Salvage tibiotarsal arthrodesis with circular external fixator for end-stage posttraumatic ankle arthritis, infection, and bone loss.

Abstract

Background: Chronic posttraumatic sequelae, such as chronic ankle joint infection with loss of the articular cartilage, significant ankle deformities with advanced osteoarthritis, or significant bone loss of the distal tibia or talus, cause chronic ankle pain and functional impairment. Arthrodesis is usually required to relieve pain and improve function. These disabling conditions cannot be treated with ordinary arthrodesis methods, particularly if they are associated with severe osteoporosis and/or poor soft-tissue coverage. The present study aimed to report the outcomes and complications of ankle arthrodesis with circular external fixators in patients with end-stage, posttraumatic ankle arthritis, infection, and/or bone loss.

Methods: Patients treated with tibiotalar and tibiocalcaneal fusion for posttraumatic sequelae using the circular external fixator between January 2001 and January 2022 were retrospectively reviewed. The outcomes were evaluated using the Catagni tibiotarsal fusion score, and the complications were recorded.

Results: The study included 81 consecutive patients; 58 were males, and 23 were females. The mean age of the patients was 41.52 years (range, 18-75). Successful arthrodesis was obtained in 73 patients (90.1 %). Twenty-four patients (29.6 %) developed complications. Most complications were minor except for unacceptable deformity in four patients, refracture of the arthrodesis site in one patient, and failure of arthrodesis in seven patients. At the final evaluation, the mean Catagni Score was 85.4 (range, 52-96). Fifty-eight patients achieved excellent results, 13 patients achieved good results, two patients achieved fair results, and eight patients achieved poor results. Higher Catagni scores were associated with patients without pre-operative infection, with union, without unplanned additional surgical procedures, without complications, and with better final results (all p < 0.001). In the multivariate regression analyses, we observed that the Catagni score tends to decrease as patient age increases (p = 0.010). Catagni scores of the anterior arthrodesis position were higher than the cases of the sinus tarsi position (p < 0.001).

Conclusion: Tibiotarsal arthrodesis with the circular external fixator can effectively treat complex ankle joint problems resulting from severe injuries. The Catagni score is a simple and reliable evaluation score after tibiotarsal arthrodesis surgeries.