Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation

Abstract

Objective: To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

Methods: From June 2013 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution. Conventional double-feet standing X-ray films were taken before and after operation. The tibiotalar angle on X-ray image was measured to evaluate the degree of talipes varus and valgus. The Foot and Ankle pain score of American Orthopaedics Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) were compared by using paired t-test to evaluate the functional recovery.

Results: All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All patients were included in the analysis, among which 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). All ankles achieved bony fusion; the clinical healing time was 12.7 weeks on average (11-18 weeks). The AOFAS score was 45.36 ± 6.43 preoperatively and 80.25 ± 9.16 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The VAS score was 8.56 ± 1.85 on average preoperatively and 2.72 ± 0.83 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The tibiotalar angle was 101.93° ± 4.12° preoperatively and 94.45° ± 2.37° at 12 months post-operation, with a statistically significant difference (p < 0.0001). The results of the functional evaluation indicated that 44 patients (61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.

Conclusion: Our study demonstrated that it is possible to obtain satisfactory outcome with Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

Keywords: Ilizarov external fixation; arthrodesis; elderly traumatic ankle arthritis; end-stage.

Fig. 1

The surgical procedure. (A) exposure of ankle; (B) debridement of articular cartilage and sclerosis subchondral bone; (C) the harvest of cancellous bone; (D) installation of Ilizarov external frame

Fig. 2

Typical case, female, 63 years old, pain after right ankle sprain for 10+ years. Diagnosis: Right ankle traumatic arthritis. (A) preoperative anteroposterior and lateral X‐ray films. (B) postoperative anteroposterior and lateral X‐ray films. (C) anteroposterior and lateral X‐ray films 6 months after the operation. (D) anteroposterior and lateral X‐ray films 12 months after the operation

Fig. 3

Typical case, female, 68 years old, trauma caused right talus fracture 1+ years after surgery, walking pain 10+ months. Diagnosis: Right ankle traumatic arthritis. (A) preoperative anteroposterior and lateral X‐ray films. (B) postoperative anteroposterior and lateral X‐ray films. (C) anteroposterior and lateral X‐ray films 6 months after the operation. (D) anteroposterior and lateral X‐ray films 12 months after the operation