Open ankle arthrodeses via an anterior approach

In open ankle arthrodesis, debate remains as to which surgical approach and fixation devices should be used. The purpose of this study was to identify union, complication, and patient satisfaction rates of ankle fusions performed at our institution, using the plane between extensor hallucis longus and tibialis anterior with medial tibiotalar screw internal fixation.

A retrospective review was performed of all isolated primary fusions between 2005 and 2009. Eighty-two ankles were identified in 73 patients. All patient records were reviewed, and 57 patients (65 ankles) attended for clinical evaluation and scoring. Age range at surgery was 18 to 75 years (mean, 56.1 years); 8 patients were smokers. Diagnoses were trauma in 52 patients (63%), osteoarthritis in 17, rheumatoid arthritis in 7, Charcot-Marie-Tooth disease in 3, congenital talipes equinovarus in 2, and talar avascular necrosis in 1. Follow-up range was 7 months to 8.3 years (mean, 4 years).

Time to union ranged from 8 to 39 weeks (mean, 13.3) with a union rate of 100%. The AOFAS range was 12 to 93 (mean, 70). Eighty percent were "very satisfied" or "satisfied." Major complication rate was 14.6%: 7 malalignments; 3 wound problems; 2 complex regional pain syndrome; and 2 delayed unions, both smokers.

An excellent union rate, high patient satisfaction, and low complication rate were achieved with this technique. Varus malalignment and persistent pain resulted in dissatisfaction. Many patients remained highly active, and bilaterally fused patients functioned as well as unilateral ones.

Level IV, retrospective case series.