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Yong-Sik Lee, Il-Hyun Nam
, Tae-Hun Lee, Gil-Yeong Ahn, Yeong-Hyeon Lee, Hee-Hyung Lee, Sung-Hyun Hwang
, Tae-Hun Lee, Gil-Yeong Ahn, Yeong-Hyeon Lee, Hee-Hyung Lee, Sung-Hyun Hwang
Abstract
Purpose
The aim of this study is to evaluate if the Ilizarov external fixation procedure with axial compression can help to obtain fusion across the ankle joint in patients with a high risk of nonunion.
Materials and Methods
From January 2006 to December 2015, the study reviewed 17 patients who underwent ankle arthropathy with a high risk of nonunion and who underwent ankle fusion using the Ilizarov external fixator with axial compression and auto bone grafting. After the lateral surface of the ankle joint was exposed through a lateral trans-fibular approach, massive removal of the articular cartilage and excision of any loose or avascular bone were done. With the cortical bone harvested from the pelvis as corticocancellous bone blocks, we inserted the two cortical blocks longitudinally into the anterior and posterior part of the free ankle space from lateral to medial to make the rectangular chamber to fill the cancellous bones. After the Ilizarov external fixator was equipped, we tightened the frame by 5 mm to compress the bone graft space. We accessed the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score both preoperatively and postoperatively.
Results
The average age at the time of operation was 63.4 years (range, 47~78 years). The mean frame time was 17.4 weeks (range, 15~23 weeks). The average follow-up period was 3.7 years (range, 2~6 years). Osseous fusion was obtained in 15 patients (88.2%). There were two stable pseudarthroses among the rheumatoid arthritis patients, and we continued their follow-up. The mean AOFAS Ankle-Hindfoot score improved from 48.5 to 73.7 points.
Figures and Tables
Figure 1
(A) The left ankle of a 78-year-old female with rheumatoid arthritis shows marked secondary arthritis. (B, C) Articular cartilage and sclerotic avascular bone around the ankle joint were massively removed. (D) Temporary fixation through the calcaneus, talus, and tibia was done using a Steinman pin.
Figure 4
(A) A 53-year-old male, lateral radiograph showed avascular necrosis of the talar body due to comminuted fracture of the talus. (B) Necrotic talar body was removed completely. (C) We inserted two cortical blocks longitudinally into the anterior and posterior part of free ankle space from lateral to medial to make a rectangular chamber. (D) We filled the chamber with the autogenous cancellous bones. (E) We confirmed the solid bony union at 26 weeks after operation.
Figure 5
(A, B) After the Ilizarov external fixator which was composed of two tibial rings and one foot plate was equipped, we tightened the frame by 5 mm to compress the bone graft space.
Figure 6
(A) Anteroposterior radiopraph of a 65-year-old male with diabetic charcot neuroarthropathic joint. (B) We confirmed the solid bony union at 38 weeks after operation.
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