Foot Ankle Int. 1997 May;18(5):300-309. Erratum in: Foot Ankle Int 1997 Jun;18(6):379
Anderson JG, Coetzee JC, Hansen ST
BACKGROUND: We reviewed 20 revision ankle fusions performed using internal compression arthrodesis with screw fixation.
METHODS: Clinical, functional, and radiographic results were measured at an average follow-up of 30 months (range, 12-50 months). The reasons for the index procedures were nonunion in 11, malunion in 7, infected nonunion in 1, and nonunion associated with avascular necrosis of the talus in 1 case.
RESULTS: Fusion occurred in 15 of 20 patients. Two additional patients obtained fusion after subsequent procedures, for a final union rate of 85%. The average time to fusion was 6 months (range, 2-32 months). Nineteen additional operations were necessary in 12 patients, including three amputations for chronic infection (two infected nonunions and one chronic osteomyelitis). All but one patient had a plantigrade limb at follow-up. Seventeen of 20 patients were satisfied with their ultimate outcome, including all three patients with amputations. The three dissatisfied patients were bothered by chronic pain.
CONCLUSION: Revision ankle fusion for nonunion or malunion using internal compression arthrodesis with screw fixation is beneficial for most patients. It is a technically demanding procedure that is associated with a high complication rate. Many patients can be expected to have residual pain. We emphasize the need for accurate alignment and early, aggressive treatment of infectious complications. Amputation should be considered a viable option to improve functional outcome in patients with solid, well-aligned fusions who are disabled by severe chronic pain.
Copyright © 1997 (Foot Ankle Int. May;18(5):300-309. Erratum in: Foot Ankle Int Jun;18(6):379) by the American Orthopaedic Foot and Ankle Society, Inc., originally published in Foot & Ankle International, and reproduced here with permission.
Original Text by Clifford R. Wheeless, III, MD.