When evaluating the role of ankle arthrodesis in the treatment of severe ankle arthritis, postoperative infection, nonunion, and the development of arthritis at the adjacent joints are major issues when considering treatment alternatives. We evaluated the rate of complications, the functional outcome, and compensatory range of motion at the midtarsal joint at medium-term followup after ankle arthrodesis with four cancellous screws. We performed 94 ankle fusions in 92 patients; 12 patients were lost to followup and eight declined to participate, leaving 72 patients (76%) for evaluation. The minimum followup was 4.8 years (mean, 5.9; range, 4.8-7.8 years). No patient developed a deep infection; three patients developed postoperative hematoma which we operatively drained. Union occurred in 93 of the 94 patients (99%). The sagittal motion at the midtarsal joint averaged 24°. Secondary arthritis of the subtalar and talonavicular joints developed during the followup period in 17% and 11%, respectively.

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Between October 1993 and September 1999 a total of 62 tibial pilon fractures in 59 patients were treated at the Clinic for Trauma and Reconstructive Surgery, University Hospital Carl-Gustav-Carus, Technical University Dresden. In a retrospective study 49 patients with 50 tibial pilon fractures (81%) could be examined an average of 28 months after injury. The purpose of this study was to compare clinically and radiographically the healing results obtained after using the Ilizarov technique in combination with minimally invasive internal fixation (group I) with those after a conventional surgical procedure (internal fixation with a plate, external fixation with or without minimally invasive internal fixation, and screw fixation exclusively, group II) and to evaluate the efficacy of the Ilizarov technique. Data analysis showed a significantly higher incidence of 43 C2/C3 fractures in Ilizarov group I (73%) than in group II (33.3%). Severe soft tissue injuries and particularly open injuries had a significantly higher incidence in Ilizarov group I (100%) than in group II (38%). Despite the high incidence of C2/C3 fractures and severe soft tissue injuries in group I, there was no incidence of pseudarthrosis or osteitis in the further course and there was no need for arthrodesis during the long-term course. After therapy with a conventional surgical technique, the incidence of osteitis was 5% and of delayed union of a fracture 2.5% and arthrodesis was necessary in 8%. A disadvantage of the Ilizarov system was the relatively frequent incidence of pin infection (45%) necessitating surgical debridement in 18%. The efficacy of the treatment of 43 C2/C3 fractures with the Ilizarov technique was obvious by a statistically significantly better Maryland Foot Score in comparison with group II. More than 87% of the patients treated with the Ilizarov technique and only 38% of the patients treated with a conventional surgical procedure obtained a very good or good score. According to these findings, the Ilizarov technique in combination with minimally invasive internal fixation is an effective method to treat complicated tibial pilon fractures with severe soft tissue trauma.

Between January 1, 1994 and December 31, 1998 this technique was performed in 50 ankles of 48 patients. 40 patients could be followed up for an average of 5.6 years (4.8-7.6 years). No serious complications. The average compensatory movement of the Chopart joint amounted to 26 degrees . Osteoarthritis of the subtalar joint was seen in 13%, and of the talonavicular joint in 12.5% of patients. Preexisting osteoarthritis of these joints remained in general unchanged. The AOFAS Score was assessed pre- and postoperatively. Preoperatively, 17.5% of patients showed a satisfactory and 82.5% a poor score. Postoperatively, 52.5% had an excellent, 30% a good, 10% a satisfactory, and 7.5% a poor outcome.

In cases of osteitis, osteonecrosis, osteoporosis, and poor soft-tissue condition, external fixation techniques are preferred. In the presence of severe loss of bone stock at the distal tibia, stability can be achieved by using a compression nail for tibiotalar fusion without additional subtalar arthrodesis.