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

Verhulst FV, Swierstra BA - Acta Orthop (2009)

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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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Patient 6. A. Pseudoarthrosis with screw breakage 4 months after the first operation. B. Fusion 11 weeks after removal of broken screws, refixation with posterior screws, and posterior inlay bone grafting.
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Figure 0002: Patient 6. A. Pseudoarthrosis with screw breakage 4 months after the first operation. B. Fusion 11 weeks after removal of broken screws, refixation with posterior screws, and posterior inlay bone grafting.

Mentions: Between 2004 and 2007, 11 patients with radiographically confirmed pseudoarthrosis of the ankle were operated on with this technique (Table 1). Their mean age at operation was 52 (29–80) years. The average time from the last arthrodesis attempt until revision arthrodesis was 8 (2–19) months. Primary diagnosis included: osteoarthritis (8), rheumatoid arthritis (1), Charcot Marie tooth disease (1), and polio paralysis (1). In 4 patients, an external fixator was used. Fusion occurred in 10 of the 11 patients (Figure 2). The mean time to full, unprotected weight bearing was 14 (6–22) weeks.


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

Verhulst FV, Swierstra BA - Acta Orthop (2009)

Patient 6. A. Pseudoarthrosis with screw breakage 4 months after the first operation. B. Fusion 11 weeks after removal of broken screws, refixation with posterior screws, and posterior inlay bone grafting.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Patient 6. A. Pseudoarthrosis with screw breakage 4 months after the first operation. B. Fusion 11 weeks after removal of broken screws, refixation with posterior screws, and posterior inlay bone grafting.
Mentions: Between 2004 and 2007, 11 patients with radiographically confirmed pseudoarthrosis of the ankle were operated on with this technique (Table 1). Their mean age at operation was 52 (29–80) years. The average time from the last arthrodesis attempt until revision arthrodesis was 8 (2–19) months. Primary diagnosis included: osteoarthritis (8), rheumatoid arthritis (1), Charcot Marie tooth disease (1), and polio paralysis (1). In 4 patients, an external fixator was used. Fusion occurred in 10 of the 11 patients (Figure 2). The mean time to full, unprotected weight bearing was 14 (6–22) weeks.

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