A modified transfibular technique of ankle arthrodesis using partial fibular resection and onlay bone graft

Abstract

The transfibular approach is a common procedure for tibiotalar fusion. However, this technique has several concerns: inadequate stability to resist rotational and shearing forces, a fibula is suboptimal for bone grafting, and an onlay fibular graft that might prevent impacting and cause distraction. We present a modified transfibular technique using partial fibular resection and onlay bone graft, which may address these potential problems. This study aimed to evaluate whether the ankle joint is well fused with neutral alignment and functionally improved at the final follow-up. For this study, 27 consecutive patients (mean age, 68.5 years; range, 58–83) who underwent tibiotalar fusion with a follow-up period of >1 year were retrospectively included. A modified transfibular lateral approach was performed, in which the distal anterior half fibula was resected and fixed as an onlay graft to achieve fusion between the tibia, fibula, talus, and fibular onlay graft simultaneously. Radiographic outcomes were assessed using computed tomography at 4 months after operation and serial follow-up radiographs. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society hindfoot scale and Foot and Ankle Outcome Score. The mean follow-up period was 17.3 (range, 12–32) months. Four months after operation, complete union was achieved in 13 patients, near-complete union in 8 patients, and partial union in the remaining 6 patients. At the final follow-up, all the patients achieved complete union and maintained neutral ankle alignment. The functional outcome showed a significant increase between the preoperative and postoperative periods. One minor complication occurred, in which medial side ankle pain was relieved after screw removal. This modified technique is safe and effective, and has several merits, including saving the soft tissue of the anterior ankle, saving the course of the peroneal tendons by leaving the posterior half of the fibula, resected fibula serving as a good bone stock, and reducing the likelihood of valgus deformity after fibulectomy.

Combined Transfibular and Anterior Approaches Increase Union Rate and Decrease Non-Weight-Bearing Periods in Ankle Arthrodesis: Combined Approaches in Ankle Arthrodesis

“…The biggest limitation of this study is the lack of a control group with ankle arthrodesis treated using the transfibular approach alone. However, this study was comparable to previously reported studies with respect to clinical results, union rate, and postoperative complications [19,[29][30][31]. The relatively small sample size and retrospective nature are also limitations of this study.…”

Removal of Broken Tibiotalocalcaneal Nail: Case Report and Technical Tip

“…This may include either the tibiotalar or the subtalar joint, as in our case. Because the modified transfibular approach has great advantages in visualizing the tibiotalar and subtalar joints, 7 the translateral approach with corticotomy of the lateral cortex demonstrated herein could be feasible at the respective level of nonunion. If we expand the indications for the method we suggest, it could be applied in situations such as ankle trauma or even in cases of charcot foot.…”

“…Subsequently, we proceeded with the rest of the operation via a lateral approach using anterior partial fibulectomy (Figure 2). 7 This approach enabled the visualization of the subtalar joint and, concomitantly, provided a clear path to reach the breakage site of the nail. The interlocking screw near the breakage site was removed, and a corticotomy window was made at the lateral cortex of the talus, extending proximally to the distal tibiotalar junction, which helped visualize the site of breakage.…”

Transfibular approach to ankle arthrodesis: surgical technique guide and tips

“…There is a variety of approaches and techniques for arthrodesis of the tibiotalar joint with over 40 different methods being reported [3][4][5] . Each approach has its own inherent risks and benefits, and the surgeon should choose the technique based on comfortability, fixation preference, and the state of the surrounding soft tissue.…”

“…The lateral approach, which was first described in 1948 by Adams 6 , is often utilized due to its familiar anatomic location and shared incisional approach as with a standard distal fibular fracture. Other advantages include avoiding any vital neurovascular structures and the ability to use the fibula as an autograft if desired [5][6][7] .…”