Fixator-assisted nailing for revision ankle fusion with deformity, bone loss and or infection

Abstract

Context: Ankle nonunions with deformity and bone loss are challenging cases, often with broken hardware and infection. These cases are often associated with multiple previous surgeries making revision surgery difficult. Ankle fusion for failed total ankle arthroplasty or neuropathic joints are particularly challenging, which is reflected in high reported failure rates. Aims: Fixator-assisted nailing combines Taylor spatial frame (TSF) with an intramedullary nail, allowing for correction of deformity and compression at the nonunion site, as well as internal fixation protecting the fusion after frame removal. Subjects and Methods: Between 2001 and 2014, 24 patients with 26 failed ankle fusions, with bone loss and deformity, were treated using this technique. After removal of the original internal fixation hardware and revision of the fusion surfaces, a Taylor frame is used for acute or gradual correction of deformity and compression at the nonunion site. This was followed by insertion of intramedullary nail. The nail was locked at the time of fixator removal. Results: Acute correction was possible in 23 of the 26 cases with gradual correction in the others. Union was obtained in 25 cases (96.2%) and maintained at 24 months in 23 cases (88.4%). The overall salvage rate (avoidance of amputation) was 96.2% (25/26 cases). All salvaged limbs remain free of clinical infection and do not require ongoing antibiotic treatment. The foot was in neutral position in all salvaged cases. The average time in external fixation was 11 weeks (6-13 weeks). The average AOFAS ankle/hindfoot score was 74 (range: 61-80). Conclusions: Fixator-assisted nailing, combining a TSF and an intramedullary nail, is a reliable technique for revision ankle fusion for complex nonunion with deformity and/or infection.