Ankle Arthrodesis Using Combined Internal and External Fixation: Outcomes in High-risk Patients

Average follow-up of these patients was 2 years.The etiology of all cases was recorded.Our study includes age-group from 26 to 72 years, with a mean age of 48.25.Out of this, there were 16 males and 8 females (Fig. 1).Inclusion criteria included end-stage tibiotalar arthritis due to posttrauma with poor soft tissue cover over the heel, infection following fixation of ankle with arthritis, and ankle fusion with TTF nail with infection (Fig. 2).Patients were above 18 years of age.Exclusion criteria included associated arthritis of other joints of the foot.Patients were evaluated with anteroposterior and lateral radiographs of the ankle joint.Associated investigations pertaining to the infection were worked up.Out of 24 patients, 16 patients had postfixation ankle arthritis with infection, 6 patients had poor heel pad soft tissue condition following trauma, and 2 patients had acute infection following fusion with TTF nail. IntroductIonIncidence of ankle arthritis is 1% of population or 2-4% of total osteoarthritis.1,2 Ankle arthritis occurs at a relatively younger age compared to other joint arthritis.The most common cause includes post-traumatic etiology.Other causes include postinfection, inflammatory, and idiopathic.Tibiotalar arthrodesis is considered to be the gold standard in the management of end-stage ankle osteoarthritis.The procedure was first described by Edward Albert in 1879 and modified by John Charnley with an external fixator.Currently, there are more than 40 different techniques described in literature for ankle arthrodesis which include open procedures using various approaches with external or internal fixation systems to arthroscopic ankle fusion.Tibiotalocalcaneal (TTC) nail is the preferred choice of implant for ankle fusion as it has excellent results in literature.However, certain high-risk patients with multiple comorbidities present with tibiotalar arthritis following fixation of tibial plafond with infection, poor soft tissue covers around the heel, or fixation failure with infection following TTC nailing for tibiotalar fusion (TTF).We present our clinical experience using combined internal and external fixation for tibiotalar arthrodesis.This hybrid approach was utilized to mitigate the high risks associated with TTC nailing, specifically regarding surgical site infections, the potential for osteomyelitis, and significant soft tissue compromise in high-risk patients. MaterIals a n d MethodsA retrospective analysis of our data identified 24 cases of ankle arthrodesis for high-risk patients performed during the time period of 2020-2024 at Dr. Muthus Superspeciality Ortho Hospital, Coimbatore.