Distraction Osteogenesis Followed Arthrodesis Using Internal Fixation As A Surgical Option For Complex Pathologic Conditions Of The Ankle

Aims: The purpose of this study was to present the technique of bone transport followed arthrodesis using internal fixation to treat complex pathologic conditions of the ankle joint such as infection,trauma,and tumor,and to present the preliminary results of this technique.Patients and methods: Between 2004 and 2014,bone transport followed by arthrodesis using internal fixation was carried out in 17 patients with complex pathologic conditions of the ankle joint including infection,traumatic bone or soft tissues loss,and primary distal tibial sarcomas.The patients included 12 men and 5 women with an average age of 30(10 to51)years at the time of surgery.Bone healing and functional recovery were evaluated according to the criteria described by Paley.Functional outcomes were also measured using the ankle–hindfoot scale of the American Orthopedic Foot and Ankle Society(AOFAS).For patients with distal tibial sarcomas,functional results were also evaluated using Musculoskeletal Tumour Society score.Results: A solid fusion of the ankle joint and complete eradication of infection was achieved in all patients.A mean lengthening of 7.8(2.5 to 14)cm was achieved.The mean external fixation index(EFI)was 38(22.8 to 58)days/cm.Functional results were judged excellent in 10 patients and good in the remaining 5patients.Bone results were graded as excellent in 14 cases and good in 3 cases.The mean AOFASscore was 37.3(5 to 77)pre-operatively and 75.3(61 to 82)at the final follow-up.The mean functional score according to the rating system of the Musculoskeletal Tumour Society was 88%(83–90%)in patients with bone tumor.Minor complications(treated conservatively)included pain,pin tract infection,loosening of wires,and midfoot stiffness.Major complications(treated surgically)included grade V(inflamed with osteolysis)pin traction infection,poor consolidation of the regenerate bone,and soft tissue invagination and local recurrence of sarcoma.The re-operations required to treat the major complications included pins and wires exchanges,bone grafting,invagination split surgery and belowknee amputation.Conclusion: The technique of bone transport followed by arthrodesis using internal fixation is an fierce alternative method for the treatment of complex pathologic conditions of the ankle.This technique can provide a very high rate of bony union,effectively eliminate infective or tumor lesion,and reduce the duration of external fixation.