Pantalar and tibiotalocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot.

Abstract

Twenty-one patients had a unilateral extended arthrodesis of the ankle and hindfoot (a tibiotalocalcaneal procedure in thirteen patients and a pantalar procedure in eight) for post-traumatic osteoarthrosis or deformity, or both. The operation was performed through a transfibular extended lateral approach, and autogenous bone graft and rigid internal fixation was used. A final alignment of 0 to 5 degrees of valgus, 0 to 5 degrees of calcaneus, and external rotation equal to that of the contralateral side was sought. Subjective and objective evaluation, including a personal interview, physical examination, and radiographic and dynamic pedobarographic analysis, was performed at a mean interval of thirty-two months (range, twenty-four to fifty-four months) after the operation. A solid fusion was achieved in eighteen (86 per cent) of the twenty-one patients. There were five malunions (24 per cent) and two superficial wound problems (10 per cent). Of the seventeen patients who were not retired from work, eleven returned to work: nine to an occupation that involved standing and two to a sedentary occupation. Although seventeen (81 per cent) of the twenty-one patients reported that they were much improved, twenty (95 per cent) had some pain, and most benefited from modifications in shoe-wear. Patients who had had a tibiotalocalcaneal arthrodesis were more mobile and functioned at a higher level than those who had had a pantalar arthrodesis. Extended arthrodesis of the ankle and hindfoot is a complex, technically demanding procedure, and should be regarded as a salvage operation capable of producing a satisfactory result and usually providing a reasonable alternative to amputation.