Arthrodesis of the ankle joint.

Arthrodesis of the ankle that uses lag screws for internal fixation is a safe and biomechanically stable method to obtain a solid ankle fusion; it generates good to excellent results in most patients. Prompt bone healing can be expected and allows a functional rehabilitation with full weight bearing. The surgical technique can be simplified further when using cannulated screws. Malalignment hazards while doing the ankle fusion are minimized by respecting the shape of the ankle mortise because no osteotomy of the lateral malleolus is performed. Generally, removal of the implanted material is not necessary. Major complications such as infection, stress fractures, or nonunion were not seen in our series. A meticulous resection of all cartilage and sclerotic bone and an atraumatic surgical technique are essential for preventing those major complications. The need for revision surgery is minimized by correction of talar malalignment, fusion with the ankle in a 90 degrees position, and preoperative evaluation of the subtalar joint. External fixation methods are used in cases of osteitis, osteonecrosis, osteoporosis, and poor soft tissue conditions. With severe loss of bone stock at the distal tibia, stability can be achieved by using an intramedullary nail for ankle fusion.