The results of ankle arthrodesis

The results are presented of 47 compression arthrodeses of the ankle performed for osteoarthritis in 44 patients. In 26 cases the transverse anterior incision of Charnley had been used and in 21 cases medial and lateral incisions with division of the malleoli. Complications included infection (19%), non-union (14.9%) and malposition requiring a further procedure (8.5%). Three patients (6.4%) eventually had an amputation. Clinical assessment using a standard grading method showed that the functional result was not related to the angle of plantar flexion of the ankle, but was related to the varus/valgus position of the heel, the neutral position being associated with the best results. The anterior approach was more reliable in avoiding varus or valgus of the heel.     

The long-term results of ankle arthrodesis

The results of 62 ankle arthrodeses, mostly performed for osteoarthritis, have been reviewed; of these, 39 were examined clinically and radiographically after an average follow-up period of seven years. Compression arthrodesis was associated with the highest incidence of complications, and an anterior sliding graft gave the most satisfactory results. Very few patients required modification of their footwear; most could walk independently with a slight limp and were able to return to their pre-operative work. However, after operation, the ability to run and to participate in vigorous sporting activities was limited. Complications included wound infection, non-union, and some change in midtarsal mobility, but excellent pain relief was reported by all patients.     

Arthroscopic arthrodesis of the ankle joint.

SUMMARY: The authors report on 15 cases of arthrodesis of the ankle joint performed by operative arthroscopy. The follow-up ranges from 1 to 3 years, and 100% of the ankle joints achieved fusion at an average of 11.5 weeks. Two of the patients had some hindfoot pain, probably because of degenerative changes to their subtalar joints, even with this short follow-up. Five patients required further surgical treatment to correct complications related to infection, symptomatic hardware, or subtalar joint arthritis. Although the fusion rate is certainly encouraging, this procedure in the senior author's hand has a significant complication rate.     

Arthroscopically assisted arthrodesis of the ankle joint

In 26 patients we performed an arthroscopically assisted arthrodesis of the ankle. The patients' ages ranged from 31 to 69 years. The male: female ratio. Sixteen patients had posttraumatic degenerative joint disease, three patients suffered from a previous infection, four patients had rheumatoid arthritis, and three patients had an osteochondritis dissecans in their past history. The time taken for surgery ranged from 65 to 135 min. Compared with open procedures we documented less postoperative swelling and minor use of analgesics. Time of follow-up was a minimum of 6 months and a maximum of 75 months. In 22 patients we found solid fusion at the time of follow-up. Fusion was accomplished by 2 months postoperatively in four patients, by 3 months in nine patients, by 4 months in another six patients, and by 6 months in 3 patients. Three patients did not evidence any bony fusion, but they were free of pain. In one patient an open revision was necessary. According to our experience, we recommend arthroscopically assisted arthrodesis of the ankle in patients with degenerative joint disease without rotational or varus/valgus malalignment, severe bone defects or neuropathic disease.     

Statistical evaluation of 4,141 osteosyntheses with autocompression plates

Statistical display of the cases of our hospital who underwent osteosynthesis with autocompression plate between 1968 and 1986. Based on the unselected evaluation of our surgical reports and computer monitoring an analysis of the total of 4.141 ACP-osteosynthesis is given according to the various origin types of surgical procedures, age and sex distribution and chiefly complications of the operative revisions. The total of revised complications was 4.18%, among that the rate of infections was 1.37%, of pseudarthroses 0.92%, breaking out of plates 2.2 per thousand and of material fractures 1.9 per thousand. From these data a high security of the osteosynthesis by autocompression plates concluded.     

Long-term results of arthrodesis of the ankle

Summary Forty-four arthrodeses of the ankle were carried out between 1965 and 1984 in forty-three patients with post-traumatic osteoarthritis or poliomyelitis. Twenty-eight patients, one of whom had a bilateral arthrodesis, were followed up after an average of ten years. Twenty-four were satisfied and the patients with poliomyelitis were better than those with osteoarthritis. The condition of the tarsal joints before the operation influences the result, but the arthrodesis does not cause degenerative changes in these joints.

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Résumé De 1965 à 1984 nous avons effectué 44 arthrodèses de la cheville chez 43 patients qui souffraient soit d'une arthrose post-traumatique soit d'une instabilité poliomyélitique. Parmi les 28 opérés, qui ont été suivis pendant 10 ans en moyenne, 24 ont considéré l'opération comme satisfaisante. Le résultat post-opératoire est meilleur ches les poliomyélitiques. L'étude des observations montre que le résultat de l'arthrodèse est influencé par la condition pré-opératoire des autres articulations du pied. L'arthrodèse elle-même n'y entraîne pas de changements dégénératifs.

     

Results of arthrodesis of the upper ankle joint

AIM: This study presents the results of arthrodesis of the ankle in non-inflammatory osteoarthritic conditions. METHOD: 34 open arthrodeses (33 patients) were followed for 5.5 +/- 3.2 years after surgery. At follow-up clinical results were evaluated by the Kitaoka and Gruen scores and standing X-rays were analysed for the talo-calcaneal angle and the grade of arthrosis. RESULTS: Patients expressed high and very high satisfaction in 84 % of the cases; good results were higher with the Gruen score (79 %) than with the Kitaoka score (50 %). The patients did not complain pain but had some limitation in walking distance; gait was compensated in 44 % of the patients. A significant increase of arthrosis in adjacent joints could not be observed. A pseudoarthosis was observed in four cases and minor, conservatively treated complications arose in seven cases. CONCLUSION: We conclude that, on the basis of these results, arthrodesis of the ankle still has a place in therapy due to the high patient satisfaction.     

骨外固定支架技术在踝关节融合与矫形中的应用

目的 探讨骨外固定支架技术在踝关节融合与矫形中的疗效.方法 2001年1月至2009年6月采用外固定支架技术治疗27例踝关节创伤性患者,男18例,女9例;年龄32～68岁,平均41岁.其中创伤性关节炎13例,地方性大骨节病3例,骨关节炎5例,结核性踝关节炎2例,踝关节置换术后失败3例,骨髓炎1例.为保证骨对骨加压接触行外固定支架固定.结果 所有患者术后获6～38个月(平均10个月)随访.随访发现关节无肿胀和疼痛,行走步态和功能明显改善,X线片示关节均获骨性融合.结论 外固定支架技术用于踝关节融合率高,对踝关节感染及复合足踝关节畸形有一定优势性.

Abstract：

Objective To study the curative effect of external fixation in ankle joint arthrodesis.Methods From January 2001 to June 2009, we used external fixation in arthrodesis for 27 cases of traumatic ankle joint They were 18 males and 9 females, with an average age of 41 years (range, 32 to 68 years) . There were 13 cases of traumatic osteoarthritis of the ankle joint, 3 cases of local kaschin beck disease, 5 cases of ankle osteoarthritis, 2 cases of tuberculous ankle arthritis, 3 cases of ankle replacement failure, one case of osteomyelitis. Fibular flap grafts were used in 8 cases, bone autografts in 11 cases, bone allografts in 2 cases,and combined bone grafts in 11 cases. External fixation was applied for all cases to ensure compressive contact between bone ends. Results The patients were followed up for 6 to 38 months (average, 10 months). No pain or swelling was found at the ankle joint. Significant improvements were made in walking gait and function of the ankle. X-ray films verified bony fusion in all cases. Conclusion External fixation can lead to a high rate of bony fusion of the ankle joint, and is advantageous for treatment of ankle infection and combined deformity of the ankle and foot.     

First metatarsophalangeal joint arthrodesis with two orthogonal two hole plates

Objective

First MTP joint fusion is a reliable procedure for advanced arthritis for the first MTP joint. There are many techniques described. The purpose of our study is to report clinical, radiological, functional outcomes and complications of first metatarsophalangeal joint fusion with hand preparation of the joint and fixation with two orthogonal locking plates without a compression screw.

Dowel arthrodesis of the ankle joint in rheumatoid arthritis

Surgical Principles Dowel arthrodesis of the ankle is a simple, safe and effective form of arthrodesis for the rheumatoid ankle joint in those cases where there is no significant deformity. The basic technique of the operation is similar to that used for anterior interbody fusion of the spine and uses similar instruments [1].     

Monolateral external compression arthrodesis of the upper ankle joint

A new method of compression-arthrodesis of the ankle joint using monolateral external fixation is introduced. After bimalleolar incision and resection of the tibio-talar joint-surfaces, compression fixation was achieved by the Monofixateur placed ventromedially. The lateral malleolus was used as a bar-chip fixed with two screws. Between 1985 and 1988 this operation was performed on ten patients, mostly because of posttraumatic joint destruction. On the average the hospital stay was 17 days. Walking with crutches was allowed on the third postop. day with partial weight bearing after one week. Two patients developed a pin-tract infection with one of them needing operative revision. Except in a case of primary arthrodesis done in a severely open talus dislocation fracture bony fusion was achieved between 8 to 12 weeks postoperatively. Eight patients were followed up after an average of 2.5 years. Four patients were completely painfree and showed an almost normal gait. Four patients were able to walk 2 to 3 hours without serious complains. Five patients classified the result as good, two as fair and one as poor. In the poor result the distal Schanz-screws had partially penetrated the subtalar joint with consecutive joint deterioration. The tarsal mobility had a mean value of 23 degrees. The length of the operated leg was on the average one cm shorter. Due to the favourable results we recommend monolateral external compression-arthrodesis as a useful procedure.