[Interposition arthrodesis of the ankle]

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Foot and Ankle Surgery

Background:

• Extensive bone defects in the ankle joint often result from trauma, infection, or congenital deformities.
• These defects can lead to disabling pain, osteoarthritis, and functional impairment, necessitating surgical intervention.
• Achieving bony fusion in a favorable position is crucial for pain-free weight-bearing and preventing leg length discrepancies.

Purpose of the Study:

• To describe and evaluate a surgical technique for ankle arthrodesis in patients with significant ankle bone defects.
• To assess the functional outcomes and complication rates associated with this specific surgical approach.

Main Methods:

• A lateral approach was used, involving fibular osteotomy and posterior repositioning.
• Articular cartilage and bone defects were debrided, with tricortical iliac crest bone grafts and autogenous cancellous bone used for reconstruction.
• Fixation was achieved with titanium lag screws and, in some cases, a plate, with additional screw fixation for the fibula.

Main Results:

• The technique was applied to five patients with extensive ankle bone defects, showing no immediate complications.
• The American Orthopedic Foot and Ankle Society (AOFAS) score significantly improved from a mean of 23 to 76 postoperatively.
• Two patients experienced nonunion, requiring revision with an ankle arthrodesis nail, and one case of valgus malposition was corrected.

Conclusions:

• This surgical technique offers a viable option for ankle fusion in the presence of extensive bone defects, leading to significant functional improvement.
• While generally effective, potential complications like nonunion should be considered, necessitating careful patient selection and management.
• Further research may explore modifications to improve union rates and long-term outcomes.