The Comparison of the Ankle Arthrodesis According to Surgical Procedures

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

Abstract

The aim in arthrodesis of ankle is to gain a painless, normal walking gait of destroyed ankle joint caused by various origins. Despite more than 30 different fusion techniques have been described in the literature, but the results were not always satisfactory. Blair introduced tibial sliding graft, rectangular hone block donated at distal tibia, to the neck of talus. His method has advantages of a normal apperance of the foot, no shortening, and the weight bearing thrust on normal tissue. The purpose of this study was to compare the ankle arthrodesis according to surgical procedures & introduce the method which could produce excellent results for ankle arthrodesis. We reviewed 23 patients(24 cases) undergone ankle arthrodesis from Jan. 1989 to Dec. 1996 in Kyung Hee Medical Center. Male were twelve(13 cases) and female were eleven. Mean age was 42.6(l8-75)years. The Blair fusion method was used in ten cases. Iliac bone graft followed by internal fixation using Steinmann pin in 4 cases, using cancellous screw in I case, and using both Steinmann pin and staple in 1 case, while tibiotalar coaptation without bone graft followed by internal fixation using Steinmann pin in 3 cases, using staple in 1 case, and using cancellous screw in 1 case. In 3 cases, arthroscopic abrasion and cancellous screw was used. The mean duration of follow-up was 46(6-99) inonths. Time to union was average l4.6(8-23) weeks in Blair fusion and 17.5(8-40) weeks in other methods. Delayed union was observed in three cases, but no case was found in Blair fusion. Pain was ohserved in 5 cases, 3 in Blair fusion and 2 in other methods. Nonunion or pseudoarthrosis was not ohserved. On the clinical criteria for Boston Childrens Hospital ankle-scoring system, we ohserved nineteen excellent and five good cases. The difference in results according to fusion method was not ohserved. The results in tibiopedal motion using cineroentgenography were seven good and three fair cases in Blair, while two good, ten fair and two poor in other methods. By using Blair fusion, we expect early bony union and better clinical results.