Arthrodesis of the infected ankle and subtalar joint: Technique, indications, and results of 45 consecutive cases

Objective: To analyze the results of 45 patients after ankle arthrodesis in the presence of joint infection. Methods: Arthrodesis was performed with two compression screws and an anter ior plate in 29 patients and with two compression screws only in 16 patient s, In all patients, additional stabilization with external fixation was use d. In 29 patients, isolated fusion of the ankle joint was performed; in 13 patients, the ankle and subtalar joints were fused, and in 3 patients, isol ated arthrodesis of the subtalar joint was performed. Results: In 39 of 45 patients (86.6%), solid fusion was obtained. Nonunions occurred in 6 patients (13.4%). A below-knee amputation was necessary for one patient. Full weight-hearing was achieved after 21.6 weeks on average. Thirty-two patients returned to work after 35.5 weeks on average. Five of t he six patients with failed ankle fusion needed special shoes; in one patie nt, a below-knee amputation was performed, A total of 33.3% of failed ankle Fusions were associated with systemic disorders such as diabetes mellitus, and other concomitant diseases compromising local arterial blood supply an d proprioception. Conclusion: Our results prove that limb salvage is possible even in complex ankle and subtalar pathology by thorough fusion by using a number of diffe rent techniques.