足と足首の臨床研究

抽象的な

Results of Ankle Arthrodesis with Talarlock®-Plate in High Risk Patients

Gutteck N, Schilde S, Delank KS and Wesseler B

Background: The tibiotalar arthrodesis is an established salvage procedure in case of contraindications for ankle replacement. The plate fixation compared to the screw or nail fixation has been more stable in former biomechanical studies. The open or arthroscopic screw arthrodesis and ankle arthrodesis with anterior plates does not lead to advantages for the postoperative treatment. Limitations result out of the immobilization of the lower leg in a plaster in high risk patients.

Methods: In a retrospective study 58 consecutive patients with posterolateral plate arthrodesis of the ankle were included. Clinical and radiological assessments were performed preoperatively, six weeks, three months and one year postoperatively. Patients were prescribed an arthrodesis boot to wear for six weeks and were allowed full weight bearing.

Results: 50% of the patients had a neuromuscular disorder and belonged to a high risk group. AOFAS score improved significantly postoperative. The hind foot axis was corrected to physiological values. No pseudarthrosis occurred in the study. In one patient delayed bone healing was registered without any symptoms. Two patients (3.4%) required revision surgery because of wound healing problems and in two patients a hardware removal was necessary. In three patients a lesion of N. suralis was occurred.

Conclusion: The high rate of patients with neuromuscular disease and polyneuropathy (50%) with postoperaive mobilisation with full weight bearing did not lead to higher complication rate including nonunion.