilizarov system by closed manipulation. Following frame removal the arthrodesis was immobilised in a cast for a mean of 4 weeks.

Results: The mean follow-up period was 3,9 years. A solid ankle arthrodesis was achieved in 18 of the 19 cases. Failure of solid arthrodesis was detected in one patient with insufficient arthroscopic removal of articular cartilage and internal fixation was performed. In one case with major pin tract infection at the distal talus ring distal expansion of the frame was required. According to the Mazur rating system in 12 patients the results were good, in 5 patients fair and in 2 patients poor.

Conclusion: The use of Ilizarov external fixator for ankle arthrodesis provides significant interfragmentary compression forces, allows early weight bearing and post-operative adjustment of alignment of arthrodesis. This method should be considered as the treatment of choice in ankle arthrodesis, especially in revision cases and in the cases with infection around of the ankle joint.