The Journal of Bone and Joint Surgery, Vol 77, Issue 12 1867-1875, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Arthrodesis of the ankle with a free vascularized autogenous bone graft. Reconstruction of segmental loss of bone secondary to osteomyelitis, tumor, or trauma
AT Bishop, MB Wood and KK Sheetz
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Reconstruction after massive loss of bone about the ankle is difficult
because of the limited amount of surrounding soft tissue and because of
technical factors pertaining to adequate internal or external fixation.
Conventional techniques are often unsuccessful because of the frequency of
associated deep infection and of previous operative procedures. In this
report, we describe eleven patients with a large defect of the distal
aspect of the tibia who were managed at our institution with arthrodesis of
the ankle with free vascularized bone graft. The defect was related to a
tumor resection; an acute open fracture with bone and soft-tissue loss
caused by a shotgun injury; or osteomyelitis, either alone or in
combination with septic arthritis, with chronic non-union following a
fracture of the ankle. A free fibular graft was used in osseous defects
that were larger than four centimeters, and a free iliac-crest graft was
used in smaller defects. Osteocutaneous or osteomuscular flaps were
constructed to cover accompanying soft-tissue defects when necessary. A
successful fusion was obtained in nine of the eleven patients. The results
in the remaining two were regarded as clinical failures, and a
below-the-knee amputation was performed. One amputation was done because of
recurrent infection and the other, because of failure of the fracture to
unite after four years.
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