SLR - September 2023 - Jani
Title: Management of Elderly Traumatic Ankle Arthritis with Ilizarov External FixationReference: Li, J., Wang, W., Yang, H., Li, B. and Liu, L. (2022), Management of Elderly Traumatic Ankle Arthritis with Ilizarov External Fixation. Orthop Surg, 14: 2447-2454. https://doi.org/10.1111/os.13399
Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Neil Jani, DPM
Residency Program: Larkin Community Hospital Palm Springs, Hialeah, FL
Podiatric Relevance: Multi factorial health management is important to the elderly population. Remaining ambulatory provides an increase in daily routine independence as well as an increase in activity with reduced pain. Ankle arthrodesis is the gold standard for management of end stage ankle arthritis and provides an alternative to below the knee amputation in severe ankle pathologies. This method seeks provides surgeons with the option to achieve fixation without internal hardware and minimize soft tissue exposure. This study provides a retrospective analysis of arthrodesis achieved using the Ilizarov method.
Methods: In this clinical study 72 patients with elderly traumatic ankle arthritis were selected. These patients were treated with ankle arthrodesis via Ilizarov external fixation. Ankle radiographs were taken pre and post operatively. The inclusion and criteria for patients selected for the study were; end stage traumatic ankle arthritis, failed conservative treatment and exclusion sion criteria; 60 years or older, unilateral ankle affected, non-infected joint, no systemic illness. Intro-operatively the ankle joint was exposed using an anterior incision. The articulate cartilage and subchondral bone were debrided and a 4x2x1 cm bone block was harvested from distal tibia. The frame was then assembled from tibia to ankle to foot being secured by kirschner wires avoiding delicate structures. The auto genius bone was then squashed and placed back into ankle joint and the frame was fixed at 90 degrees with compression at ankle joint. The Tibiotalar Angle, Visual Analog (VAS) scale and American Orthopaedic Foot and Ankle Society (AOFAS) score were compared statistically.
Results: All 72 of the patients were included in the analysis 38 male and 34 female. Average age of 65.4 years with average of 11.5 years of symptoms. Major co-morbidities seen in selected patients were smoking (566.9%), diabetes mellitus (15.3%), osteomyelitis (26.4%). Radiographic measurement of tibiotalar angle showed a statistically significant difference. Preoperatively 101degrees and postoperatively 94.45%. VAS showed improvement postoperatively as well; 8.56 to 2.72. AOFAS score average pre and post operatively resulted in a statistically significant difference from 45 to 80. Complication during observation; 9 patients developed a pin-tract infection which was controlled with antibiotics and wound care. 7 had radiographic indication of anterior dislocation of talus, which was managed with an adjustment to the external fixator. 5 patients presented with midfoot pain which was controlled with NSAIDS.
Conclusion: This study of ankle arthrodesis using the Ilizarov method provides patients with a pain relief and improves ankle function in patients with end stage ankle arthritis. Post operative AOFAS and VAS scores showed improvement compacted to pre operative scores. This surgery also provides surgeons with a reliable fixation by using dynamic axial compression even if the bone and skin conditions are poor. Complications include pin tract infections and hardware malfunction.