The Results of Blair Ankle Fusion in Trauma and Disease Around the Ankle

Chung, Duke Whan; Kim, Kang Il; Park, Byung Joo

Abstract

Blair introduced talotibial fusion via tibial sliding graft, rectangular bone block donated from distal tibia, to the neck of talus to settle the problems, shortening of lower extremity and deformity of foot, which had been produced by talectomy or subtalar fusion in the treatment of the comminuted fracture-dislocation of the body of the talus. The purpose of this study was to report the excellent results of Blair ankle fusion in treatments of various diseases of ankle as well as fracture and avascular necrosis of talus, and to announce the effect of Blair ankle fusion. The ten cases were reviewed, which had undergone Blair ankle arthrodesis, from January 1989 to December 1996 in Kyung Hee Medical Center. There were 4 men and 6 women. Mean age was 4.7(18-75) years old. Preoperative diagnosis were 2 posttraumatic osteoarthritis, 2 avascular necrosis of talus, 2 degenerative osteoarthritis, 1 chronic osteomyelitis of calcaneus with myelopathy, 1 Charcot joint due to diabetes mellitus, 1 secondary osteoarthritis due to infection sequelae and 1 old crushing injury of ankle and foot. We used Boston children's Hospital ankle-scoring system as clinical assessment criteria and tibiopedal motion as functional assessment in gait. Time to union was average 14.6(8-23) weeks. Postoperative complications were pin tract infection in two cases and deep infection(chronic osteomyelitis) in one case. Pain was observed in three cases. Delayed union, nonunion or pseudoarthrosis were not observed. The average leg length discrepancy was 0.64cm(0-1.27). On the clinical criteria for Boston children's Hospital ankle-scoring system, we observed seven excellent and three good cases. The results in tibiopedal motion using cineroentgenography were 6 good and 4 fair cases. By using Blair fusion, we expect early bony union, near normal shape of foot, no shortening, and normal walking by preserving the enough range of tibiopedal motion.