OTA 2005 Posters

Scientific Poster #89 Foot & Ankle

:Complex Ankle Arthrodesis Using the Ilizarov/Taylor Spatial Frame

Austin T. Fragomen, MD; Svetlana Ilizarov, MD; Arkady Blyakher, MD;

S. Robert Rozbruch, MD (n-all authors);

Hospital for Special Surgery, New York, New York, USA

Purpose: Patients who have failed treatment for pilon and ankle fractures commonly require fusion. Problems of poor bony architecture, bone loss, disuse osteopenia, infection, contracture, and deformity make standard screw fixation an unpredictable means of obtaining ankle fusion. The purpose of this study is to review our experience with the use of the Ilizarov/Taylor spatial external fixator in complex ankle arthrodesis.

Methods: We retrospectively reviewed 40 consecutive patients from an IRB-approved database who underwent ankle arthrodesis. 37 patients had posttraumatic arthritis. 14 patients had failed prior ankle fusion. Three patients had failed total ankle replacement. 19 patients had a history of open fractures of the ankle or distal tibia. 25 patients had a history of osteomyelitis of the distal tibia or talus. 13 patients were actively smoking during treatment. 17 patients had ankle deformity of greater than 10°. Four patients had osteonecrosis of the talus. 20 patients had ankle joint bone loss of an average 2.8 cm. Nontraumatic pathology included one patient with rheumatoid arthritis of the ankle joint, another with clubfoot deformity, and a third with neuropathic foot and ankle arthritis. All patients underwent ankle fusion surgery using the Ilizarov/Taylor spatial frame. Simultaneous or staged tibial lengthening was performed in nine cases.

Results: Average follow-up was 16 months with an average AOFAS score of 74 points. Average time in frame was 6 months. Average leg length discrepancy after treatment was 1.4 cm. 20 patients developed superficial pin infections. 17 were treated with oral antibiotics. Three required admission for intravenous antibiotics. Osteomyelitis was eradicated in 24 of 25 patients. 37 patients obtained successful fusion without deformity. Five of these patients failed the first attempt and required a second arthrodesis procedure using the same technique. There were three patients in whom fusion was not obtained. Two were treated with amputation, and one had a stiff painless nonunion.

Conclusion: The Ilizarov/Taylor spatial frame allows for acute or gradual compression of the fusion and deformity correction, simultaneous lengthening, and eradication of deep infection by avoiding internal fixation, making the Ilizarov method a powerful tool for achieving arthrodesis in the presence of complex ankle pathology.