Retrospective and prospective analysis of functional outcome following various modalities of ankle fusion

Vignesh, P S (2018) Retrospective and prospective analysis of functional outcome following various modalities of ankle fusion. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: The Ankle is a hinge type of joint. It consists of distal tibia, distal fibula and talus which articulates with each other. The lateral circumference of the talar dome is larger than the medial circumference. The dome is wider anteriorly than posteriorly. The syndesmotic ligaments allow widening of the joint with dorsiflexion of the ankle, into a stable, close-packed position. In tibiotalar joint there is continuous change in axis of rotation during walking, but fixation in neutral position does not produce any severe biomechanical consequences in the limb. Talus is surrounded by medial malleolus, tibial plafond and lateral malleolus, all of which provide potential bone surfaces for healing of arthrodesis. Arthrodesis is a term derived from the latin word “arthron” meaning joint and the Greek word “Desis” meaning binding. Ankle Arthrodesis is a surgical procedure wherein the arthritic ankle joint gets converted into an immobile bone segment. This provides a painless, plantigrade stable foot. Wu and his colleagues found that after an ankle fusion, the sagittal plane motion of forefoot and the transverse plane motion of the rearfoot increased. A growing population with ankle arthritis has led to the imperative need for effective ankle reconstruction surgeries. Ankle arthrodesis, which accounts for more than 85% of ankle surgeries , has been reported to be an effective surgery for pain relief and retaining plantigrade foot function. Ankle arthrodesis fixation techniques includes cross screw, external fixation, intramedullary nailing and plating. The most commonly used construct of ankle arthrodesis fixation is by using 2 or more internal fixation screws. The end result of ankle arthrodesis should be a well aligned ankle joint with foot at a 90 degree to leg. A well positioned ankle fusion can be very helpful in alleviating pain, correcting the deformity, as well as restoring a functional limb. In extra articular arthrodesis the joint surface is not prepared, so it depends on osteoconduction along a bone graft. It is not usually useful in foot and ankle surgery, except in paediatric cases. In Intra articular arthrodesis all cartilage is denuded and primary bone healing proceeds between the two opposed cancellous surfaces. Dowel grafting is a technique where only part of joint surface is prepared and union is attempted by osteoconduction along an interposed bone graft. AIM OF THE STUDY: To study the Functional and Radiological outcome following various modalities of ankle fusion. METHODS: Twenty one patients who presented with arthritic changes in the ankle joint to our institute of Orthopaedics and Traumatology during the period of 2015-2017 are studied retrospectively and prospectively. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used for ankle evaluation. All patients are taken radiographs of Ankle both Antero-posterior, lateral and Mortise views. Xray Foot AP and Lateral views. INCLUSION CRITERIA: • Post traumatic Arthritis. • AVN Talus. • Post Infective Sequelae of Ankle Joint. • Paralytic Deformities. • Rheumatoid Arthritis. • Charcot’s Arthropathy EXCLUSION CRITERIA: • Uncontrolled Diabetes Mellitus. • Vascular TAO. • Children. RESULTS: The Common Age Group who presents in this study belong to 46-60yrs (53%). The most common cause in our study is post traumatic arthritis (76%). Time taken for fusion in most patients are 6 weeks (48%) followed by 8weeks(33%). Out of 21 patients, fracture united in 20 patients, malunited 1 in patients. The most common method of fixation is cancellous screw fixation (53%). CONCLUSIONS: Cancellous screw fixation is the most common method of arthrodesis which provides best result in terms of function and union. Intramedullary nailing is suitable for treatment of charcot’s arthropathy. External fixator s useful in compound fractures.

Item Type: Thesis (Masters)
Uncontrolled Keywords: arthrodesis ; cancellous screw ; intramedullary nailing.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Jul 2018 01:16
Last Modified: 14 Jul 2018 01:23

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