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Outcome of ankle arthrodesis in posttraumatic arthritis.

Gowda BN, Kumar JM - Indian J Orthop (2012)

Bottom Line: The functional outcomes following ankle arthrodesis are not very well known.They were all returned to their preinjury activities.Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, PES Medical College, Kuppam, Chittore Dist., Andhra Pradesh, India.

ABSTRACT

Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley's compression device.

Materials and methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females) who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN) talus (n=6), malunited bimalleolar fracture (n=4), distal tibial plafond fractures (n=3), medial malleoli nonunion (n=2). All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1-5.7 years).

Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities.

Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

No MeSH data available.


Related in: MedlinePlus

(a) Preoperative X-ray of right ankle showing arthritic changes; (b) immediate post-op X-ray AP showing fixator in situ; (c) 2 year 6 months followup X-ray ankle AP showing union of arthrodesis; (d) 2 year 6 months followup X-ray ankle lateral view showing union; (e) 2 year 6 months followup clinical photo showing not much difference compared to left ankle
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Figure 3: (a) Preoperative X-ray of right ankle showing arthritic changes; (b) immediate post-op X-ray AP showing fixator in situ; (c) 2 year 6 months followup X-ray ankle AP showing union of arthrodesis; (d) 2 year 6 months followup X-ray ankle lateral view showing union; (e) 2 year 6 months followup clinical photo showing not much difference compared to left ankle

Mentions: 15 patients of ankle arthrodesis operated for ankle arthritis between January 2006 and December 2009 were included in study. There were 10 males and 5 females. All the patients had posttraumatic arthritis secondary to avascular necrosis of talus (n=6), malunited bimalleolar fracture (n=4), distal tibial plafond fractures (n=3) and medial malleoli nonunion (n=2) [Figure 1a]. All the 15 patients had undergone open ankle fusion by anterolateral approach [Figure 1b] in supine position under tourniquet control and spinal anesthesia. Compression was achieved using Charnley's compression device and an additional calcaneotibial Steinmann's pin to maintain the desired alignment (neutral flexion, 0°–5° of valgus, 5°–10° of external rotation with slight posterior displacement of the talus, Figures 1c–f, 2a–d, 3a–e). The patient was made ambulant with non weight bearing on operated site after 48 hours. All the patients were evaluated clinically and radiologically at 6 weeks and tibiocalcaneal Steinmann's pin was removed and the patients were allowed to bear weight as tolerated with Charnley's compression device in situ. The Charnley's compression device was removed after 12 weeks and below knee walking cast was applied. Walking cast was removed once the radiological features showed bridging trabecular bone across the arthrodesis site [Figures 1e,f, 2c and 3c,d].


Outcome of ankle arthrodesis in posttraumatic arthritis.

Gowda BN, Kumar JM - Indian J Orthop (2012)

(a) Preoperative X-ray of right ankle showing arthritic changes; (b) immediate post-op X-ray AP showing fixator in situ; (c) 2 year 6 months followup X-ray ankle AP showing union of arthrodesis; (d) 2 year 6 months followup X-ray ankle lateral view showing union; (e) 2 year 6 months followup clinical photo showing not much difference compared to left ankle
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377143&req=5

Figure 3: (a) Preoperative X-ray of right ankle showing arthritic changes; (b) immediate post-op X-ray AP showing fixator in situ; (c) 2 year 6 months followup X-ray ankle AP showing union of arthrodesis; (d) 2 year 6 months followup X-ray ankle lateral view showing union; (e) 2 year 6 months followup clinical photo showing not much difference compared to left ankle
Mentions: 15 patients of ankle arthrodesis operated for ankle arthritis between January 2006 and December 2009 were included in study. There were 10 males and 5 females. All the patients had posttraumatic arthritis secondary to avascular necrosis of talus (n=6), malunited bimalleolar fracture (n=4), distal tibial plafond fractures (n=3) and medial malleoli nonunion (n=2) [Figure 1a]. All the 15 patients had undergone open ankle fusion by anterolateral approach [Figure 1b] in supine position under tourniquet control and spinal anesthesia. Compression was achieved using Charnley's compression device and an additional calcaneotibial Steinmann's pin to maintain the desired alignment (neutral flexion, 0°–5° of valgus, 5°–10° of external rotation with slight posterior displacement of the talus, Figures 1c–f, 2a–d, 3a–e). The patient was made ambulant with non weight bearing on operated site after 48 hours. All the patients were evaluated clinically and radiologically at 6 weeks and tibiocalcaneal Steinmann's pin was removed and the patients were allowed to bear weight as tolerated with Charnley's compression device in situ. The Charnley's compression device was removed after 12 weeks and below knee walking cast was applied. Walking cast was removed once the radiological features showed bridging trabecular bone across the arthrodesis site [Figures 1e,f, 2c and 3c,d].

Bottom Line: The functional outcomes following ankle arthrodesis are not very well known.They were all returned to their preinjury activities.Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, PES Medical College, Kuppam, Chittore Dist., Andhra Pradesh, India.

ABSTRACT

Background: Ankle arthrodesis is still a gold standard salvage procedure for the management of ankle arthritis. There are several functional and mechanical benefits of ankle arthrodesis, which make it a viable surgical procedure in the management of ankle arthritis. The functional outcomes following ankle arthrodesis are not very well known. The purpose of this study was to perform a clinical and radiographic evaluation of ankle arthrodesis in posttraumatic arthritis performed using Charnley's compression device.

Materials and methods: Between January 2006 and December 2009 a functional assessment of 15 patients (10 males and 5 females) who had undergone ankle arthrodesis for posttraumatic arthritis and/or avascular necrosis (AVN) talus (n=6), malunited bimalleolar fracture (n=4), distal tibial plafond fractures (n=3), medial malleoli nonunion (n=2). All the patients were assessed clinically and radiologically after an average followup of 2 years 8 months (range 1-5.7 years).

Results: All patients had sound ankylosis and no complications related to the surgery. Scoring the patients with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, we found that 11 of the 15 had excellent results, two had good, and two showed fair results. They were all returned to their preinjury activities.

Conclusion: We conclude that, the ankle arthrodesis can still be considered as a standard procedure in ankle arthritis. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function. Still, one should keep in mind that it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of subtalar arthritis.

No MeSH data available.


Related in: MedlinePlus