The Journal of Bone and Joint Surgery (American). 2005;87:302-309.
doi:10.2106/JBJS.C.01421
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Foot/Ankle Test 6: Spring 2005
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Treatment of Malunion and Nonunion at the Site of an Ankle Fusion with the Ilizarov Apparatus

Dimitris Katsenis, MD1, Anil Bhave, PT1, Dror Paley, MD1 and John E. Herzenberg, MD1

1 International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for D. Paley: dpaley{at}lifebridgehealth.org

Investigation performed at the International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, Maryland

video supplement to this article is available from the1 Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Smith and Nephew) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Malunion and nonunion of an ankle fusion site are associated with pain, osteomyelitis, limb-length discrepancy, and deformity. The Ilizarov reconstruction has been used to treat these challenging problems.

Methods: We reviewed the results in twenty-one ankles that had undergone a revision of a failed fusion, with simultaneous treatment of coexisting pathologic conditions, with use of the Ilizarov technique. Eight patients had undergone ankle fusion only, eleven had undergone ankle and subtalar fusion, and two had undergone pantalar fusion. Eighteen patients with an average limb-length discrepancy of 4 cm underwent limb lengthening simultaneously with the revision surgery. The average patient age was forty years. Indications for treatment were malunion (eleven patients), aseptic nonunion (eight patients), and infected nonunion (two patients). Clinical, subjective, objective, gait, and radiographic analyses were performed after an average duration of follow-up of 83.4 months.

Results: Solid union was achieved in all ankles. The functional result was excellent for fifteen patients, good for three, fair for two, and poor for one. The bone result was excellent for ten ankles, good for nine, fair for one, and poor for one. All eighteen patients who underwent gait analysis had a heel-to-toe progression gait, and twelve achieved normal walking velocity with their shoes on. A plantigrade foot was achieved in each case, and only two patients had >5° of residual deformity. During the Ilizarov treatment, forty-one minor complications (treated conservatively) and twenty major complications (treated surgically) occurred. After removal of the circular frame, seven other complications, which required four additional operations, occurred.

Conclusions: In patients with a failed ankle fusion, infection, limb-length discrepancy, and foot deformity can be addressed simultaneously with use of the Ilizarov apparatus to achieve a solid union and a plantigrade foot, usually with a clinically satisfactory result.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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