• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.189-194
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• 2014

Purpose: The purpose of this study was to compare the clinical and radiologic results of arthrodesis between anterior approach and transfibular approach arthrodesis in ankle arthritis. Materials and Methods: There were 61 cases of ankle arthritis treated by anterior or transfibular ankle arthrodesis in our hospital from April 2008 to March 2012. We investigated 29 cases (27 patients) who underwent ankle arthrodesis with an anterior approach (15 cases) and transfibular approach (14 cases), and were followed for over two years. Clinically, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analogue scale (VAS), and subjective satisfaction degrees were evaluated. In addition, ankle coronal and sagittal alignments were evaluated using plain radiographs at 6 and 24 months, postoperatively. Results: Clinically, preoperative mean AOFAS score and VAS was 41.3 and 6.4, and were changed to 58.9 and 3.3 postoperatively in the anterior approach group. In the transfibular approach group, preoperative mean AOFAS score was 36.6 and VAS was 7.1, and they were changed to 54.9 and 3.4 postoperatively. However, no significant differences in the clinical results were observed between the two groups (p=0.297). Duration of attaining union was 8.1 weeks in the anterior approach group and 10.4 weeks in the transfibular approach group. Complications were delayed union in one case, nonunion in three cases, cancellous screw breakage in three cases, and complex regional reflex syndrome in one case. Conclusion: After transfibular ankle arthrodesis as treatment of ankle osteoarthritis, the tendency for valgus angulation of the ankle at the final follow-up was observed and 6.5 mm cancellous screw breakage occurred frequently. Therefore, in order to achieve better stability, it is necessary to use 6.5 mm cannulated screws rather than 6.5 mm cancellous screws for ankle arthrodesis.

• Journal of Korean Foot and Ankle Society
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• v.1 no.1
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• pp.15-22
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• 1997

A variety of surgical approach for ankle and tibiotalocalcaneal arthrodesis has been described. We used a transfibular approach between the sural nerve and lateral branch of the superficial peroneal nerve. This permits excellent visualization of the ankle and subtalar joint so that the fusion can readily be achieved under the direct visualization. Eight ankle fusions and four tibiotalocalcaneal fusions were carried out through a transfibular approach and reviewed. The resected fibula was utilized for bone graft. The follow up period was from 12 to 22 months. Ages of the patients ranged from 27 to 58 years. The postoperative regimen was six weeks nonweight bearing in a short leg cast, followed by weight bearing in a short leg cast until union occurred. All cases were fused except one who had preoperative pyogenic arthritis of the ankle and hindfoot. The results were as follows; 1. The chance of incisional neuroma is lessened through incision between the sural nerve and superficial peroneal nerve. 2. The possibility of a skin slough is reduced by using full thickness skin flaps. 3. Excellent visualization of the ankle and subtalar joint is easily achieved. So, we believed that the transfibular approach for ankle and tibiotalocalcaneal arthrodesis is the excellent surgical approach.

• Journal of Korean Foot and Ankle Society
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• v.27 no.4
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• pp.131-136
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• 2023

Purpose: This study compared the clinical and radiology results of arthrodesis between the anterior and transfibular approaches with a lateral malleolar-saving procedure in ankle arthritis. Materials and Methods: This study was a retrospective study of 31 cases who underwent ankle arthrodesis with the anterior approach (14 cases) and trans-fibular approach (17 cases). The remnant lateral malleolus was fixed during the trans-fibular procedure. The patients included 17 females and 14 males with a mean age of 57.2 (range 41~73) years; the mean follow-up was 30.4 (range 15~68) months. The clinical and radiology outcomes, including the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and union time, were recorded. The complications and subjective satisfaction degrees were also recorded and compared between the two groups. Results: Clinically, the preoperative mean AOFAS score and VAS in the anterior approach group were 39.3 and 7.4, respectively, which changed to 61.9 and 3.1 postoperatively. In the trans-fibular approach group, the mean AOFAS score and VAS increased from 36.6 to 64.2 and 7.1 to 2.4, respectively. On the other hand, no significant differences in the clinical results were observed between the two groups. The time to achieve union was 9.2 and 11.6 weeks in the anterior and transfibular approach groups, respectively. Three patients (21%) complained of tenderness and discomfort around the fibular tip in the anterior approach group, and seven patients (41%) showed a gap between the talus and remnant lateral malleolus in the trans-fibular approach group. Conclusion: There was no difference in the clinical and radiological results between the anterior and transfibular approaches with a lateral malleolar saving procedure in ankle arthrodesis. Careful selection of the approach method according to the patient's preoperative condition is needed to prevent remnant discomfort or nonunion around the lateral malleolus.

• Journal of Korean Foot and Ankle Society
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• v.14 no.2
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• pp.135-139
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• 2010

Purpose: We analyse and report the result of transfibular ankle arthrodesis using lateral malleolar saving procedureversus lateral malleolar sacrificing procedure. Materials and Methods: Eighteen cases of transfibular ankle arthrodesis which were performed since 2001 were included. We devided them into lateral malleolar saving and lateral malleolar sacrificing groups. We reattached and fixed lateral malleolus in 10 cases and sacrificed malleolus for morcelized bone graft in 8 cases. We evaluated clinical results by AOFAS ankle-hindfoot score, visual analogue scale (VAS) and radiological results by union time. Complications and subjective satisfaction degrees were also recorded and compared between two groups. Results: Preoperative mean AOFAS score was 32 points (16~41) and VAS was 7.5 points (7~8) and they were changed into 68.6 points (61~77) and 2.8 points (2~4) postoperatively. There was no significant difference in clinical results between the two groups even though lateral malleolar saving group showed higher AOFAS score (69.4) than lateral malleolar sacrificing group (67.7). Duration of getting union was 11.3 weeks in lateral malleolar saving group and 10.6 weeks in lateral malleolar sacrificing group. There was no difference in subjective satisfaction level. There were one delayed union and one nonunion in lateral malleolar sacrificing group and one nonunion in lateral malleolar saving group. Conclusion: There was no difference in clinical and radiological results between lateral malleolar saving group and lateral malleolar sacrificing group of transfibular ankle arthrodesis. Therefore it may not necessary to sacrifice lateral malleolus for bone graft except very selective case for which heavy graft is needed.

• Journal of Korean Foot and Ankle Society
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• v.21 no.3
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• pp.98-103
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• 2017

Purpose: The aim of this study was to analyze the factors related to nonunion in tibiotalar arthrodesis. Materials and Methods: Eighty cases of ankle arthritis treated with tibiotalar arthrodesis in our hospital from November 2008 to November 2015 with more than one year follow up were analyzed. Simple anteroposterior and lateral radiographs after 6 and 12 months of surgery were analyzed. Union was defined as more than 50% connection of the trabecular bone at the ankle joint surface in the anteroposterior and lateral radiographs. The nonunion group was defined as no signs of union with persistent pain 9 months after surgery. The surgical approach, type of used screw, preoperative and postoperative ankle alignment, body mass index (BMI), bone mineral density, and patients' prior history were compared between the two groups. Results: There were 69 union cases and 11 nonunion cases. In the patient factors, the gender and BMI was related to nonunion (p<0.05). The mean preoperative and postoperative ankle alignment in the nonunion group was $9.93^{\circ}{\pm}6.92^{\circ}$ and $5.43^{\circ}{\pm}3.35^{\circ}$ respectively, and $9.80^{\circ}{\pm}7.55^{\circ}$ and $5.63^{\circ}{\pm}3.45^{\circ}$ in the union group, respectively; the difference was not statistically significant (p>0.05). In the technical factors, the transfibular approach showed a better relationship but the association was not significant (p<0.05). In 40 cases of the transfibular approach, 12 cases used cancellous screws, and 4 cases showed nonunion due to screw breakage. Conclusion: Technical factors, such as the surgical approach and the type of screw used can be a risk factor in nonunion. In addition, patients' factors, such as gender and BMI, must be considered to reduce the nonunion rate.

• Journal of Korean Foot and Ankle Society
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• v.12 no.1
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• pp.66-73
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• 2008

Purpose: To report the clinical results of tibio-talo-calcaneal arthrodesis fixed with multiple cannulated screws for the cases of painful ankle and hindfoot arthropathy regardless of any deformity or instability. Materials and Methods: A retrospective analysis was performed upon 10 patients that underwent tibio-talo-calcaneal arthrodesis from October 1999 to May 2006. There were 4 males and 6 females, with an average age of 63 years (43-70). The etioloty of arthrodesis included 5 osteoarthritis, 2 Charcot joints, 1 rheumatoid arthritis, 1 Tbc arthritis and 1 residual poliomyelitis. Chief complaints were pain in 9 cases and instability in 1 case. Three patients had combined severe varus deformity. Tibio-talo-calcaneal arthrodesis using multiple cannulated screws was performed by transfibular approach for all cases and short leg cast was applied for 12 weeks postoperatively. Results: The average follow-up period was 16.5 months (12-26 months). VAS pain score was average 8.2 (7-10) and modified AOFAS score was average 25 (8-40, total 86) preoperatively. At final follow-up, VAS score was average 1.0 (0-3) and AOFAS score improved to average 66 (58-75). There were 4 complications: 2 nonunion, 1 tibia stress fracture and 1 malunion. Seven of 8 patients were satisfied with the results at final follow-up. Conclusion: Fixation with multiple cannulated screws for tibio-talo-calcaneal arthrodesis through transfibular approach is a recommendable surgical option.

• Journal of Korean Foot and Ankle Society
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• v.9 no.1
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• pp.47-51
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• 2005

Purpose: We reviewed the results of ankle arthritis with advanced deformity treated with open arthrodesis. Materials and Methods: Seventeen patients who had painful ankle arthritis with advanced deformity underwent open arthrodesis using chevron osteotomy or transfibular approach and were followed for an average of 4.2 years (range, 1.5 to 9.7 years). The average age was 51.4 years and the most common cause was traumatic arthritis (13 patients). Postoperative outcome was evaluated using Mazur's grading system for ankle function. we also checked time to union, patient satisfaction, complications, position of arthrodesis and degenerative changes of adjacent joints. Results: Clinical score was improved to 76.4 points from 46.7 points. Average time to union was 4.3 months and the rate of satisfaction was 88%. Complications included 1 nonunion, 2 malunion, 1 superficial infection and 1 combined delayed union and malunion. There were 14 cases within $5^{\circ}$ valgus in frontal plane and 13 cases within neutral to $5^{\circ}$ dorsiflexion in sagittal plane. 3 cases in chevron osteotomy revealed valgus and plantarflexed position over $5^{\circ}$. Degenerative changes of adjacent joints was seen in 2 patients. Conclusion: Open arthrodesis for ankle arthritis with advanced deformity shows favorable clinical outcome. Transfibular approach shows more consistent results than chevron soteotomy for desired position of arthrodesis.

• Journal of Korean Foot and Ankle Society
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• v.18 no.4
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• pp.147-152
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• 2014

Ankle arthrodesis has been used as standard treatment of ankle arthritis unresponsive to conservative treatment. Transfibular approach was used for ankles with severe deformities and minimally invasive arthroscopic ankle arthrodesis was used for patients with mild deformities. Anterior approach may be used when lateral approach couldn't be performed. Tibiotalocalcaneal arthrodesis is standard treatment for coexisting ankle and subtalar arthritis, and modified Blair arthrodesis can be used if the talus body resection is necessary in severe talar necrosis. In serious infection of ankle arthritis, arthrodesis can be performed as staged operation. In cases with low bone density and severe deformities, Charcot arthropathy should be considered.