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Revision arthrodesis of the ankle: posterior inlay bone grafting in 11 patients.

Verhulst FV, Swierstra BA - Acta Orthop (2009)

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands.

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We present a posterior inlay bone grafting technique that was originally described for primary ankle arthrodesis but which also appears to be useful for revision of ankle pseudoarthrosis... Complications occurred in 4 patients and included: 1 slow wound healing, 1 low-grade late infection (after 4 weeks) of the iliac crest wound, and 2 pin tract infections of external fixators... The infections healed by conservative means and did not compromise the outcome... Different procedures have been tried for revision arthrodesis... Most series have been small, like ours, and the results have been similar: fusion occurs often but not always, and complications are common (Table 2)... Bone grafts are widely used but and could not find a correlation between bone grafting and union rate, probably due to the small number of patients... The best way to approach the ankle (anteriorly, posteriorly, or laterally) has been discussed... The advantages of our posterior approach are the avoidance of old scars and the danger of disturbed wound healing, the ample amount of healthy tissue covering the arthrodesis site, and minimal disturbance of local osseous vascularization... Our technique is, however, less suitable for correction of coexisting deformities... This technique of ankle arthrodesis with bone grafting by a posterior approach has not been used before as a revision technique after pseudoarthrosis... Fusion time and complications compared favorably with other techniques.

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Technique of revision ankle arthrodesis with posterior inlay bone grafting.
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Figure 0001: Technique of revision ankle arthrodesis with posterior inlay bone grafting.

Mentions: The patient is placed in a prone position with a tourniquet around the upper leg. A posterior longitudinal incision is made medially to the Achilles tendon, which is exposed and divided by a Z-plasty. The posterior compartment is opened to provide access to the distal tibia and the talocrural pseudoarthrosis. When there is macroscopic instability, existing hardware is removed and 2 cannulated screws are put in from the posterior tibial cortex into the talar body and neck. Their position is checked with an image intensifier. If existing hardware cannot be removed without major exposure (e.g. when original screws are broken) or if skeletal deformity precludes the use of 2 posterior screws, an external fixator is used with 2 pins through the calcaneus and 2 pins through the tibia, connected by a bilateral rod. A 3-cm × 2-cm wide and 2-cm deep slot is cut into the talocrural area, including removal of the pseudoarthrosis. An ample amount of cancellous bone chips from the posterior iliac crest is packed into the slot (Figure 1).


Revision arthrodesis of the ankle: posterior inlay bone grafting in 11 patients.

Verhulst FV, Swierstra BA - Acta Orthop (2009)

Technique of revision ankle arthrodesis with posterior inlay bone grafting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823178&req=5

Figure 0001: Technique of revision ankle arthrodesis with posterior inlay bone grafting.
Mentions: The patient is placed in a prone position with a tourniquet around the upper leg. A posterior longitudinal incision is made medially to the Achilles tendon, which is exposed and divided by a Z-plasty. The posterior compartment is opened to provide access to the distal tibia and the talocrural pseudoarthrosis. When there is macroscopic instability, existing hardware is removed and 2 cannulated screws are put in from the posterior tibial cortex into the talar body and neck. Their position is checked with an image intensifier. If existing hardware cannot be removed without major exposure (e.g. when original screws are broken) or if skeletal deformity precludes the use of 2 posterior screws, an external fixator is used with 2 pins through the calcaneus and 2 pins through the tibia, connected by a bilateral rod. A 3-cm × 2-cm wide and 2-cm deep slot is cut into the talocrural area, including removal of the pseudoarthrosis. An ample amount of cancellous bone chips from the posterior iliac crest is packed into the slot (Figure 1).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

We present a posterior inlay bone grafting technique that was originally described for primary ankle arthrodesis but which also appears to be useful for revision of ankle pseudoarthrosis... Complications occurred in 4 patients and included: 1 slow wound healing, 1 low-grade late infection (after 4 weeks) of the iliac crest wound, and 2 pin tract infections of external fixators... The infections healed by conservative means and did not compromise the outcome... Different procedures have been tried for revision arthrodesis... Most series have been small, like ours, and the results have been similar: fusion occurs often but not always, and complications are common (Table 2)... Bone grafts are widely used but and could not find a correlation between bone grafting and union rate, probably due to the small number of patients... The best way to approach the ankle (anteriorly, posteriorly, or laterally) has been discussed... The advantages of our posterior approach are the avoidance of old scars and the danger of disturbed wound healing, the ample amount of healthy tissue covering the arthrodesis site, and minimal disturbance of local osseous vascularization... Our technique is, however, less suitable for correction of coexisting deformities... This technique of ankle arthrodesis with bone grafting by a posterior approach has not been used before as a revision technique after pseudoarthrosis... Fusion time and complications compared favorably with other techniques.

Show MeSH
Related in: MedlinePlus