Salvage of Complex Ankle Arthropathy and Injury of the Tibial Plafond Utilizing a Posterior Locked Plating Arthrodesis Construct

A technique for salvage of complex ankle pathology utilizing a posterior approach and application of locked-plate fixation is described. An adaptation of a proximal humeral locking plate (Synthes, Paoli PA) is recommended as the principal form of fixation. Indications for this type of arthrodesis include arthropathy of the ankle (or ankle and subtalar joints) complicated by associated structural defects and/or nonunion. Preliminary results of 15 patients treated with this technique are presented with an average follow-up of 5.8 months (maximum 13 months): 8 tibiotalar, 5 tibiotalocalcaneal, and 2 pantalar fusions were performed with this technique. Autogenous posterior iliac crest bone grafting was performed in all cases. Healing of metaphyseal defects, nonunion sites, and radiographic incorporation of the proposed arthrodesis site(s) has been demonstrated in all patients to date. No failures of the posterior locked fixation construct have been identified. Although several minor complications are reported, initial results have yielded salvage in all cases with no deep infections or amputations. Despite the nature and degree of preoperative deformity, bone defects, or instability, a plantigrade foot position was achieved in all cases without clinically significant malpositioning. An extensile trans-Achilles approach allows for bone grafting and repair of metaphyseal defects and nonunions with concomitant arthrodesis of the ankle. The technique affords considerable flexibility, allowing the subtalar joint to be included in the proposed arthrodesis or spared, depending on the clinical situation. With multiple points of fixed-angle fixation, locked-plate fixation provides a rigid construct for arthrodesis stabilization, even in the face of bone defects and osteopenic bone.