Ilizarov ankle arthrodesis.

Six consecutive patients, four with failed infected ankle fusions and two with posttraumatic degenerative ankle arthritis, were treated by monofocal compression arthrodesis using the Ilizarov external fixator. The average age was 48 years (range, 33-74 years). The average preoperative duration after failed infected ankle fusion was 18 months and for posttraumatic arthritis after fracture, 23 months. Infected failed pseudarthroses had significant fixed valgus deformity of the foot, bilateral draining sinuses, and near complete destruction and loss of the talus. Compression was dynamically applied during treatment. Custom foot plates were secured to the frame, and weight bearing as tolerated was allowed throughout the treatment period. Tibiocalcaneal fusion was obtained in three of four infected failed ankle fusions at an average of seven months (range, five to nine months). There was no evidence of infection at follow-up evaluation in these patients. One patient did not tolerate the frame and developed a fibroarthrosis. One patient sustained a refracture of the fusion at six months. Successful tibiocalcaneal fusion was obtained with reapplication of the frame and a Pappineau graft. Two primary ankle fusions healed with tibial talar fusion at an average of 3.5 months. Overall follow-up time averaged 26 months (range, 19-30 months). Six wires broke, requiring simple replacement. Four of these six were 1.5-mm wires. The Ilizarov frame may have several advantages in primary ankle arthrodesis and in the salvage of infected failed ankle fusions.