JFAS Instructional Course| Volume 49, ISSUE 6, P566-570, November 2010

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Technical Guide: Transfibular Ankle Arthrodesis with Fibular-Onlay Strut Graft

Published:September 01, 2010DOI:


      A wide range of techniques have been described for ankle arthrodesis, and although all of these have been shown to provide stability, few have been shown to achieve a solid construct in patients at risk of nonunion. In this technical guide, we describe a modified transfibular approach to ankle arthrodesis that uses a fibular-onlay strut graft for use in patients at high risk for nonunion. In our experience, the technique has been effective and reliable.


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        • Mann R.A.
        • Van Manen J.W.
        • Wapner K.
        • Martin J.
        Ankle fusion.
        Clin Orthop Relat Res. 1991; 268: 49-55
        • Albert E.
        Beitrage zur operativen Chirugie. Zur resketion des kniegelenkes.
        Wein Med Press, 1879 (20 705–708)
        • Colman A.B.
        • Pomeroy G.C.
        Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome.
        Foot Ankle Int. 2007; 28: 303-307
        • Sowa D.T.
        • Krackow K.A.
        Ankle fusion: a new technique of internal fixation using a compression blade plate.
        Foot Ankle. 1989; 9: 232-240
        • Scranton Jr., P.E.
        Use of internal compression in arthrodesis of the ankle.
        J Bone Joint Surg Am. 1985; 67: 550-555
        • Frey C.
        • Halikus N.M.
        • Vu-Rose T.
        • Ebramzadeh E.
        A review of ankle arthrodesis: predisposing factors to nonunion.
        Foot Ankle Int. 1994; 15: 581-584
        • Mann R.A.
        • Rongstad K.M.
        Arthrodesis of the ankle: a critical analysis.
        Foot Ankle Int. 1998; 19: 3-9
        • Holt E.S.
        • Hansen S.T.
        • Mayo K.A.
        • Sangeorzan B.J.
        Ankle arthrodesis using internal screw fixation.
        Clin Orthop Relat Res. 1991; 268: 21-28
        • Cobb T.K.
        • Gabrielsen T.A.
        • Campbell 2nd, D.C.
        • Wallrichs S.L.
        • Ilstrup D.M.
        Cigarette smoking and nonunion after ankle arthrodesis.
        Foot Ankle Int. 1994; 15: 64-67
        • Ishikawa S.N.
        • Murphy G.A.
        • Richardson E.G.
        The effect of cigarette smoking on hindfoot fusions.
        Foot Ankle Int. 2002; 23: 996-998
        • Perlman M.H.
        • Thordarson D.B.
        Ankle fusion in a high risk population: an assessment of nonunion risk factors.
        Foot Ankle Int. 1999; 20: 491-496
        • Maenpaa H.
        • Lehto M.U.
        • Belt E.A.
        Why do ankle arthrodeses fail in patients with rheumatic disease?.
        Foot Ankle Int. 2001; 22: 403-408
        • Horwitz T.
        The use of the transfibular approach in the arthrodesis of the ankle.
        Am J Surg. 1942; 55: 550-552
        • Thordarson D.B.
        • Markolf K.L.
        • Cracchiolo 3rd, A.
        Arthrodesis of the ankle with cancellous-bone screws and fibular strut graft. Biomechanical analysis.
        J Bone Joint Surg Am. 1990; 72: 1359-1363
        • Adams J.C.
        Arthrodesis of the ankle joint; experiences with the transfibular approach.
        J Bone Joint Surg Am. 1948; 30B: 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
        • Lance E.M.
        • Paval A.
        • Fries I.
        • Larsen I.
        • Patterson Jr., R.L.
        Arthrodesis of the ankle joint. A follow-up study.
        Clin Orthop Relat Res. 1979; 142: 146-158
        • Monroe M.T.
        • Beals T.C.
        • Manoli 2nd, A.
        Clinical outcome of arthrodesis of the ankle using rigid internal fixation with cancellous screws.
        Foot Ankle Int. 1999; 20: 227-231
        • Kitaoka H.B.
        • Alexander I.J.
        • Adelaar R.S.
        • Nunley J.A.
        • Myerson M.S.
        • Sanders M.
        Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.
        Foot Ankle Int. 1994; 15: 349-353
        • Kirkpatrick J.S.
        • Goldner J.L.
        • Goldner R.D.
        Revision arthrodesis for tibiotalar pseudarthrosis with fibular onlay-inlay graft and internal screw fixation.
        Clin Orthop Relat Res. 1991; 268: 29-36
        • Brown K.D.
        • Seligson D.
        An optimal technique for ankle arthrodesis.
        J Foot Ankle Surg. 2004; 43: 64-66