A comparison of open and arthroscopic ankle fusion

Abstract

The aim of this paper is to compare the infection rate and outcome of open and arthroscopic methods of ankle fusion, with fixation either by compression screws and plaster alone or with these supplemented by external fixation with Charnley compression clamps and pins. 41 ankles were fused, 20 by open methods, 21 arthroscopically. 26 ankles had osteoarthritis, eight had rheumatoid, seven post-traumatic, and one post tubercular arthritis. They were reviewed between 8 months and 8 years post op. There was no significant difference between open and arthroscopic methods for clinical fusion rates (85% open, 90% for arthroscopic), radiographic fusion rates (70% open, 76% for arthroscopic), or clinical score as assessed by American Orthopaedic Foot and Ankle Score (65 open, 68 arthroscopic). However, when external fixation with Charnley compression clamps and pins was used in 25 ankles, four (16%) developed infection, two superficial and two deep infection requiring debridement and curettage, one developed a stress fracture through the talar neck which united after a further 8 weeks in plaster. When pins and clamps were not used these complications were not seen. We conclude that external compression pins and clamps are best avoided unless stability cannot be achieved by internal fixation while carrying ankle arthrodesis.