Ankle arthrodesis

Question 1

What are the indications for ankle athrodesis?

Answer 1

• Painful arthritis following
  
  • Infection
  • trauma
  • chronic instability
  • AVN of talus
  • Inflammatory arthopathy
  • primary OA
• Neuropathic arthropathy
• Tumour resection
• Salvage for failed ORIF

Question 2

What is the technique for ankle arthrodesis?

Answer 2

• Optimal position
  
  • Neutral Dorsiflexion
  • 5-10^o external rotation
  • 5^o hindfoot valgus
• Arthroscopic- only if minimal deformity present
• Open
  
  • Transfibular approach- remove distal 5cm and use as bone graft
  • screw fixation
  • plate and screw construct

Question 3

What is the technique for tibiotalocalcaneal fusion?

Answer 3

• Open technique
  
  • Transfibular approach
  • use retrograde nail after 2.5mm wire fixation
  • Must be in middle of calcaneus which pushes you lateral on the tibia otherwise if just aim fo rmiddle of tibia will be too lateral in calcaneus and blow it apart. Use wire on lateral side of tibia/ calcaneus to prevent you aiming too lateral.
  • Ream to 11.5 and put 11 mm nail in to test
  • Then back to transfibular approach- remove 5cm distal fibular
  • use as bone graft
  • Use Laminar spreaders to aid visualisation of the ankle and subtalar joint- go in at sinuys tarsi
  • Using burr- take of cartilage to ankle and subtalar joint
  • pack with bone graft
  • then drive nail up
  • sequre screw- 2 lateral tibia, one calcanueus and set screw in nail

Question 4

What are the complications of ankle arhrodesis?