Abstract
Introduction
Debate remains which surgical technique should be used for ankle arthrodesis. Several open approaches have been described, as well as the arthroscopic method, using a variety of fixation devices.
Both arthroscopic and open procedures have good results with union rates of 93–95%, 3% malunion rate and patient satisfaction of 70–90%, although some report complication rates as high as 40%.
Aims
To identify union, complication and patient satisfaction rates with open ankle fusions (using the plane between EHL and tibialis anterior).
Method
A retrospective review of all isolated primary fusions performed between 2005 and 2009. Patient records were reviewed and patients were recalled for clinical evaluation and AOFAS scoring. Follow up range was 7 months–8.3 years (mean 4 years).
Results
82 ankles were identified in 73 patients. Medical notes were reviewed for all patients. Fifty five patients were clinically reviewed (75% response rate), a further 3 contacted by telephone (79% response rate). Fifeteen were not contactable. Male 47: 35 female, age range at surgery 18–75 years (mean 56.1), left 37: 45 right, 8 were smokers.
Causes leading to fusion were: Trauma 52 (63%), OA 17, Rh.A 7, CMT 3, CTEV 2, Talar AVN 1. All fusions were performed with 2 (78) or 3 (4) medial tibiotalar screws. Length of stay range: 1–12 days (mean 3.1). All patients were placed in plaster post operatively for a minimum 12 weeks. Time to union ranged from 8 to 39 weeks (mean 13.3) with a union rate of 100%.
Major complications were 14.6%: 7 (8.5%) malalignment, 3 (3.7%) wound problems, 2 (2.4%) complex regional pain syndrome. There were no non unions, DVT, PE, stress fractures or deep infections. There were 2 (2.4%) delayed unions (> 6 months, both smokers), 6 (7%) asymptomatic superficial peroneal nerve injuries and one saphenous nerve injury. Four (4.8%) required screw removal. Subsequent fusions were performed in 7.3%, 4 subtalar, 1 triple and 1 chopart.
The AOFAS range was 8–89 (mean 66). 79% were either ‘very satisfied’ or ‘satisfied’ and 8% were ‘very disatisfied’ or ‘disatisfied’. Patients played a variety of sports including golf, squash, badmington and sky diving.
Conclusion
These results show excellent union rates (100%) in part related to the strong no smoking policy and meticulous surgical technique. Two delayed unions (union at 39 and 31 weeks) were smokers. There were high satisfaction rates, however varus malalignment and persistent pain (particularly CRPS) resulted in dissatisfaction. Many patients remained highly active. These results exceed the current reported union rates and compare favourable with complications and patient satisfaction and we therefore advocate this technique.
