Fri., 10/9/09 Pilon/Foot & Ankle, Paper #60, 4:46 pm OTA-2009
Clinical Results of the Anatomic Compression Arthrodesis Technique with Anterior Plate Augmentation for Ankle Arthrodesis
Michael P. Clare, MD1 (n); Scott A. Swanson, MD1 (n); John P. Ketz, MD1 (n);
Matthew A. Mormino, MD2 (n); Lori K. Reed, MD2 (n); Ivan S. Tarkin, MD3 (n);
Arthur K. Walling, III1, MD (4, 7-AO; 7, 8-DePuy, A Johnson &Johnson Company;
7-DJ Orthopaedics, Encore Medical, Johnson &Johnson, Smith &Nephew, Stryker, Zimmer;
7, 10-Link Orthopaedics; 8-Merck); Roy Sanders, MD1 (2-Wolters Kluwer Health - Lippincott Williams &Wilkins: Journal of Orthopaedic Trauma; 3-Linvatec; 3, 7-Stryker; 3, 5A, 7-Smith &Nephew; 3,7-DePuy, A Johnson & Johnson Company; 7-Pfizer);
1Florida Orthopaedic Institute, Tampa, Florida, USA;
2University of Nebraska Medical Center, Omaha, Nebraska, USA;
3University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Purpose: Ankle arthrodesis remains the gold standard for treatment of end-stage ankle arthritis. The anatomic compression arthrodesis technique is proven and reliable, and features multiplanar screw fixation outside the plane of primary motion. Anterior plate augmentation of this same technique provides fixation in the sagittal plane, which is hypothesized to decrease the incidence of arthrodesis nonunion. The purpose of this study is to review the clinical results of the anatomic compression arthrodesis technique with anterior plate augmentation for ankle arthrodesis.
Methods: We reviewed 275 isolated, primary ankle arthrodeses performed in 273 patients from 2000 to 2006. The average age was 57.4 years. All patients underwent an ankle arthrodesis through an anterior approach using the anatomic compression arthrodesis technique. Fixation was achieved with multiplanar cannulated screws, and augmented with an anterior plate and small fragment screws. The postoperative protocol included serial cast immobilization and strict non-weightbearing for 10 to 12 weeks. Functional outcomes were assessed prospectively using the Short Form-36 Physical Component Summary and Mental Component Summary, American Orthopaedic Foot and Ankle Society ankle and hindfoot score, and Maryland foot score.
Results: The average follow-up was 4.15 years, and all patients had a minimum follow-up of 2 years. 264 of 275 arthrodeses went on to primary union (96.0% union rate). The average time to clinical union was 3.35 months. Ten nonunions healed with revision arthrodesis; 1 patient refused further surgery. There was a statistically significant difference (P <0.05) in all functional outcome scores postoperatively relative to preoperatively. Radiographically, 12 had a fracture of 1 or more of the anterior small fragment screws; with the numbers available, there was no correlation between screw fracture and union rate. Complications included 13 with delayed wound healing, 2 with deep infection, 4 required a subsequent subtalar arthrodesis, and 15 had subtalar pain or stiffness but underwent no further surgery.
Conclusion: The anatomic compression arthrodesis technique with anterior plate augmentation is an effective technique that results in a high union rate, improved functional outcome, and an acceptable complication rate. We believe the anterior plate is a useful complement to standard multiplanar screw fixation, and the increased rigidity provided by the anterior plate effectively counters forces, particularly in the sagittal plane, which may otherwise lead to failure of multiplanar screw constructs.• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant