“…Numerous techniques have been described, with inconsistent fusion rates. 5,6,11,13,20,23,25 Failure to achieve fusion may be a result of hardware factors, (insufficient fixation or compression), operative factors (insufficient debridement, lack of exact bone coaptation) or patient factors (sensory neuropathy, obesity, smoking, noncompliance etc.). 6,13,15 Often the soft-tissue envelope of the ankle has been compromised by previous trauma, surgery, or both -an additional complicating factor.…”