Effectiveness analysis of Ilizarov external fixation and ankle arthrodesis in treatment of late traumatic ankle arthritis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jun , HUANG Zeyu , FANG Yue , HUANG Fuguo ,  LIU Lei

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIU Lei, Email: liuinsistence@163.com

Keywords：

Ilizarov external fixation; ankle fusion; traumatic ankle arthritis

DOI：

10.7507/1002-1892.201702010

Video：

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Objective To evaluate the effectiveness of Ilizarov external fixation and ankle arthrodesis in the treatment of late traumatic ankle arthritis. Methods Between June 2013 and June 2015, 27 patients with late traumatic ankle arthritis were treated with Ilizarov external fixation technique. There were 16 males and 11 females with an age of 27-69 years (mean, 45.7 years). Sixteen cases were on the left side, 11 on the right side. All the patients suffered from traumatic ankle fractures or ligament damages caused by initial traumas. After 6 months of standard conservative treatment, the results was invalid and all patients had ankle joint pain and movement disorders. The disease duration was 3-39 years (mean, 11.5 years). According to Takakura ankle arthritis staging, there were 16 cases in stage 3 and 11 cases in stage 4. The tibial-talar angle before operation was (102.55±4.02) ° measured on conventional double-feet loading anteroposterior and lateral X-ray films. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot joint score was 45.72±6.45, and the visual analogue scale (VAS) score was 8.61±1.96. Results All the patients were followed up 15-42 months (mean, 28.1 months). All ankles achieved bony fusion, the clinical healing time was 12.9 weeks on average (range, 11-18 weeks). No persistent bleeding in the incisions and needle tract occurred during the follow-up. There were 4 cases of mild needle infection, 2 cases of anterior dislocation of talus, and 3 cases with different degree of limited activity. No traumatic bone defect, bone disconnection, and false joint formation was observed. At 12 months after operation, the AOFAS ankle and foot joint score, VAS score, and tibial-talar angle were 80.53±9.14, 2.77±0.82, and (94.36±2.48)°, respectively, which were significantly improved when compared with preoperative ones (t=16.17, P=0.00; t=14.28, P=0.00; t=9.01, P=0.00). The effectivenss was excellent in 9 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 81.5%. Conclusion Satisfactory effectiveness can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of traumatic ankle arthritis, showing certain application prospect, while long-term effectiveness should be comfirmed by large sample randomized controlled trials.

Citation： LI Jun, HUANG Zeyu, FANG Yue, HUANG Fuguo, LIU Lei. Effectiveness analysis of Ilizarov external fixation and ankle arthrodesis in treatment of late traumatic ankle arthritis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1311-1315. doi: 10.7507/1002-1892.201702010 Copy

1.	Santos AL, Demange MK, Prado MP, et al. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm. Rev Bras Ortop, 2014, 49(6): 565-572.
2.	Rabinovich RV. Complex ankle arthrodesis: Review of the literature. World J Orthop, 2015, 6(8): 602-613.
3.	Takakura Y, Tanaka Y, Kumai T, et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg (Br), 1995, 77(1): 50-54.
4.	段小军, 尹力, 杨柳, 等. 关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎. 中华骨科杂志, 2013, 33(4): 403-408.
5.	赵宏谋, 俞光荣, 杨云峰. 踝关节骨性关节炎的治疗现状. 中华关节外科杂志 (电子版), 2009, 3(1): 86-89.
6.	Ploegmakers JJ, van Roermund PM, van Melkebeek J, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage, 2005, 13(7): 582-588.
7.	Fragomen AT, Borst E, Schachter L, et al. Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res, 2012, 470(10): 2864-2873.
8.	Ramos T, Ekholm C, Eriksson BI, et al. The Ilizarov external fixator—a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients. BMC Musculoskelet Disord, 2013, 14: 11.
9.	Rodriguez-Collazo ER, Urso ML. Combined use of the Ilizarov method, concentrated bone marrow aspirate (cBMA), and platelet-rich plasma (PRP) to expedite healing of bimalleolar fractures. Strategies Trauma Limb Reconstr, 2015, 10(3): 161-166.
10.	Tellisi N, Fragomen AT, Ilizarov S, et al. Limb salvage reconstruction of the ankle with fusion and simultaneous tibial lengthening using the Ilizarov/Taylor spatial frame. HSS J, 2008, 4(1): 32-42.
11.	Thordarson DB, Markolf K, Cracchiolo A 3rd. Stability of an ankle arthrodesis fixed by cancellous-bone screws compared with that fixed by an external fixator. A biomechanical study. J Bone Joint Surg (Am), 1992, 74(7): 1050-1055.
12.	Hoover JR, Santrock RD, James WC 3rd. Ankle fusion stability: a biomechanical comparison of external versus internal fixation. Orthopedics, 2011, 34(4). doi: 10.3928/01477447-20110228-04.
13.	焦绍锋, 秦泗河, 王振军, 等. Ilizarov 技术治疗四肢畸形并发症分析. 中华骨科杂志, 2012, 32(3): 245-248.
14.	Rozbruch SR. Posttraumatic reconstruction of the ankle using the Ilizarov method. HSS J, 2005, 1(1): 68-88.
15.	Kugan R, Aslam N, Bose D, et al. Outcome of arthrodesis of the hindfoot as a salvage procedure for complex ankle pathology using the Ilizarov technique. Bone Joint J, 2013, 95-B(3): 371-377.
16.	Salem KH, Kinzl L, Schmelz A. Ankle arthrodesis using Ilizarov ring fixators: a review of 22 cases. Foot Ankle Int, 2006, 27(10): 764-770.
17.	Illgner U, Budny T, Frohne I, et al. Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet. BMC Musculoskelet Disord, 2014, 15: 392.
18.	Laporta GA, Nasser EM, Mulhern JL. Tibiocalcaneal arthrodesis in the high-risk foot. J Foot Ankle Surg, 2014, 53(6): 774-786.
19.	Malizos KN, Gougoulias NE, Dailiana ZH, et al. Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique. Strategies Trauma Limb Reconstr, 2008, 3(3): 109-117.
20.	Schuh R, Hofstaetter J, Krismer M, et al. Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome. Int Orthop, 2012, 36(6): 1207-1214.
21.	McCoy TH, Goldman V, Fragomen AT, et al. Circular external fixator-assisted ankle arthrodesis following failed total ankle arthroplasty. Foot Ankle Int, 2012, 33(11): 947-955.
22.	Labek G, Thaler M, Janda W, et al. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg (Br), 2011, 93(3): 293-297.

1. Santos AL, Demange MK, Prado MP, et al. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm. Rev Bras Ortop, 2014, 49(6): 565-572.
2. Rabinovich RV. Complex ankle arthrodesis: Review of the literature. World J Orthop, 2015, 6(8): 602-613.
3. Takakura Y, Tanaka Y, Kumai T, et al. Low tibial osteotomy for osteoarthritis of the ankle. Results of a new operation in 18 patients. J Bone Joint Surg (Br), 1995, 77(1): 50-54.
4. 段小军, 尹力, 杨柳, 等. 关节镜辅助踝关节融合术治疗晚期创伤性踝关节炎. 中华骨科杂志, 2013, 33(4): 403-408.
5. 赵宏谋, 俞光荣, 杨云峰. 踝关节骨性关节炎的治疗现状. 中华关节外科杂志 (电子版), 2009, 3(1): 86-89.
6. Ploegmakers JJ, van Roermund PM, van Melkebeek J, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage, 2005, 13(7): 582-588.
7. Fragomen AT, Borst E, Schachter L, et al. Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res, 2012, 470(10): 2864-2873.
8. Ramos T, Ekholm C, Eriksson BI, et al. The Ilizarov external fixator—a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients. BMC Musculoskelet Disord, 2013, 14: 11.
9. Rodriguez-Collazo ER, Urso ML. Combined use of the Ilizarov method, concentrated bone marrow aspirate (cBMA), and platelet-rich plasma (PRP) to expedite healing of bimalleolar fractures. Strategies Trauma Limb Reconstr, 2015, 10(3): 161-166.
10. Tellisi N, Fragomen AT, Ilizarov S, et al. Limb salvage reconstruction of the ankle with fusion and simultaneous tibial lengthening using the Ilizarov/Taylor spatial frame. HSS J, 2008, 4(1): 32-42.
11. Thordarson DB, Markolf K, Cracchiolo A 3rd. Stability of an ankle arthrodesis fixed by cancellous-bone screws compared with that fixed by an external fixator. A biomechanical study. J Bone Joint Surg (Am), 1992, 74(7): 1050-1055.
12. Hoover JR, Santrock RD, James WC 3rd. Ankle fusion stability: a biomechanical comparison of external versus internal fixation. Orthopedics, 2011, 34(4). doi: 10.3928/01477447-20110228-04.
13. 焦绍锋, 秦泗河, 王振军, 等. Ilizarov 技术治疗四肢畸形并发症分析. 中华骨科杂志, 2012, 32(3): 245-248.
14. Rozbruch SR. Posttraumatic reconstruction of the ankle using the Ilizarov method. HSS J, 2005, 1(1): 68-88.
15. Kugan R, Aslam N, Bose D, et al. Outcome of arthrodesis of the hindfoot as a salvage procedure for complex ankle pathology using the Ilizarov technique. Bone Joint J, 2013, 95-B(3): 371-377.
16. Salem KH, Kinzl L, Schmelz A. Ankle arthrodesis using Ilizarov ring fixators: a review of 22 cases. Foot Ankle Int, 2006, 27(10): 764-770.
17. Illgner U, Budny T, Frohne I, et al. Clinical benefit and improvement of activity level after reconstruction surgery of Charcot feet using external fixation: 24-months results of 292 feet. BMC Musculoskelet Disord, 2014, 15: 392.
18. Laporta GA, Nasser EM, Mulhern JL. Tibiocalcaneal arthrodesis in the high-risk foot. J Foot Ankle Surg, 2014, 53(6): 774-786.
19. Malizos KN, Gougoulias NE, Dailiana ZH, et al. Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique. Strategies Trauma Limb Reconstr, 2008, 3(3): 109-117.
20. Schuh R, Hofstaetter J, Krismer M, et al. Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome. Int Orthop, 2012, 36(6): 1207-1214.
21. McCoy TH, Goldman V, Fragomen AT, et al. Circular external fixator-assisted ankle arthrodesis following failed total ankle arthroplasty. Foot Ankle Int, 2012, 33(11): 947-955.
22. Labek G, Thaler M, Janda W, et al. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg (Br), 2011, 93(3): 293-297.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of Ilizarov external fixation and ankle arthrodesis in treatment of late traumatic ankle arthritis

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