Strategies in Trauma and Limb Reconstruction

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VOLUME 14 , ISSUE 3 ( September-December, 2019 ) > List of Articles

Original Article

A New Classification for Ankle Arthrodesis When Using an External Fixator

Hidenori Matsubara, Koji Watanabe, Munetomo Takata, Issei Nomura

Keywords : Ankle arthrodesis, Bone defect, Classification, Deformity, External fixation

Citation Information : Matsubara H, Watanabe K, Takata M, Nomura I. A New Classification for Ankle Arthrodesis When Using an External Fixator. 2019; 14 (3):148-154.

DOI: 10.5005/jp-journals-10080-1436

License: CC BY-NC-SA 4.0

Published Online: 03-09-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: We have classified ankle arthrodesis when using an external fixator into four types based on the deformity and defect. Each of the four types of technique have been evaluated retrospectively. Materials and methods: Thirty-three lower limb segments in 30 patients (average age 49 years) were treated by ankle arthrodesis using an external fixator in our institution. We classified the pre-treatment problems into four types and adjusted the surgical treatment accordingly: type I—no bone defect, no or mild deformity; type II—no bone defect, severe deformity; type III—bone defect with the possibility to shorten acutely after resection of the pathological focus; and type IV—bone defect but without the ability to shorten acutely after resection of the pathological focus. Type I problems were treated with curettage of ankle cartilage and bone graft with external fixation. Type II problems were treated with mobilisation using an external fixation after performing a type I ankle arthrodesis. Type III problems were treated with ankle arthrodesis using acute shortening and distraction. Type IV problems were treated with ankle arthrodesis using bone transport. Results: All patients had secure ankle fusion and were able to bear total weight in walking on completion of treatment. The mean external fixation period was 96 days in type I, 181 days in type II, 231 days with lengthening in type III and IV. The complications included re-fracture in three cases, deformity at the lengthening site in one, delayed union in one, and infection at fusion site in one. Conclusion: We have strategized ankle arthrodesis procedures using an external fixator into four groups in order to align the surgical technique with the pre-treatment problem. Our classification can help decide the appropriate operative method when using an external fixator, especially for difficult cases.


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  1. Jerosch J, Steinbeck J, Schroder M, et al. Arthroscopically assisted arthrodesis of the ankle joint. Arch Orthop Trauma Surg 1996;115(3-4):182–189. DOI: 10.1007/bf00434550.
  2. Yasui Y, Hannon CP, Seow D, et al. Ankle arthrodesis: A systematic approach and review of the literature. World J Orthop 2016;18(11):700–708. DOI: 10.5312/wjo.v7.i11.700.
  3. Woo BJ, Lai MC, Ng S, et al. Clinical outcomes comparing arthroscopic vs open ankle arthrodesis. Foot Ankle Surg 2019;19:30100–30106. DOI: 10.1016/j.fas.2019.06.004.
  4. Zarutsky E, Rush SM, Schuberth JM. The use of circular wire external fixation in the treatment of salvage ankle arthrodesis. J Foot Ankle Surg 2005;44(1):22–31. DOI: 10.1053/j.jfas.2004.11.004.
  5. Eylon S, Porat S, Bor N, et al. Outcome of Ilizarov ankle arthrodesis. Foot Ankle Int 2007;28(8):873–879. DOI: 10.3113/FAI.2007.0873.
  6. Salem KH, Kinzl L, Schmelz A. Ankle arthrodesis using Ilizarov ring fixators: A review of 22 cases. Foot Ankle Int 2006;27(10):764–770. DOI: 10.1177/107110070602701002.
  7. Wallace SJ, Liskutin TE, Schiff AP, et al. Ankle fusion following failed initial treatment of complex ankle fractures in neuropathic diabetics. Foot Ankle Surg 2020;26(2):189–192. DOI: 10.1016/j.fas.2019. 01.010.
  8. Badahdah HM, Zgonis T. Ankle arthrodiastasis with circular external fixation for the treatment of posttraumatic ankle arthritis. Clin Podiatr Med Surg 2017;34(4):425–431. DOI: 10.1016/j.cpm.2017.05.001.
  9. El-Alfy B. Arthrodesis of the ankle joint by Ilizarov external fixator in patients with infection or poor bone stock. Foot Ankle Surg 2010;16(2):96–100. DOI: 10.1016/j.fas.2009.06.004.
  10. Fragomen AT, Borst E, Schachter L, et al. Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res 2012;470(10):2864–2873. DOI: 10.1007/s11999-012-2470-9.
  11. Khanfour AA. Versatility of Ilizarov technique in difficult cases of ankle arthrodesis and review of literature. Foot Ankle Surg 2013;19(1):42–47. DOI: 10.1016/j.fas.2012.10.001.
  12. Onodera T, Majima T, Kasahara Y, et al. Outcome of transfibular ankle arthrodesis with Ilizarov apparatus. Foot Ankle Int 2012;33(11):964–968. DOI: 10.3113/FAI.2012.0964.
  13. Matsubara H, Tsuchiya H, Takato K, et al. Correction of ankle ankylosis with deformity using the Taylor spatial frame: A report of three cases. Foot Ankle Int 2007;28(12):1290–1294. DOI: 10.3113/FAI.2007.1290.
  14. Paremain GD, Miller SD, Myerson MS. Ankle arthrodesis: results after the miniarthrotomy technique. Foot Ankle Int 1996;17(5):247–252. DOI: 10.1177/107110079601700502.
  15. Choi G, Ghalambor N, Nihal A, et al. Revision ankle arthrodesis with lateral cannulated angled blade plate fixation. Foot Ankle Surg 2001;7(3):187–191. DOI: 10.1046/j.1460-9584.2001.00270.x.
  16. Fujimori J, Yoshino S, Koiwa M, et al. Ankle arthrodesis in rheumatoid arthritis using an intramedullary nail with fins. Foot Ankle Int 1999;20(8):485–490. DOI: 10.1177/107110079902000804.
  17. Plaass C, Knupp M, Barg A, et al. Anterior double plating for rigid fixation of isolated tibiotalar arthrodesis. Foot Ankle Int 2009;30(7):631–639. DOI: 10.3113/FAI.2009.0631.
  18. Colman AB, Pomeroy GC. Transfibular ankle arthrodesis with rigid internal fixation: An assessment of outcome. Foot Ankle Int 2007;28(3):303–307. DOI: 10.3113/FAI.2007.0303.
  19. Minematsu K, Tsuchiya H, Taki J, et al. Blood flow measurement during distraction osteogenesis. Clin Orthop 1998;347(347):229–235. DOI: 10.1097/00003086-199802000-00028.
  20. Thiryayi WA, Naqui Z, Khan SA. Use of the Taylor spatial frame in compression arthrodesis of the ankle: A study of 10 cases. J Foot Ankle Surg 2010;49(2):182–187. DOI: 10.1053/j.jfas.2009.05.015.
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