Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study

Abstract

Background: Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications.

Materials and methods: 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years). The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scale.

Results: All cases of ankle fusions (100%) progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months). All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34). The mean AOFAS score was 74 (pain score = 32, functional score = 42). We found that twenty patients (68.96%) out of 29, had excellent results, 7 (24.13%) had good, and 2 (6.89%) showed fair results.

Conclusion: Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.

Keywords: Ankle arthritis; Arthrodesis; ankle fusion; ankle injuries; ankle joint; arthritis; neglected ankle fractures; rheumatoid arthritis; tibiotalar compression screw; transfibular ankle arthrodesis.

Figure 1

(a) Peroperative photograph showing osteotomy of the fibula 2 cms above the ankle joint. (b) Peroperative photograph showing complete removal of the distal fibula after the osteotomy gives good exposure of the joint. (c) Peroperative photograph showing excision of the medial malleolus through a medial incision gives additional exposure when needed. (d) Immediate postoperative radiograph anteroposterior and lateral views showing multiple screws used in arthrodesis

Figure 2

X-ray of right ankle joint anteroposterior and lateral views of a 45 years old female showing (a) post traumatic malunited bimalleolar fracture (b) immediate postoperative x-rays with trans fibular ankle arthrodesis (c) Six months followup x-rays

Figure 3

X-ray of right ankle joint anteroposterior and lateral views in a 28 years old male showing (a) failed open reduction internal fixation and malunited bimalleolar fracture. (b) Immediate postoperative X-ray with transfibular ankle arthrodesis. (c) Six months followup X-rays showing arthrodesis

Figure 4

X-ray ankle joint anteroposterior and lateral views in a 61 years old male showing (a) tubercular arthritis. (b) Immediate postoperative X-rays with transfibular ankle arthrodesis. (c) Six months followup X-ray showing arthrodesis