The use of circular wire external fixation in the treatment of salvage ankle arthrodesis

doi:10.1053/j.jfas.2004.11.004

The Journal of Foot and Ankle Surgery

Volume 44, Issue 1, January–February 2005, Pages 22-31

https://doi.org/10.1053/j.jfas.2004.11.004 Get rights and content

The authors retrospectively reviewed their experience with circular wire external fixation in the treatment of salvage ankle arthrodesis during the past 9 years. The results of 43 cases in a difficult patient population are presented with an average follow-up of 27.0 months. Thirty-three patients (80.5%) went on to achieve a solid fusion or stable pseudarthrosis. A minimum of a 4-ring frame construct was applied for an average of 96.1 days. The major complication rate was 51.2%, including 3 below-knee amputations (7.3%), 7 unstable nonunions (17.1%), 7 cases of osteomyelitis and/or deep-space infection (16.3%), 3 malunions (7.3%), and 2 tibial stress fractures (4.7%). The incidence of complications occurred similarly in patients with Charcot arthropathy, failed total ankle arthroplasty, septic fusion, posttraumatic deformity, or avascular necrosis of the talus, whereas it was relatively higher in patients who were diabetics, smokers, or had an increased body mass index. In addition, the incidence of a nonunion tended to increase with longer follow-up, suggesting that early presumption of a solid union may be erroneous. Based on our defined criteria of a stable, well-aligned fusion without severe pain or activity restrictions, 28 patients (68.3%) had a good result. Circular wire external fixation can be a viable treatment for complex ankle salvage pathology; however, it is difficult to predict the prospects of success or failure.

Section snippets

Materials and methods

This outcome study was a retrospective review of clinical charts and radiographs from a series of consecutive patients who required a salvage arthrodesis of the ankle by using circular wire external fixators. For the purposes of this investigation, salvage was defined as any patient that had 1 or more of the following: 1) failed prior ankle arthrodesis; 2) a large bone loss or defect; 3) severe osteopenia, as determined by plain film radiography; 4) clinically significant instability usually

Results

The clinical results and individual patient characteristics are summarized in Table 1. There were 28 men and 14 women. One death occurred in a male patient from complications associated with viral pneumonitis 27 days into the postoperative course. There was no evidence of PE, MI, or stroke found at autopsy. The patient was significantly immunocompromised with multiple medical conditions, including type 1 diabetes mellitus and end-stage renal disease. Because it is not known if the surgery

Discussion

A wide variety of surgical options and approaches exist to tackle the difficult problem of a salvage ankle arthrodesis. Because the majority of these patients suffer from a substantial amount of segmental bone loss, osteopenia, or infection, internal fixation and some types of external fixation can be inadequate for stabilization of these pathologies and may potentiate nonunion. Active infection is an absolute contraindication to any implantable hardware, whereas osteoporotic bone or segmental

Conclusion

Salvage ankle arthrodesis with external fixation can be a difficult undertaking and should be performed by an experienced surgeon after appropriate preoperative planning. Each case is unique and fraught with its own difficulties and inherent complications. Multiple variables preclude accurate prediction of the likelihood of success or failure.

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Original articlesThe use of circular wire external fixation in the treatment of salvage ankle arthrodesis

Section snippets

Materials and methods

Results

Discussion

Conclusion

Orthop Clin North Am

Foot Ankle Clin

Foot Ankle Clin

Injury

Foot Ankle Clin

Foot Ankle Clin

J Foot Ankle Surg

Foot Ankle Clin

Injury

Foot Ankle Clin

Injury

J Arthroplasty

J Nucl Cardiol

Gait Posture

Clin Podiatr Med Surg

Orthop Clin North Am

Tibiotalocalcaneal arthrodesis

Foot Ankle Int

Ankle arthrodesis. A comparison of internal and external fixation

Clin Orthop

Ankle arthrodesis using internal screw fixation

Clin Orthop

Role of internal and external fixation in ankle fusion

Arch Orthop Trauma Surg

Arthrodesis of the anklea critical analysis

Foot Ankle Int

Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws

Foot Ankle Int

Long-term results of arthrodesis for osteoarthritis of the ankle

Clin Orthop

Revision ankle fusion using internal compression arthrodesis with screw fixation

Foot Ankle Int

Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities

Foot Ankle Int

Ankle fusion in a high risk populationan assessment of nonunion risk factors

Foot Ankle Int

A review of ankle arthrodesispredisposing factors to nonunion

Foot Ankle Int

Tibiocalcaneal arthrodesis for nonbraceable neuropathic ankle deformity

Foot Ankle Int

Charcot ankle fusion with a retrograde locked intramedullary nail

Foot Ankle Int

The treatment of fractures with a dynamic axial fixator

J Bone Joint Surg

Treatment of infected pilon nonunions with small pin fixators

Foot Ankle

Surgical arthrodesis of the neuropathic foot. A salvage procedure

Clin Orthop

A biomechanical analysis of the Ilizarov external fixator

Clin Orthop

Ilizarov treatment of tibial nonunions with bone loss

Clin Orthop

Ilizarov ankle arthrodesis

Clin Orthop

Original articles
The use of circular wire external fixation in the treatment of salvage ankle arthrodesis