An Analysis of Talar Surface Area Occupied by Screw Fixation in Ankle Fusions

Abstract

The use of additional screw fixation when performing an ankle arthrodesis does not sacrifice a major amount of the tibiotalar contact area and will most likely not affect the biologic environment needed to obtain fusion.

Ankle arthrodesis from lateral transfibular approach: analysis of treatment results of 23 feet treated by the modified Mann’s technique

“…g and h Clinical appearance after failed operation. i and j Xrays 8 months after repeated ankle arthrodesis with axis correction and stabilization with two parallel screws joint do not occupy large space (16 % of articular surface only) and allow for good contact between resected articular surfaces [12]. Secondly, it seems to be logical to insert the screws from the talus to the tibia (smaller and more distal part is screwed down to the bigger and closer one)-reverse action seems to be illogical as it does not assure good stabilization.…”

Results of Arthroscopic Ankle Arthrodesis with Fixation Using Two Parallel Headless Compression Screws in a Heterogenic Group of Patients

“…Ankle arthrodesis is increasingly performed with arthroscopic assistance [5, 6]. Uncomplicated fixation methods to maintain proper foot alignment long enough to achieve solid bone union is a major concern of many orthopedic surgeons [9, 10, 12-16]. The ideal technique for obtaining adequate fusion is based on the least amount of hardware to achieve the strongest mechanical stability while preserving the biological environment for fusion to occur.…”

“…The number of screws necessary to achieve solid fusion varies between studies. In a sawbones model study, Brodsky et al found that the addition of a third screw does not result in a major decrease in the amount of bone contact available for fusion [16]. In a composite ankle joint model, Clifford et al found no significant differences in bending stiffness between anterior plate or lateral plate fixation and the three compression screws construct, suggesting that the addition of a compression screw will considerably increase the primary bending stiffness of ankle arthrodesis [14].…”

“…In a composite ankle joint model, Clifford et al found no significant differences in bending stiffness between anterior plate or lateral plate fixation and the three compression screws construct, suggesting that the addition of a compression screw will considerably increase the primary bending stiffness of ankle arthrodesis [14]. Yoshimura et al found that the fastest bone union in AAA is achieved with three parallel 6.0-mm cannulated cancellous screws placed medially from the distal tibia into the talus [16]. Arthroscopic joint preparation creates a more favorable environment for fusion and decreases the number of screws used [2, 6].…”

“…We hypothesized that, after arthroscopic preparation of a joint surface, fixation performed with only two parallel, mediolateral HCSs provides adequate stability to achieve bone fusion [9-11]. The use of only two screws requires less talar and tibial surface, further facilitating bone fusion, minimizing the soft tissue damage from surgical approaches, and potentially decreasing the need for hardware removal [16, 17]. …”