Original Research| Volume 49, ISSUE 6, P508-512, November 2010

Outcome of Ankle Arthrodesis Using a Transfibular Approach

Published:September 20, 2010DOI:


      Variable union rates in ankle arthrodesis using different surgical techniques have been reported in the biomedical literature. However, the advantages of a transfibular approach with sagittal splitting of the fibula have not been widely reported, even though the technique is well known and even described in surgical textbooks. We analyzed outcomes in our practice for all patients who underwent ankle arthrodesis. Over a 5-year period, 2 surgeons using the same transfibular approach performed 26 ankle arthrodeses in 25 patients. The medical records and radiographs of the patients were reviewed for duration of hospital admission, time to union, and complications. All (100%) of the ankle fusions progressed to solid union in a mean postoperative duration of 4.5 ± 1.8 months (range, 2-10 months), and the only clinically significant complication involved 1 patient with suspected complex regional pain syndrome, who responded to treatment and recovered fully.

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        • Coester L.M.
        • Saltzman C.L.
        • Leupold J.
        • Pontarelli W.
        Long-term results following ankle arthrodesis for post-traumatic arthritis.
        J Bone Joint Surg (Am). 2001; 83-A: 219-228
        • Rowan R.
        • Davey K.J.
        Ankle arthrodesis using an anterior AO T plate.
        J Bone Joint Surg (Br). 1999; 81-B: 113-116
        • Scranton P.E.
        An overview of ankle arthrodesis.
        Clin Orthop. 1991; 168: 96-101
        • Albert E.
        Zur Resektion des Kniegelenkes.
        Wien Med Press. 1879; 20: 705-708
        • Feihel R.J.
        • Uhthoff H.K.
        Primary Ilizarov ankle fusion for nonreconstructable tibial plafond fractures.
        Oper Orthop Traumatol. 2005; 17: 457-480
        • Braly W.G.
        • Baker J.K.
        • Tullos H.S.
        Arthrodesis of the ankle with lateral plating.
        Foot Ankle Int. 1994; 15: 649-653
        • Horwitz T.
        The use of the transfibular approach in arthrodesis of the ankle joint.
        Am J Surg. 1942; 60: 550-552
        • Adams J.C.
        Arthrodesis of the ankle joint: experiences with the transfibular approach.
        J Bone Joint Surg (Br). 1948; 30-B: 506-511
        • Verhelst M.P.
        • Mulier J.C.
        • Hoogmartens M.J.
        • Spaas F.
        Arthrodesis of the ankle joint with complete removal of the distal part of the fibula: experience with the transfibular approach and three different types of fixation.
        Clin Orthop Relat Res. 1976; 118: 93-99
      1. Canale T (ed). Campbell’s Operative Orthopaedics, 10th ed, vol. 1, p 155, 2002, Mosby-Elsevier, Philadelphia, 2002.

        • Ogilvie-Harris D.J.
        • Fitsialos D.
        • Hedman T.P.
        Arthrodesis of the ankle. A comparison of two versus three screw fixation in a crossed configuration.
        Clin Orthop Relat Res. 1994; 304: 195-199
        • Bennet G.L.
        • Cameron B.
        • Njus G.
        • Saunders M.
        • Kay D.B.
        Tibiotalocalcaneal arthrodesis: a biomechanical assessment of stability.
        Foot Ankle Int. 2005; 26: 530-536
        • Brodsky A.R.
        • Bohne W.H.
        • Huffard B.
        • Kennedy J.G.
        An analysis of talar surface area occupied by screw fixation in ankle fusions.
        Foot Ankle Int. 2006; 27: 53-55
        • Wang G.
        • Shen W.
        • McLaughlin R.E.
        • Stamp W.G.
        Transfibular compression arthrodesis of the ankle joint.
        Clin Orthop Relat Res. 1993; 289: 223-227
        • Muckley T.
        • Hofmann G.
        • Buhren V.
        Tibiotalar arthrodesis with the tibial compression nail.
        Oper Orthop Traumatol. 2005; 17: 407-425
        • Schuberth J.M.
        • Cheung C.
        • Rush S.M.
        • Blitz N.
        • Roling B.
        The medial malleolar approach for arthrodesis of the ankle: a report of 13 cases.
        J Foot Ankle Surg. 2005; 44: 125-132
        • Kopp F.J.
        • Banks M.A.
        • Marcus R.E.
        Clinical outcome of tibiotalar arthrodesis utilizing the chevron technique.
        Foot Ankle Int. 2004; 25: 225-230
        • Belt E.A.
        • Maenpaa H.
        • Lehtu M.U.
        Outcome of ankle arthrodesis performed by dowel technique in patients with rheumatic disease.
        Foot Ankle Int. 2001; 22: 666-669
        • Berman A.T.
        • Bosacco S.J.
        • Parks B.G.
        • Israelit C.L.
        • Austin D.K.
        • Farrel E.D.
        • Quartararo L.G.
        Compression arthrodesis of the ankle by triangular external fixation: biomechanical and clinical evaluation.
        Orthopaedics. 1999; 22: 1129-1134
        • Fu Y.C.
        • Huang P.J.
        • Tien Y.C.
        • Hung S.H.
        • Cheng Y.M.
        • Lin S.Y.
        • Chen Y.C.
        • Liu L.L.
        • Huang S.H.
        Ankle arthrodesis: internal non-compression arthrodesis versus internal compression arthrodesis.
        Kaohsiung J Med Sci. 1999; 15: 550-555
        • Sonnabend D.H.
        • Duckworth D.
        A new technique of ankle arthrodesis. Aust N Z J Surg. 1992; 62: 965-968
      2. Miller MD. Review of Orthopaedics, 4th ed, pp 4–5, 2004, Saunders-Elsevier, Philadelphia, 2004.

        • Bargiotas K.
        • Wohlrab D.
        • Sewecke J.J.
        • Lavinge G.
        • Demeo P.J.
        • Sotereanos N.G.
        Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection.
        J Bone Joint Surg (Am). 2006; 88-A: 553-558
        • Charnley J.
        Arthrodesis of the knee.
        Clin Orthop. 1960; 18: 37-42
        • Hagemann W.F.
        • Woods G.W.
        • Tullos H.S.
        Arthrodesis in failed total knee replacement.
        J Bone Joint Surg Am. 1978; 60-A: 790-794
        • Woods G.W.
        • Lionberger D.R.
        • Tullos H.S.
        Failed total knee arthroplasty. Revision and arthrodesis for infection and non-infectious complications.
        Clin Orthop Relat Res. 1983; 173: 184-190
        • Alonso-Vazquez A.
        • Lauge-Pedersen H.
        • Lidgren L.
        • Taylor M.
        Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis.
        Clin Biochem. 2004; 19: 751-759