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Complications of Ankle Arthrodeses

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strong>- Pseudarthrosis:/strong>br/>
       - a major complication;br/>
       - consider managing patient nonoperatively w/ orthosis;br/>
       - w/ operative treatment consider if old incisions can be used;br/>
       - acquired pes valgus, metatarsalgia, or other complication may occur;br/>
       - ref: a href="http://www.ncbi.nlm.nih.gov/pubmed/24043351">Establishing the relationship between clinical outcome and extent of osseous bridging between CT in isolated hindfoot and span style="background-color:" class="highlight">ankle/span> fusions./a>br/>
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strong>- Malaligned Fusion:/strong>br/>
       - significant problems arise when the fusion position is incorrect;br/>
       - genu recurvatum, or backknee, will result from a plantar-flexed foot;br/>
       - heel lift may compensate for moderate plantar flexion (5-10 deg), but significant problems arise with excessive plantar flexion;br/>
       - to avoid vaulting over plantar-flexed foot, patient must turn leg out, & secondary medial collateral laxity can occur;br/>
       - if foot is translated medially or laterally, other subtalar and gait problems can occur;br/>
       - when subtalar joint is inverted or in varus position, transverse tarsal  joint is locked, making rigid foot that needs to be vaulted over;br/>
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    - case example: br/>
           70-year-old male who underwent an ankle fusion for DJD following an ankle frx which occured in the distant past; br/>
                 - the initial fusion attempt w/ crossed screws made no attempt to control rotatory forces (which is usually obtained w/a br/>
                           screw directed into talar head - from posterior to anterior); br/>
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                        a href="/images/i1/ankf5.jpg">img align="middle" src="/images/i1/ankf5a.jpg" alt=""/>/a> a href="/images/i1/ankf6.jpg">img align="middle" src="/images/i1/ankf6a.jpg" alt=""/>/a> br/>
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                 - after 6 months it was clear that the fusion had failed, w/lysis around the screws and gross motion at the ankle joint; br/>
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                        a href="/images/i1/ankf7.jpg">img align="middle" src="/images/i1/ankf7a.jpg" alt=""/>/a> img align="middle" src="/images/i1/ankf8a.jpg" alt=""/> br/>
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                 - this fusion was salvaged w/ a revision fusion consisting of: br/>
                        - excision of the fibula for exposure and source of bone graft (along w/ ICBG); br/>
                        - recutting the distal tibia and talus; br/>
                        - application of an EBI fixator (w/ one talar pin and one calcaneal pin) which facilitated positioning of the br/>
                                    ankle, temporary compression across the ankle joint (while screws were inserted), and which helped tobr/>
                                    control rotatory forces; br/>
                        - insertion of two Synthes 7.3 cannulated screws from the sinus up into the distal tibia, as vertically as possible (which br/>
                                    would allow for some additional impaction across the ankle once the patient begins walking); br/>
                        - once the screws were inserted, the external fixator compression was partially released in order to avoid compression br/>
                                    across the subtalar jointbr/>/div>br/>hr/>br/>br/>br/>Last updated by Clifford R. Wheeless, III, MD on Sunday, April 12, 2015 4:13 pmbr/>

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