Risk factors for delayed and non-union following transfibular ankle arthrodesis

Authors

  • Hyeon Soo Kim Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
  • Sung Jin Shin Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
  • Jin Woo Kim Department of Orthopaedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20210526

Keywords:

Delayed union, Non-union, Transfibular ankle arthrodesis

Abstract

Background: This study was to identify risk factors associated with delayed union and non-union in patients who underwent transfibular ankle arthrodesis.

Methods: This study included 43 patients who underwent ankle arthrodesis using transfibular approach between January 2012 and September 2018 and were followed up for more than 12 months. The patients were divided into two groups according to delayed union or non-union. Group A included patients who had delayed union or non-union and Group B included patients without these complications. Variables that could contribute to non-union including etiologies, age, chronic renal failure, hypertension, diabetes, smoking, pre-operative talus bone quality, pre-operative angulation of the talus and fixation methods were evaluated.

Results: The mean time to bone union was 12.7±7.25 weeks. Group A included 12 patients with 5 cases of non-union and 7 cases of delayed union and group B included 31 patients. Infection of the ankle joint (OR, 1.73; p=0.041) was risk factor for non-union and delayed union on the basis of multivariate analysis.

Conclusions: We concluded that infection of the ankle joint is the most significant risk factor for delayed union and nonunion in our study. Careful attention should be paid preoperatively, intraoperatively and postoperatively to patients who have this risk factor to obtain a satisfactory surgical outcome.

References

Kim JG, Ha DJ, Gwak HC, Kin CW, Kim JH, Lee SJ et al. Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach. Clin Orthop Surg. 2018;10:368-73.

Lee DY, Kyung MG, Cho YJ, Hwang S, Kang HW, Lee DO. A modified transfibular technique of anke arthrodesis using partial fibular resection and onlay bone graft. PLos One. 2020;15(10):e0241141.

Yasui Y, Hannon CP, Seow D, Kennedy JG. Ankle arthrodesis: A systematic approach and review of the literature. World J Orthop. 2016;7:700-8.

Horwitz T. The use of the transfibular approach in the arthrodesis of the ankle. Am J Surg. 1942;55:550-52.

Sung W, Greenhagen RM, Hobizal KB, Burns PR, Wukich DK. Technical guide: transfibular ankle arthrodesis with fibular-onlay strut graft. J Foot Ankle Surg. 2010;49:566-70.

Lee HJ, Min WK, Kim JS, Yoon SD, Kim DH. Transfibular ankle arthrodesis using burring, curettage, multiple drilling, and fixation with two retrograde screws through a single lateral incision. J Orthop Surg (Hong Kong). 2016;24:101-5.

Mann RA, Van Manen JW, Wapner K, Martin J. Ankle fusion. Clin Orthop Relat Res. 1991;268:49-55.

Quayle J, Shafafy R, Khan MA, Ghosh K, Sakellarious A, Gougoulias N. Arthroscopic versus open ankle arthrodesis. Foot Ankle Surg. 2018;24:137-42.

Thevendran G, Younger A, Pinney S. Current concepts review: risk factors for nonunions in foot and ankle arthrodesis. Foot Ankle Int. 2012;33(11):1031-40.

Thevendran G. Shah K, Pinney SJ, Younger AS. Perceived risks factors for nonunions following foot and ankle arthrodesis. J Orthop Surg (Hong Kong). 2017;25(1)2309499017692703.

Alonso-Vazquez A, Lauge-Pedersen H, Lidgren L, Talylor M. The effect of bone quality on the stability of ankle arthrodesis. A finite element study. Foot Ankle Int. 2004;25:840-50.

Stapleton JJ, Zgonis T. Concomitant osteomyelitis and avascular necrosis of the talus treated with talectomy and tibiocalcaneal arthrodesis. Clin Podiatr Med Surg. 2013;30:251-6.

Moore J, Berberian WS, Lee M. An analysis of 2 fusion methods for the treatment of osteomyelitis following fractures about the ankle. Foot Ankle Int. 2015;36:547-55.

Downloads

Published

2021-02-23

Issue

Section

Original Research Articles