A biomechanical comparison of micromotion after ankle fusion using 2 fixation techniques: intramedullary arthrodesis nail or Ilizarov external fixator.
BACKGROUND
In difficult ankle arthrodesis situations, intramedullary (IM) arthrodesis nails and external fixation are often considered in lieu of standard fusion techniques. The purpose of this study was to compare the amount of micromotion measured across an ankle fusion site stabilized with either an IM nail or with the Ilizarov external fixator.


METHODS
The relative bone mineral density of 8 pairs of human cadaveric lower legs was measured by DEXA scanning. One specimen from each pair was randomly assigned to be stabilized with a new generation IM nail and the other with an Ilizarov external fixator. Specimens were tested in compression, rotation, and dorsiflexion. Optical motion capture was used to measure the direct motion occurring at the fusion site.


RESULTS
No significant difference was found between the axial displacements (p = 0.94), torsional displacement (p = 0.07), or the dorsiflexion angular displacement (p = 0.28) for the IM rod group and the external fixation group. A weak correlation was found between BMD and displacement.


CONCLUSIONS
Both the new generation IM nail and the Ilizarov external fixator imparted excellent stability to the fusion site despite a wide range of bone mineral densities. Medialization of the talus, the ability to compress the nail, and the addition of a posterior-to-anterior locking screw were thought to improve the performance of the nail.


CONCLUSIONS
Both IM nail and Ilizarov external fixation provided excellent fusion site stability. The decision of which implant to use for complex arthrodesis should be dictated by the clinical needs.
Fragomen
Austin T
AT
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FragomenA@hss.edu
Meyers
Kathleen N
KN
Davis
Nicole
N
Shu
Hengsheng
H
Wright
Timmothy
T
Rozbruch
S Robert
SR
D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology* / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D015519:Bone Density; D001858:Bone Nails; D002102:Cadaver; D016267:External Fixators; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D018889:Ilizarov Technique / Q000295:instrumentation*; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D016474:Weight-Bearing / Q000502:physiology