Ilizarov Ankle Arthrodesis provides stable fixation and early healing of fusion site: study

The retrospective study by Ajit Chalak found that - the Ilizarov fixator for ankle arthrodesis provides an excellent way for strong bone fusion, infection eradication, early weight-bearing and the added benefits of compression at the arthrodesis site post-operatively.

Infection around the ankle joint after fracture fixation, or septic arthritis with active discharging sinuses is often challenging to manage with conventional procedures of arthrodesis. The Ilizarov method of arthrodesis gives a better alternative for salvage in such cases. The Ilizarov device is a flexible external fixator that permits dynamic and multidirectional stresses to be applied. The ability to alter the alignment of the hindfoot and forefoot after the surgery by repositioning the frame as required is a distinct benefit of the Ilizarov technique, allowing for the rectification of intraoperative errors or early postoperative loss of position. These advantages significantly improve the outcome of the surgery and are quite helpful in the correction of malalignment, providing an improved level of activity, and pain management.

Ajit Chalak et al conducted a retrospective study including 20 patients who were subjected to tibiotalar arthrodesis with Ilizarov method. The major pathologies included internal fixation of ankle fractures complicated by infection, posttraumatic infected ankle arthritis, and osteomyelitis. The patients were evaluated on the basis of Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. The aim of the surgery was to achieve plantigrade, stable, and painless foot with no signs of infection.

The results of the study were:

• A total of 20 patients were operated and reviewed at the institute.

• The study comprised of 15 male and 5 female patients with a mean age of 43.9 years (range 33–55 years).

• The external fixation time averaged 22.9 (range 18–34) weeks.

• The average period of follow-up for all patients was 39.4 (26–50) months.

• Out of 20 patients, 4 patients had complications of pin-tract infection and one had wire breakage of the forefoot ring.

• The average postoperative limb length discrepancy (LLD) was 1.9 cm (range 1–2.5 cm) and all the patients were given an appropriately sized shoe raise as none of the patients opted for bone lengthening.

• According to the ASAMI criteria, 17 patients had excellent bone scores and 18 patients had good functional scores.

The authors concluded that - Ilizarov fixator should be considered as an important tool for arthrodesis in failed ankle fractures, Charcot joint, and arthritis of ankle joint especially in presence of infection when the other methods of internal fixation are difficult to consider. Ilizarov ring fixator has an advantage over the other external fixators for better control of axial and torsional forces, better hold in osteoporotic bones, and hence providing stable fixation which would aid in early healing of fusion site.

Further reading:

Ilizarov Ankle Arthrodesis: A Simple Salvage Solution for Failed and Neglected Ankle Fractures

Ajit Chalak, Sushmit Singh et al

Indian Journal of Orthopaedics (2022) 56:1587–1593

https://doi.org/10.1007/s43465-022-00669-6