Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion.
BACKGROUND
Ankle arthrodesis may be achieved using the Ilizarov method. Comorbidities, such as diabetes, Charcot neuroarthropathy, osteomyelitis, leg length discrepancy, and smoking, can make an ankle fusion complex and may be associated with lower rates of healing.


OBJECTIVE
We asked if (1) smoking and other comorbidities led to lower fusion rates, (2) time wearing the frame affected outcome, and (3) simultaneous tibial lengthening improved fusion rates.


METHODS
We retrospectively studied 101 patients who underwent complex ankle fusion using the Ilizarov technique. The median time wearing the frame was 25 weeks (range, 10-65 weeks). Twenty-four patients had simultaneous tibial lengthening. The minimum followup for 91 of the 101 patients was 27 months (median, 65 months; range, 27-134 months).


RESULTS
Fusion was achieved in 76 of 91 patients. Smoking was associated with a 54% rate of nonunion. Fifteen of 19 patients with Charcot neuroarthropathy achieved union but had a high rate of subsequent subtalar joint failure. Time wearing the frame did not affect union rates. Tibial lengthening did not improve ankle fusion rates.


CONCLUSIONS
Smokers should be warned of the high risk of nonunion and we recommend they quit smoking. We also recommend surgeons recognize the higher nonunion rate in patients with Charcot neuroarthropathy. We believe tibial lengthening should not be performed to enhance healing at the fusion site.


METHODS
Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Fragomena@hss.edu
Austin T
AT
Fragomen
Eugene
E
Borst
Lindsay
L
Schachter
Stephen
S
Lyman
S Robert
SR
Rozbruch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D001177:Arthropathy, Neurogenic / Q000150:complications; D002648:Child; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult