The Ilizarov external fixator has numerous advantages applicable to ankle fusion, including: stable fixation, respect for soft tissues, and the possibility of postoperative alignment 'fine-tuning'. Additionally, the ability to direct forces through or around skeletal elements allows varying of the load through the skeletal elements, allowing early weightbearing. The Ilizarov technique, with its high union rate, may be considered for any ankle arthrodesis but is especially useful in complex cases such as revisions, talar osteonecrosis, soft-tissue compromise, and infection. Early weightbearing is an added benefit.
These results help to partially explain the widely recognized clinical observation that molded insoles and shoes, no matter how well conformed to the foot, do not reduce plantar loads as effectively as a total contact cast. The mechanism appears to be a critical unloading function of the proximal, 'shank' portion of the cast, presumably due to reduction in ankle motion.
US is effective for the detection of radiographically silent fractures of the paediatric ankle. It may be used as an adjunct to radiography in clinically suspicious, but radiographically negative ankle injuries.
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