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World J Orthop. Sep 18, 2015; 6(8): 602-613
Published online Sep 18, 2015. doi: 10.5312/wjo.v6.i8.602
Complex ankle arthrodesis: Review of the literature
Remy V Rabinovich, Amgad M Haleem, S Robert Rozbruch
Remy V Rabinovich, Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY 10075, United States
Amgad M Haleem, S Robert Rozbruch, Department of Orthopaedic Surgery, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: Rabinovich RV performed the literature search and review and wrote the paper; Haleem AM made substantial contributions to conception and design of the review and was involved with critical revisions related to important intellectual content of the manuscript; Rozbruch SR made critical revisions related to important intellectual content of the manuscript and made the final approval of the version of the article to be published.
Conflict-of-interest statement: Rabinovich RV and Haleem AM have no disclosures of potential conflicts of interest; Rozbruch SR is a consultant for Smith and Nephew as well as Small Bone Innovations and receives royalties.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: S Robert Rozbruch, Professor, Department of Orthopaedic Surgery, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States. rozbruchsr@hss.edu
Telephone: +1-212-6061415
Received: March 3, 2015
Peer-review started: March 8, 2015
First decision: May 13, 2015
Revised: June 28, 2015
Accepted: July 29, 2015
Article in press: August 3, 2015
Published online: September 18, 2015
Processing time: 199 Days and 8.9 Hours
Abstract

Complex ankle arthrodesis is defined as an ankle fusion that is at high risk of delayed and nonunion secondary to patient comorbidities and/or local ankle/hindfoot factors. Risk factors that contribute to defining this group of patients can be divided into systemic factors and local factors pertaining to co-existing ankle or hindfoot pathology. Orthopaedic surgeons should be aware of these risk factors and their association with patients’ outcomes after complex ankle fusions. Both external and internal fixations have demonstrated positive outcomes with regards to achieving stable fixation and minimizing infection. Recent innovations in the application of biophysical agents and devices have shown promising results as adjuncts for healing. Both osteoconductive and osteoinductive agents have been effectively utilized as biological adjuncts for bone healing with low complication rates. Devices such as pulsed electromagnetic field bone stimulators, internal direct current stimulators and low-intensity pulsed ultrasound bone stimulators have been associated with faster bone healing and improved outcomes scores when compared with controls. The aim of this review article is to present a comprehensive approach to the management of complex ankle fusions, including the use of biophysical adjuncts for healing and a proposed algorithm for their treatment.

Keywords: Ankle; Arthrodesis; Ilizarov; Reconstruction; Salvage

Core tip: This research article aims to review the definition, current trends and future direction of complex ankle arthrodesis surgery. To our knowledge, there has not been a review article in the literature on this important and challenging topic. This article discusses the major risk factors that entail this type of ankle fusion surgery. It brings forth the debate in recent literature on how to treat this complex pathology, mainly in regards to internal vs external fixation, and various adjuncts that are available to promote healing.