APPLICATION OF ANKLE OSTEOTOMY-TOOL IN ANKLE ARTHRODESIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PENGChaohua ^1,2 ,  ZHANGHui ¹ ,  HUANGFuguo ¹ , XIANGZhou ¹

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, People's Hospital of Meishan Cit;

Corresponding author：

ZHANGHui, Email: caesarzh@163.com; HUANGFuguo, Email: huang-f-g@163.com

Keywords：

Ankle arthrodesis; Ankle osteotomy-tool; Ankle arthritis; Internal fixation

DOI：

10.7507/1002-1892.20150120

Video：

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Objective To explore the feasibility and short-term effectiveness of ankle arthrodesis by ankle osteotomy-tool. Methods A retrospective analysis was made on the data of 38 patients with end-stage ankle arthritis undergoing ankle arthrodesis between February 2009 and March 2012. There were 24 males and 14 females, with an average age of 67 years (range, 40-85 years). The left ankle was involved in 18 cases and the right ankle in 20 cases. There were 20 cases of post-traumatic arthritis, 7 cases of avascular necrosis of talus, 5 cases of rheumatoid arthritis, 5 cases of primary osteoarthritis, and 1 case of post infective arthritis. The disease duration ranged 3.2-6.1 years (mean, 4.7 years). The ankle osteotomy-tool was used to remove the joint surfaces, and proximal humeral locking plate combined with compression screws were used for internal fixation. Results The operation time was 40-90 minutes (mean, 60 minutes). The healing of incisions by first intention was obtained in the other cases except 1 case of superficial infection, which was cured after dressing change. Thirty-eight patients were followed up 10 to 36 months (mean, 23 months). The ankles in 4 patients started to swell repeatedly when they walked early after operation and the swelling subsided at 1 year after rehabilitation therapy. The X-ray films showed that bone fusion was obtained at 12 weeks after operation on average (range, 10-19 weeks). No internal fixation failure or malunion occurred. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was improved significantly from 43.11±17.49 at preoperation to 85.03±13.17 at last follow-up (t=14.412, P=0.000). The short-form 36 health survey scale (SF-36) showed that physical component summary score was increased significantly from preoperative 54.30±12.32 to postoperative 77.95±8.21 (t=7.723, P=0.000), and mental component summary score was significantly increased from preoperative 63.16±8.30 to postoperative 77.05±10.12 (t=2.523, P=0.021). According to the patients' satisfaction, 32 patients were very satisfied, 5 patients were satisfied, and 1 patient was not satisfied. The subjective satisfaction of patients was 97.37%. Conclusion Ankle arthrodesis by lateral malleolus osteotomy with ankle osteotomy-tool and internal fixation using proximal humeral locking plate and compression screws has the advantages of simple operation, less complications, rigid fixation, and high fusion rate. It may obtain a good short-term effectiveness.

Citation： PENGChaohua, ZHANGHui, HUANGFuguo, XIANGZhou. APPLICATION OF ANKLE OSTEOTOMY-TOOL IN ANKLE ARTHRODESIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 553-557. doi: 10.7507/1002-1892.20150120 Copy

1.	Mohamedean A, Said HG, EI-Sharkawi M, et al. Technique and short-term results of ankle arthrodesis using anterior plating. Int Orthop, 2010, 34(6):833-837.
2.	Hendrickx RP, Stufkens SA, de Bruijin EE, et al. Medium- to long-term outcome of ankle arthrodesis. Foot Ankle Int, 2011, 32(10):940-947.
3.	Zwipp H, Rammelt S, Endres T, et al. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res, 2010, 468(4):958-968.
4.	Fragomen AT, Borst E, Schachter L, et al. Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res, 2012, 470(10):2864-2873.
5.	Cottino U, Collo G, Morino L, et al. Arthroscopic ankle arthrodesis:a review. Curr Rev Musculoskelet Med, 2012, 5(2):151-155.
6.	Tulner S, Klinkenbijl M, Albers G. Revision arthrodesis of the ankle:a 4 cannulated screw compression fixation technique. Acta Orthop, 2011, 82(2):250-252.
7.	Dohm MP, Benjamin JB, Harrison J, et al. A biomechanical evaluation of three forms of internal fixation used in ankle arthrodesis. Foot Ankle Int, 1994, 15(6):297-300.
8.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
9.	Beaton DE, Schemitsch E. Measures of health-related quality of life and physical function. Clin Orthop Relat Res, 2003, (413):90-105.
10.	Schuh R, Hofstaetter J, Krismer M, et al. Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome. Int Orthop, 2012, 36(6):1207-1214.
11.	DeHeer PA, Catoire SM, Taulman J, et al. Ankle arthrodesis:a literature review. Clin Podiatr Med Surg, 2012, 29(4):509-527.
12.	Slater GL, Sayres SC, O'Malley MJ. Anterior ankle arthrodesis. World J Orthop, 2014, 5(1):1-5.
13.	Myerson MS, Alvarez RG, Lam PW. Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int, 2000, 21(8):643-650.
14.	Alonso-Vázquez A, Lauge-Pedersen H, Lidgren L, et al. Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis. Clin Biochem, 2004, 19(7):751-759.
15.	Rockett MS, Zygmunt KH, Brage ME. The use of the Synthes 7.3-mm. cannulated screw in rearfoot and ankle surgery:a preliminary prospective study. J Foot Ankle Surg, 1997, 36(2):87-94.
16.	Thordarson DB, Markolf KL, Cracchiolo A 3rd. Arthrodesis of the ankle with cancellous-bone screws and fibular strut graft. Biomechanical analysis. J Bone Joint Surg (Am), 1990, 72(9):1359-1363.
17.	George EF, Manhal N, Benedict AC, et al. Ankle arthrodesis using an anterior tension device. Foot and Ankle Surg, 2006, 12(2):65-69.
18.	Betz MM, Benninger EE, Favre PP, et al. Primary stability and stiffness in ankle arthrodes-crossed screws versus anterior plating. Foot Ankle Surg, 2013, 19(3):168-172.
19.	Schütz M, Südkamp NP. Revolution in plate osteosynthesis:new internal fixator systems. J Orthop Sci, 2003, 8(2):252-258.
20.	Ahmad J, Pour AE, Raikin SM. The modified use of a proximal humeral locking plate for tibiotalocalcaneal arthrodesis. Foot Ankle Int, 2007, 28:977-983.
21.	Chodos MD, Parks BG, Schon LC, et al. Blade plate compared with locking plate for tibiotalocalcaneal arthrodesis:a cadaver study. Foot Ankle Int, 2008, 29(2):219-224.
22.	Bargiotas K, Wohlrab D, Sewecke JJ, et al. Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. J Bone Joint Surg (Am), 2006, 88(3):553-558.
23.	Nihal A, Gellman RE, Embil JM, et al. Ankle arthrodesis. Foot Ankle Surg, 2008, 14(1):1-10.
24.	Vienne P. Interposition arthrodesis of the ankle. Oper Orthop Traumtol, 2005, 17(4-5):502-517.
25.	Fuchs S, Sandmann C, Skwara A, et al. Quality of life 20 years after arthrodesis of the ankle. A study of adjacent joints, J Bone Joint Surg (Br), 2003, 85(7):994-998.
26.	Wang GJ, Shen WJ, McLaughlin RE, et al. Transfibular compression arthrodesis of the ankle joint. Clin Orthop Relat Res, 1993, (289):223-227.

1. Mohamedean A, Said HG, EI-Sharkawi M, et al. Technique and short-term results of ankle arthrodesis using anterior plating. Int Orthop, 2010, 34(6):833-837.
2. Hendrickx RP, Stufkens SA, de Bruijin EE, et al. Medium- to long-term outcome of ankle arthrodesis. Foot Ankle Int, 2011, 32(10):940-947.
3. Zwipp H, Rammelt S, Endres T, et al. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res, 2010, 468(4):958-968.
4. Fragomen AT, Borst E, Schachter L, et al. Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res, 2012, 470(10):2864-2873.
5. Cottino U, Collo G, Morino L, et al. Arthroscopic ankle arthrodesis:a review. Curr Rev Musculoskelet Med, 2012, 5(2):151-155.
6. Tulner S, Klinkenbijl M, Albers G. Revision arthrodesis of the ankle:a 4 cannulated screw compression fixation technique. Acta Orthop, 2011, 82(2):250-252.
7. Dohm MP, Benjamin JB, Harrison J, et al. A biomechanical evaluation of three forms of internal fixation used in ankle arthrodesis. Foot Ankle Int, 1994, 15(6):297-300.
8. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
9. Beaton DE, Schemitsch E. Measures of health-related quality of life and physical function. Clin Orthop Relat Res, 2003, (413):90-105.
10. Schuh R, Hofstaetter J, Krismer M, et al. Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome. Int Orthop, 2012, 36(6):1207-1214.
11. DeHeer PA, Catoire SM, Taulman J, et al. Ankle arthrodesis:a literature review. Clin Podiatr Med Surg, 2012, 29(4):509-527.
12. Slater GL, Sayres SC, O'Malley MJ. Anterior ankle arthrodesis. World J Orthop, 2014, 5(1):1-5.
13. Myerson MS, Alvarez RG, Lam PW. Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int, 2000, 21(8):643-650.
14. Alonso-Vázquez A, Lauge-Pedersen H, Lidgren L, et al. Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis. Clin Biochem, 2004, 19(7):751-759.
15. Rockett MS, Zygmunt KH, Brage ME. The use of the Synthes 7.3-mm. cannulated screw in rearfoot and ankle surgery:a preliminary prospective study. J Foot Ankle Surg, 1997, 36(2):87-94.
16. Thordarson DB, Markolf KL, Cracchiolo A 3rd. Arthrodesis of the ankle with cancellous-bone screws and fibular strut graft. Biomechanical analysis. J Bone Joint Surg (Am), 1990, 72(9):1359-1363.
17. George EF, Manhal N, Benedict AC, et al. Ankle arthrodesis using an anterior tension device. Foot and Ankle Surg, 2006, 12(2):65-69.
18. Betz MM, Benninger EE, Favre PP, et al. Primary stability and stiffness in ankle arthrodes-crossed screws versus anterior plating. Foot Ankle Surg, 2013, 19(3):168-172.
19. Schütz M, Südkamp NP. Revolution in plate osteosynthesis:new internal fixator systems. J Orthop Sci, 2003, 8(2):252-258.
20. Ahmad J, Pour AE, Raikin SM. The modified use of a proximal humeral locking plate for tibiotalocalcaneal arthrodesis. Foot Ankle Int, 2007, 28:977-983.
21. Chodos MD, Parks BG, Schon LC, et al. Blade plate compared with locking plate for tibiotalocalcaneal arthrodesis:a cadaver study. Foot Ankle Int, 2008, 29(2):219-224.
22. Bargiotas K, Wohlrab D, Sewecke JJ, et al. Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection. J Bone Joint Surg (Am), 2006, 88(3):553-558.
23. Nihal A, Gellman RE, Embil JM, et al. Ankle arthrodesis. Foot Ankle Surg, 2008, 14(1):1-10.
24. Vienne P. Interposition arthrodesis of the ankle. Oper Orthop Traumtol, 2005, 17(4-5):502-517.
25. Fuchs S, Sandmann C, Skwara A, et al. Quality of life 20 years after arthrodesis of the ankle. A study of adjacent joints, J Bone Joint Surg (Br), 2003, 85(7):994-998.
26. Wang GJ, Shen WJ, McLaughlin RE, et al. Transfibular compression arthrodesis of the ankle joint. Clin Orthop Relat Res, 1993, (289):223-227.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF ANKLE OSTEOTOMY-TOOL IN ANKLE ARTHRODESIS

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