title: High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique.
abstract: When evaluating the role of ankle arthrodesis in the treatment of severe ankle arthritis, postoperative infection, nonunion, and the development of arthritis at the adjacent joints are major issues when considering treatment alternatives. We evaluated the rate of complications, the functional outcome, and compensatory range of motion at the midtarsal joint at medium-term followup after ankle arthrodesis with four cancellous screws. We performed 94 ankle fusions in 92 patients; 12 patients were lost to followup and eight declined to participate, leaving 72 patients (76%) for evaluation. The minimum followup was 4.8 years (mean, 5.9; range, 4.8-7.8 years). No patient developed a deep infection; three patients developed postoperative hematoma which we operatively drained. Union occurred in 93 of the 94 patients (99%). The sagittal motion at the midtarsal joint averaged 24 degrees . Secondary arthritis of the subtalar and talonavicular joints developed during the followup period in 17% and 11%, respectively. Progression of preexisting arthritis occurred in 13 of 43 patients (30%) at the subtalar joint and five of 26 patients (19%) at the talonavicular joint. None of these patients had fusion of an adjacent joint. The average American Orthopaedic Foot and Ankle Society score increased from 36 preoperatively to 85 at followup. Ankle arthrodesis with screws provides high rates of union, reliable pain relief, and favorable functional medium-term results.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Technical University, Fetscherstrasse 74, D-01307, Dresden, Germany. hans.zwipp@uniklinikum-dresden.de
authors.forename: Hans
authors.initials: H
authors.lastname: Zwipp
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.forename: Thomas
authors.initials: T
authors.lastname: Endres
authors.forename: Jan
authors.initials: J
authors.lastname: Heineck
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001863:Bone Screws; D018450:Disease Progression; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D016268:Internal Fixators; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D010003:Osteoarthritis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000503:physiopathology / Q000601:surgery; D010147:Pain Measurement; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index