Open ankle fusion

The term "arthrodesis" means a surgical procedure characterized by the fusion between two articular surfaces of a joint, practically obtaining a surgical ankylosis. It was used by Albert in 1879. The main indications for an ankle fusion are represented by serious neurological disorders, severe instability and, above all, by severe osteoarthritis of the joint, both primary and, much more frequently, secondary, especially post-traumatic and in recent years, ankle arthrodesis has seen its indications broaden also to cases of prostheses failure. Regarding the end-stage osteoarthritis, in the literature, the discussion between the choice of an arthrodesis and a total ankle replacement is still open, considering that in recent years ankle prostheses have undergone a marked increase in reliability. The results reported in the literature for ankle fusion seem satisfactory in rates ranging from 80 to even 100% of cases especially in terms of pain reduction, plantar loading, foot stability, walking quality and patient satisfaction. Generally speaking about ankle fusion, all authors agree that good results can be achieved if two main conditions are fulfilled: The fusion and the optimal foot position. The prerequisites for achieving bone fusion are represented by a stable fixation, possibly in compression. The surgical approaches, the choice of which is often conditioned by the planning of each individual case, can be: Anterior (or antero-lateral), posterior, medial, lateral, or combined (lateral and antero-medial). The approach is chosen according to the characteristics of the single case and, when possible, the preferred choice by the authors is the lateral trans-fibular approach. Compression screws are the main choice of the author who reserves the use of the plates for very particular cases because should be noted that with some types of plates it is not possible to have good compression at the level of the arthrodesis interface. When an ankle arthrodesis is indicated, it is mandatory not only to evaluate the sovrasegmentary or foot joints, but also any deformities of the foot. For these reasons it is always necessary to evaluate the need of combined surgery. In the end-stage of ankle osteoarthritis, arthrodesis is still considered an effective surgical solution in the right indications in relation to the alternative surgery represented by arthroplasty. In all cases the operation is performed with the aim of relieving the pain, stabilizing the ankle and of the whole lower limb, and finally recovering an acceptable functional capability in carrying out common daily and work activities.