REVISION ANKLE FUSION USING INTERNAL COMPRESSION ARTHRODESIS WITH SCREW FIXATION

We reviewed 20 revision ankle fusions performed using internal compres sion arthrodesis with screw fixation, Clinical, functional, and radiog raphic results were measured at an average follow-up of 30 months (ran ge, 12-50 months), The reasons for the index procedures were nonunion in 11, malunion in 7, infected nonunion in 1, and nonunion associated with avascular necrosis of the talus in 1 case. Fusion occurred in 15 of 20 patients, Two additional patients obtained fusion after subseque nt procedures, for a final union rate of 85%. The average time to fusi on was 6 months (range, 2-32 months), Nineteen additional operations w ere necessary in 12 patients, including three amputations for chronic infection (two infected nonunions and one chronic osteomyelitis). All but one patient had a plantigrade limb at follow-up. Seventeen of 20 p atients were satisfied with their ultimate outcome, including all thre e patients with amputations, The three dissatisfied patients were both ered by chronic pain. Revision ankle fusion for nonunion or malunion u sing internal compression arthrodesis with screw fixation is beneficia l for most patients, It is a technically demanding procedure that is a ssociated with a high complication rate, Many patients can be expected to have residual pain, We emphasize the need for accurate alignment a nd early, aggressive treatment of infectious complications. Amputation should be considered a viable option to improve functional outcome in patients with solid, well-aligned fusions who are disabled by severe chronic pain.