Ankle fusion using a 2-incision, 3-screw technique.

OBJECTIVE: Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique.

INDICATIONS: Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty.

CONTRAINDICATIONS: Active osteomyelitis, very poor soft tissues, or severe peripheral arterial occlusive disease.

SURGICAL TECHNIQUE: Osteotomy and excision medial malleolus. Osteotomy, dislocation, and denudation of the distal fibula. Osteotomy of distal tibia and talus in the desired position for optimal alignment. Temporary tibiotalar fixation with two Weber reposition clamps. Final tibiotalar fixation with a medial and lateral 4.5 mm full threaded cortical lag screw. Reduction of the distal fibula and fibulotibial fixation using a similar technique.

POSTOPERATIVE MANAGEMENT: A nonweight-bearing circular below knee cast for 6 weeks, followed by a walker or weight-bearing cast for another 6 weeks.

RESULTS: A total of 30 ankle fusions in 26 patients were analyzed. Mean age at fusion was 50 years (range 11-72.1 years). Mean follow-up time was 9.2 years (3.4-18.8 years). Radiological and clinical fusion in 28 (93%) of the primary arthrodeses. The mean American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 66 ± 12. Of the 26 patients, 22 (85%) were satisfied. Deep wound infection occurred once (3%). No other serious complications were encountered. The described technique provides reliable long-term follow-up results for a wide range of indications for ankle fusion.