Outcome of ankle arthrodesis performed by dowel technique in patients withrheumatic disease

Between the years 1988 and 1994, 19 ankle arthrodeses were performed on 18 patients (nine men) using the dowel technique. Patients were followed until a fusion had occurred, a non-union was successfully rearthrodesed, or a ps eudoarthrosis was stabilized with orthosis treatment. Patients' radiographs and documents were analyzed both preoperatively and during the healing per iod. Subtalar fusion had been performed previously in eight ankles and rheu matoid destruction of subtalar complex was observed in seven other hindfeet . The original dowel method was used in 13 ankles and a modified procedure was performed in six. Local bone grafts were utilized. Solid fusion was ach ieved in 13 ankles (68%), but with delayed union in two cases. Non-union wa s present in six ankles, and two re-arthrodeses were performed with success ful fusion in the other. Orthosis treatment was necessary in three of five ankles with permanent non-union. One chronic infection leading to non-union was detected. Only two of the six ankles (33%) with the modified technique using additional exposures heated without complications. In the dowel tech nique, the preoperative position of the ankle and location of the guiding K irschner wire are of crucial importance and the original technique with a l arge cutter should be used. In patients with rheumatic disease, this fusion method did not yield acceptable results.