[Arthroscopy-assisted ankle arthrodesis with MIPF. An alternative proposal]

The ankle is a loading joint with a small contact surface and it is therefore very vulnerable to trauma, as it is an exposed region. It is a unique joint because it forms several joints. In this joint the load falls on the contact area, which is one third of the knee or the hip, and it is the most important part of our musculo-skeletal system designed for ambulation and bipedestation. In case of ankle injuries, arthrodesis is a procedure performed to relieve pain, decrease deformity and provide stability. An optimum result of this procedure may be easily achieved if the ankle is fixed in the right position, so this technique will continue to be a treatment alternative. With "minimally invasive percutaneous fixation (MIPF)" fixation is safe, it relieves pain and stops the progression of regeneration, it is a minimally invasive method performed through a small posteromedial incision on the ventral surface of the distal tibial metaphysis, which minimizes soft tissue dissection thus eliminating wound complications. In this study we included patients with severe joint damage and pain, with a physically demanding type of work, in whom other treatments had previously failed and in whom total arthroplasty was not possible (due to questionable results). Patients with a varus-valgus > 15 degrees, talar necrosis, bone defects requiring a graft or subtalar arthrosis were excluded. Our results are no different from the world literature concerning the incidence rate of complications by age and diagnosis as well as the healing rate. Postoperative patient management was better as no rigid immobilization was required. Even though weight bearing was not immediate, at two weeks they could use an unloading boot for partial weight bearing, and total weight bearing was possible by week six. Therefore, there were less complications and in failed cases salvage surgery was possible.