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. 2024 Nov;144(11):5031-5038.
doi: 10.1007/s00402-024-05602-0. Epub 2024 Oct 3.

Ilizarov fixator as salvage procedure after frustrating arthrodesis using intramedullary nailing - is there a chance of consolidation?

Alexis Brinkemper  1   2 , Raimund H Lülsdorff  3 , Sebastian Lotzien  3 , Christiane Kruppa  3 , Thomas A Schildhauer  3 , Charlotte Cibura  3
Affiliations

Ilizarov fixator as salvage procedure after frustrating arthrodesis using intramedullary nailing - is there a chance of consolidation?

Alexis Brinkemper et al. Arch Orthop Trauma Surg. 2024 Nov.

Abstract

Introduction: Arthrodesis of the tibiotalar and subtalar joints is a salvage procedure that has been used successfully for years. Treatment options include internal procedures and external procedures. Retrograde intramedullary nailing is considered a safe procedure with a high degree of stability and comfort. Nevertheless, there are cases in which this internal arthrodesis fails and another procedure must be considered. Ilizarov fixator treatment could be a solution for those patients in whom intramedullary nailing has failed. Even if it means another surgical revision - is it possible to finally achieve consolidation with this method?

Materials and methods: In this single-center, retrospective study all documents of patients who underwent tibiotalar and subtalar joints fusion using the Ilizarov external fixator at our institution from 2003 to 2023 as secondary treatment after frustrated first arthrodesis using an intramedullary nail were reviewed. Nineteen patients (17 men and 2 women), with an average age of 55.7 (standard deviation (SD) 8.7, range 34-75) years were included.

Results: On average, 1.7 (SD 1.3, range 1-6) arthrodesis attempt were performed before final Ilizarov fixator arthrodesis. The average time spent in the Ilizarov fixator was 19 (SD 4, range 14-29) weeks. In seven cases (36.8%), both the tibiotalar and subtalar joints received bony consolidation in the end.

Conclusion: If patients have undergone fusion of the tibiotalar and subtalar joints with a retrograde nail and this fails, it is difficult to achieve complete consolidation in the further course. A further attempt at arthrodesis using an Ilizarov fixator is possible, but the overall results are also poor. This procedure must therefore be seen as a last resort before amputation.

Keywords: Ankle arthrodesis; Ilizarov fixator; Intramedullary nailing; Limb salvage; Retrospective study.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the ethical committee of the Ruhr-University Bochum (registration number 18-6582-BR). Competing interests: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Patient with an infectious situation with persistent non-union and additional tibia fracture. (a) Image seven days before the change from nail to Ilizarov fixator. (b) Image at day of Ilizarov fixator removal. (c) Follow-up three months after removing of the Ilizarov fixator
Fig. 2
Fig. 2
Overview of inclusion and progression of the cases
See this image and copyright information in PMC

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