title: [Revision of failed ankle arthrodeses].
abstract: OBJECTIVE
  Ankle arthrodesis with the foot at 90 degrees with minimal as possible leg shortening. Regain of a pain-free use of the limb.
  
  
  METHODS
  Failure of arthrodesis, septic or aseptic in origin, accompanied by pain interfering with weight bearing.
  
  
  METHODS
  General surgical or anesthesiologic risks. Acute reflex sympathetic dystrophy. Significant arterial circulatory disturbances or extensive neurologic deficits. Extensive bone or soft-tissue defects after previous surgeries.
  
  
  METHODS
  Approach using existing scars. Resection of nonunion making allowance for the planned position of arthrodesis. Removal of all necrotic bony and soft tissue. Posterior translation of talus by 1 cm. Autogenous bone grafting of major defects. Temporary fixation with a Kirschner wire with the foot at 90 degrees in the sagittal plane, in 0 degrees in the frontal plane, and 10-20 degrees of external rotation. Application of an external fixator, removal of Kirschner wire and compression of resection surfaces. If needed, apposition of cancellous bone harvested from iliac crest. Suction drain. Wound closure.
  
  
  RESULTS
  Revision of arthrodesis in 13 men and three women (average age 48 years [27-76 years]). Average follow-up 10.8 months (3-26 months). In spite of problematic preoperative conditions (local infection eight times, malposition five times) a bony consolidation occurred in 15 of 16 patients, 14 times in a perfect position. Average leg shortening 2.8 cm (1-8.5 cm). Satisfactory soft-tissue healing in twelve patients. Superficial ulceration in two patients, fistula in one. Successful repeat revision of arthrodesis in one patient on account of persisting nonunion and infection.
authors.affiliation: Berufsgenossenschaftliche Unfallklinik, Eberhard-Karls-Universität Tübingen, Schnarrenbergstrasse 95, D-72076 Tübingen, Germany. christoph.eingartner@uni-tuebingen.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Eingartner
authors.forename: Kuno
authors.initials: K
authors.lastname: Weise
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D001174:Arthrodesis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D001863:Bone Screws; D001864:Bone Wires; D016267:External Fixators; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000000981:diagnostic imaging / Q000209:etiology; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D017211:Treatment Failure; D016896:Treatment Outcome