Ankle fusion using a 2-incision, 3-screw technique

Abstract

A total of 30 ankle fusions in 26 patients were analyzed. Mean age at fusion was 50 years (range 11-72.1 years). Mean follow-up time was 9.2 years (3.4-18.8 years). Radiological and clinical fusion in 28 (93%) of the primary arthrodeses. The mean American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 66 ± 12. Of the 26 patients, 22 (85%) were satisfied. Deep wound infection occurred once (3%). No other serious complications were encountered. The described technique provides reliable long-term follow-up results for a wide range of indications for ankle fusion.

Ankle Arthrodesis

“…Typically the short 16-mm thread pattern is used for all 3 screws. 21,22,24 When performed correctly, the orientation of the tripod screw technique provides both rotational and sagittal stability. 24 However, poor insertional orientation (placing screws predominately in 1 plane) may lead to rocking of the fusion site, thereby violating the rigid fixation principle of bone healing.…”

“…Dissection is then carried down through subcutaneous tissue to the level of the fibula; care should be taken to avoid the sural nerve and perforating peroneal arteries. 21 Deep dissection is made over the anterior ankle joint; the anterior tendon and neurovascular structures should be protected using a malleable retractor (Fig. 4).…”

“…14,[21][22][23][24][25] The first screw is inserted from the medial aspect either through the previously made incision or percutaneously if performing a strictly lateral approach. The entry point is posterior medial tibia to plantar lateral talar head.…”

“…The medial malleolus cartilage can be removed via a curette through the lateral incision or a medial incision can be performed. 21,[23][24][25] A linear incision is made over the anterior medial malleolus and deepened down to the medial gutter/anterior ankle joint (Fig. 6).…”

“…All prepared joint surfaces are subchondral drilled with a 1.6-mm Kirschner wire. 21,[23][24][25] After adequate preparation of the joint, the knee/patella is palpated and marked by an assistant who holds the extremity in the correct orientation. The foot is then placed in 90 dorsiflexion (neutral) in the sagittal plane, 5 abduction in the transverse plane, a slight valgus in the frontal plane, and a posterior displacement of the foot relative to the tibia.…”