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The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses  or amphiarthroses, whereas all synovial joints are classified as diarthroses.
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A New Classification for Ankle Arthrodesis When Using an External Fixator.

Hidenori Matsubara1, Koji Watanabe1, Munetomo Takata1

  • 1Department of Orthopaedic Surgery, Kanazawa University, Takaramachi, Kanazawa, Japan.

Strategies in Trauma and Limb Reconstruction
|August 4, 2020
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Summary

This study introduces a four-type classification for ankle arthrodesis using external fixators, guiding surgical techniques for better outcomes in complex cases.

Keywords:
Ankle arthrodesisBone defectClassificationDeformityExternal fixation

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Area of Science:

  • Orthopedic Surgery
  • Traumatology
  • Limb Reconstruction

Background:

  • Ankle arthrodesis using external fixators is a common procedure.
  • Existing classifications may not adequately address diverse deformities and bone defects.
  • A refined classification is needed to optimize surgical strategy.

Purpose of the Study:

  • To propose a new classification system for ankle arthrodesis utilizing external fixators.
  • To correlate specific pre-treatment problems with tailored surgical techniques.
  • To evaluate the retrospective outcomes of this classification-guided approach.

Main Methods:

  • Retrospective evaluation of 33 lower limb segments in 30 patients undergoing ankle arthrodesis with external fixators.
  • Classification of pre-treatment conditions into four types based on deformity and bone defect.
  • Application of specific surgical techniques (curettage, bone grafting, mobilization, acute shortening, bone transport) tailored to each type.

Main Results:

  • All patients achieved secure ankle fusion and full weight-bearing capacity.
  • Mean external fixation duration varied by type (96 days for Type I, 181 for Type II, 231 for Types III/IV).
  • Complications included re-fracture (3), lengthening site deformity (1), delayed union (1), and infection (1).

Conclusions:

  • A novel four-group classification effectively strategizes ankle arthrodesis with external fixators.
  • This system aids in selecting the most appropriate operative method, particularly for challenging ankle reconstructions.
  • The classification facilitates personalized treatment based on individual patient pathology.