Abstract
Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients.Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle.Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Post-procedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months.Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.
Highlights
Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed
Ankle arthrodesis is the fusion of the ankle joint and is indicated in conditions such as advanced ankle arthritis, post traumatic arthritis, congenital and neuromuscular disorders, infection, avascular necrosis of the talus, advanced posterior tibial tendon dysfunction and Charcot neuroarthropathy, and serves as a salvage procedure for failed total ankle arthroplasty[1]
The techniques recorded in literature for arthrodesis up until now include crossed screw structure, intramedullary nail, plate, external fixation frame and so forth; there remains much controversy with respect to the optimal technique for ankle fusion to acquire steady rigid fixation, fixation methods that does not allow interfragmentary movement under functional weight bearing and utilizes the compression principle, accompanying restoration of plantigrade foot function[3,4,5,6]
Summary
Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. Internal fixation for ankle arthrodesis is sufficient in most cases; several types of infections i.e. chronic osteomyelitis and tuberculosis infections, ankle deformity or limb length discrepancy, compromised soft tissue around the ankle and deficient bone stock as well as neurological conditions can result in less than optimal situations for internal fixation. In such conditions Ilizarov fixator is preferred[7,8,9].
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