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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 3, 361-366.
doi: 10.1302/0301-620X.91B3.20935  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Ankle fusion for bone loss around the ankle joint using the Ilizarov technique

C. C. Kovoor, DOrth, DNB(Orth), Consultant Orthopaedic Surgeon1; V. Padmanabhan, DOrth, DNB(Orth), Registrar1; D. Bhaskar, MS(Orth), MRCS(Ed), Staff Grade Surgeon2; V. V. George, MS(Orth), Consultant Orthopaedic Surgeon3; and S. Viswanath, DOrth, Registrar1

1 Specialist Hospital, Eranakulam Kochi, Kerala, India 682018.
2 Department of Trauma and Orthopaedics Dewsbury and District Hospital, 107 Broomer Street, Ravensthorpe, Dewsbury, West Yorkshire WF13 3DF, UK.
3 Eranakulam Medical Centre, By-Pass, Palarivattom, Kochi-682028, India.

Correspondence should be sent to Dr C. C. Kovoor; e-mail: kovoor63{at}gmail.com

We present the results of ankle fusion using the Ilizarov technique for bone loss around the ankle in 20 patients. All except one had sustained post-traumatic bone loss. Infection was present in 17. The mean age was 33.1 years (7 to 71). The mean size of the defect was 3.98 cm (1.5 to 12) and associated limb shortening before the index procedure varied from 1 cm to 5 cm. The mean time in the external fixator was 335 days (42 to 870). Tibiotalar fusion was performed in 19 patients and tibiocalcaneal fusion in one. Associated problems included diabetes in one patient, pelvic and urethral injury in one, visual injury in one patient and ipsilateral tibial fracture in five. At the final mean follow-up of 51.55 months (24 to 121) fusion had been achieved in 19 of 20 patients. A total of 16 patients were able to return to work. The results were graded as good in 11 patients, fair in six and poor in three. The mean external fixation index was 8.8 days/mm (0 to 30). One patient with diabetes developed severe infection which required early removal of the fixator. Refractures occurred in three patients, two of which were at the site of fusion and one at a previous tibial shaft fracture site. Equinus deformity of the ankle fusion occurred after a further fracture in one patient. There were two patients with residual forefoot equinus, and one developed late valgus at the fusion site.

Poor consolidation of the regenerated bone in two patients was treated by bone grafting in one and by bone and fibular strut grafting in the other. Residual soft-tissue infection was still present in two patients.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General