A Review of Ankle Arthrodesis: Predisposing Factors to Nonunion

Abstract

The purpose of this study was to review 15 years of experience with ankle fusions, specifically addressing the underlying etiology of ankle pathology, incidence of nonunion, and associated predisposing conditions that can lead to nonunion. Seventy-eight ankle fusions, performed between 1975 and 1990, were reviewed for this study. The average follow-up was 4 years. Patients with nonunion were evaluated separately to look at the predisposing factors that may have lead to nonunion. Factors associated with nonunion included fracture type, evidence of avascular necrosis, infection, major medical problems, and open injuries. Factors that were not associated with nonunion included age, past history of subtalar or triple arthrodesis, and technique.

Ankle arthrodesis with cross-screw fixation: Good results in 36/40 cases followed 3-7 years

“…High-risk patients were defined as those with certain predisposing factors that could increase the risk of nonunion and infection (Morgan et al 1985, Cracchiolo et al 1992, Kitaoka et al 1992, Frey et al 1994, Thordarson et al 1994. These factors included a massive loss of bone from a previous fracture or of unknown etiology (3), poor quality of bone due to rheumatoid arthrosis (7), sequelae of neurogenic paralysis (4) and postseptic arthrosis (4), osteonecrosis of the talus (3), failed ankle arthrodesis (4), and diabetic neuropathy associated with posttraumatic arthrosis (1).…”

“…To solve these problems, a simple technique with crossed screws was developed by Morgan et al (1985), who used a wide exposure from an anterior approach, correction of the deformity, broad cancellous bone contact and rigid internal fixation using 2-3 cancellous screws. The method is mainly of value in arthrosis with mild deformity and good bone quality (Holt et al 1991, Mann et al 1991, Thordarson et al 1992, Frey et al 1994. Some reports have described the method used for patients with high risks of failure due to underlying disease, but gave few details (Morgan et al 1985, Moeckel et al 1991.…”

“…Complications include pseudarthrosis in 1 0 4 0 % and infection in 2 5 4 0 % (Morrey and Wiedeman 1980, Hagen 1986, Lynch et al 1988, Frey et al 1994. To solve these problems, a simple technique with crossed screws was developed by Morgan et al (1985), who used a wide exposure from an anterior approach, correction of the deformity, broad cancellous bone contact and rigid internal fixation using 2-3 cancellous screws.…”

Arthroscopic ankle arthrodesis: a review

“…Controversies exist regarding body mass index and cigarette smoke as risk factors. No association between age, diabetes mellitus, peripheral neuropathy, and nonunion has been found [17,31,33,34]. No advantages were shown by the addition of demineralized bone matrix or platelet rich plasma [31].…”

Ankle and Subtalar Joint Arthrodesis with Retrograde Intramedullary Nail

“…Bu yöntemlerin en büyük dezavantajı hastaya ameliyat sonrası erken yük verilememesi ve bazen de kaynamanın oluşmaması-dır. [10] Romatoid artritli ve kemik kalitesi zayıf hastalarda uzun süre yük vermeme, kullanmama atrofisine neden olabilir. Bu nedenle ameliyat sonrası erken yük verme, kaynamanın hızlanması ve ekstremite fonksiyon kaybını önlemek amacıyla arzu edilen bir durumdur.…”