Journal List > J Korean Foot Ankle Soc > v.21(3) > 1043453

J Korean Foot Ankle Soc. 2017 Sep;21(3):98-103. Korean.
Published online September 15, 2017.
Copyright © 2017 Korean Foot and Ankle Society
Analysis about Associated Factors of Nonunion Following Tibiotalar Arthrodesis
Jun Young Lee, Bo Sun Kim and Jung Woo Lee
Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea.

Corresponding Author: Jun Young Lee. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmundaero, Dong-gu, Gwangju 61453, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, Email:
Received May 19, 2017; Revised July 13, 2017; Accepted July 21, 2017.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



The aim of this study was to analyze the factors related to nonunion in tibiotalar arthrodesis.

Materials and Methods

Eighty cases of ankle arthritis treated with tibiotalar arthrodesis in our hospital from November 2008 to November 2015 with more than one year follow up were analyzed. Simple anteroposterior and lateral radiographs after 6 and 12 months of surgery were analyzed. Union was defined as more than 50% connection of the trabecular bone at the ankle joint surface in the anteroposterior and lateral radiographs. The nonunion group was defined as no signs of union with persistent pain 9 months after surgery. The surgical approach, type of used screw, preoperative and postoperative ankle alignment, body mass index (BMI), bone mineral density, and patients' prior history were compared between the two groups.


There were 69 union cases and 11 nonunion cases. In the patient factors, the gender and BMI was related to nonunion (p<0.05). The mean preoperative and postoperative ankle alignment in the nonunion group was 9.93°±6.92° and 5.43°±3.35° respectively, and 9.80°±7.55° and 5.63°±3.45° in the union group, respectively; the difference was not statistically significant (p>0.05). In the technical factors, the transfibular approach showed a better relationship but the association was not significant (p<0.05). In 40 cases of the transfibular approach, 12 cases used cancellous screws, and 4 cases showed nonunion due to screw breakage.


Technical factors, such as the surgical approach and the type of screw used can be a risk factor in nonunion. In addition, patients' factors, such as gender and BMI, must be considered to reduce the nonunion rate.

Keywords: Arthrodesis; Nonunion


Figure 1
Preoperative standing anteroposterior radiographs showing ankle alignment which is defined as the angle between the anatomical axis of the tibia (α) and a line drawn perpendicular to the talar dome (β).
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Figure 2
(A) Preoperative standing radiograph shows lateral compartment ankle osteoarthritis. (B) Ankle arthrodesis was performed with anterior approach using three cannulated screws. (C) Nonunion occurs after 12 month of first operation. (D) Revision operation with 4 cannulated screw was done.
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Figure 3
(A) Preoperative standing radiograph shows medial compartment ankle osteoarthritis. (B) Ankle arthrodesis was performed with transfibular approach using three cancellous screws. (C) Follow-up radiograph shows breakage of cancellous screws and valgus tibiotalar alignment. (D) Revision arthrodesis with cannulated screws was performed and bony union was evident 12 months after surgery.
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Table 1
VAS and AOFAS of the Nonunion and Union Groups
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Table 2
Mean Difference of the Nonunion and Union Groups
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Table 4
Tensile and Flexion Strength for Cancellous and Cannulated Screws
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Financial support:This study was supported by research fund from Chosun University, 2016.

Conflict of interest:None.

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