In ankle arthrodeses several clinical and biomechanical studies have s
hown the superiority of the screw technique over external fixation. As
a maximum of stability is a major goal, especially for functional aft
er-treatment or in patients with poor bone stock, the arthrodeses tech
nique at Hannover Medical School is performed with four screws. Two pa
rallel anterior/posterior screws are placed from the tibia to the talu
s, providing anterior stabilization. One screw posterio-medial has a p
osterior tension-wiring effect and one screw placed through the fibula
to the talus acts against rotational and sagittal translation. From M
ay 1975 to May 1995, 225 ankle arthrodeses with internal or external f
ixation technique were performed. Complications were found in 47% in t
he external fixation treatment group (n = 44) and in 10% the patients
stabilized with the screw technique (n = 181). Fifty of these 225 pati
ents had a follow-up evaluation after an average of 7.4 years (externa
l fixation, n = 22; screw fixation, n = 28). All patients were examine
d and scored with three different scoring systems: (1) MHH Score, (2)
Clinical Rating System according to Kitaoka et al. (1994) and (3) Outc
ome Questionnaire for evaluating the overall outcome. The results from
the questionnaire were compared to the clinical scores. Retrospective
analysis revealed a higher rate of complications for arthrodeses perf
ormed by external fixation. The overall results of all three different
scoring systems showed a trend in favor of the screw-fixation techniq
ue without reaching statistical significance (P > 0.05). The results o
f the Outcome Questionnaire are statistically as valid as the two clin
ical scoring systems.