Ankle fusion for bone loss around the ankle joint using the Ilizarov technique

Abstract

We present the results of ankle fusion using the Ilizarov technique for bone loss around the ankle in 20 patients. All except one had sustained post-traumatic bone loss. Infection was present in 17. The mean age was 33.1 years (7 to 71). The mean size of the defect was 3.98 cm (1.5 to 12) and associated limb shortening before the index procedure varied from 1 cm to 5 cm. The mean time in the external fixator was 335 days (42 to 870). Tibiotalar fusion was performed in 19 patients and tibiocalcaneal fusion in one. Associated problems included diabetes in one patient, pelvic and urethral injury in one, visual injury in one patient and ipsilateral tibial fracture in five. At the final mean follow-up of 51.55 months (24 to 121) fusion had been achieved in 19 of 20 patients. A total of 16 patients were able to return to work. The results were graded as good in 11 patients, fair in six and poor in three. The mean external fixation index was 8.8 days/mm (0 to 30). One patient with diabetes developed severe infection which required early removal of the fixator. Refractures occurred in three patients, two of which were at the site of fusion and one at a previous tibial shaft fracture site. Equinus deformity of the ankle fusion occurred after a further fracture in one patient. There were two patients with residual forefoot equinus, and one developed late valgus at the fusion site.Poor consolidation of the regenerated bone in two patients was treated by bone grafting in one and by bone and fibular strut grafting in the other. Residual soft-tissue infection was still present in two patients.No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion

“…The extended time required for fusion and the fusion rate in their series were similar to those in our complex fusion cohort. In another study, a cohort of patients with posttraumatic bone loss and infection was treated with the Ilizarov method with good results [23]. In that series, 19 of 20 (95%) patients achieved successful fusion after an average of 11 months wearing the external fixator.…”

“…Ankle fusion using circular fixation has been regarded as a last resort, limb-salvage procedure [3,5,6,8,10,11,14,16,17,20,21,23,25,[28][29][30][31] (Table 5). We asked whether (1) smoking and other comorbidities (Charcot neuroarthropathy, Type B hosts), (2) time wearing the frame, or (3) tibial lengthening affected union rate after ankle arthrodesis surgery?…”

“…Healing was judged by cortical bridging at the fusion site and loss of lucency between fusion surfaces [3,[20][21][22][23]. Determination of healing was not straightforward and cortical bridging was not often seen.…”

“…Although not shown in the literature, performing a tibial osteotomy in the setting of an ankle fusion has been thought to enhance healing at the arthrodesis site [19]. The Ilizarov method [19] has been used in these complex cases [3,5,6,8,10,11,14,16,17,20,21,23,25,[28][29][30][31]. An improved understanding of the contributions of each complex variable (smoking, diabetes, Charcot neuroarthropathy, osteomyelitis, time wearing the external fixator, limb length discrepancy [LLD], and tibial lengthening) to the healing of ankle fusions would be valuable to provide information for patients' and surgeons'.…”

The use of a ceramic talar body prosthesis in patients with aseptic necrosis of the talus

“…10 Tibiocalcaneal fusion appears to produce favourable functional results, but at the expense of shortening. Dennison et al 10 and Kovoor et al 11 reported tibiotalar or tibiocalcaneal fusion for patients with bone loss of the talus combined with callotasis using the Ilizarov technique, which makes these operations technically demanding. Recently ankle or tibiocalcaneal fusion using allograft has been reported for patients with collapse of the talus and either osteonecrosis or severe bone loss.…”