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Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Ankle arthrodesis may be achieved using the Ilizarov method. Comorbidities, such as diabetes, Charcot neuroarthropathy, osteomyelitis, leg length discrepancy, and smoking, can make an ankle fusion complex and may be associated with lower rates of healing.

Questions/Purposes

We asked if (1) smoking and other comorbidities led to lower fusion rates, (2) time wearing the frame affected outcome, and (3) simultaneous tibial lengthening improved fusion rates.

Methods

We retrospectively studied 101 patients who underwent complex ankle fusion using the Ilizarov technique. The median time wearing the frame was 25 weeks (range, 10–65 weeks). Twenty-four patients had simultaneous tibial lengthening. The minimum followup for 91 of the 101 patients was 27 months (median, 65 months; range, 27–134 months).

Results

Fusion was achieved in 76 of 91 patients. Smoking was associated with a 54% rate of nonunion. Fifteen of 19 patients with Charcot neuroarthropathy achieved union but had a high rate of subsequent subtalar joint failure. Time wearing the frame did not affect union rates. Tibial lengthening did not improve ankle fusion rates.

Conclusion

Smokers should be warned of the high risk of nonunion and we recommend they quit smoking. We also recommend surgeons recognize the higher nonunion rate in patients with Charcot neuroarthropathy. We believe tibial lengthening should not be performed to enhance healing at the fusion site.

Level of Evidence

Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Austin T. Fragomen MD & S. Robert Rozbruch MD

  2. Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA

    Eugene Borst BA

  3. Department of Medicine, St. George’s University, Grenada, West Indies

    Lindsay Schachter BS

  4. Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY, USA

    Stephen Lyman PhD

Authors
  1. Austin T. Fragomen MD
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  2. Eugene Borst BA
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  3. Lindsay Schachter BS
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  4. Stephen Lyman PhD
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  5. S. Robert Rozbruch MD
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Corresponding author

Correspondence to Austin T. Fragomen MD.

Additional information

The institution of one or more of the authors (SRR, ATF) received funding from Smith & Nephew (Memphis, TN, USA), but no funding was received for this specific study.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

The work was performed at The Hospital for Special Surgery, New York, NY, USA.

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Fragomen, A.T., Borst, E., Schachter, L. et al. Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion. Clin Orthop Relat Res 470, 2864–2873 (2012). https://doi.org/10.1007/s11999-012-2470-9

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  • DOI: https://doi.org/10.1007/s11999-012-2470-9

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