Role of internal and external fixation in ankle fusion.

Between August 1980 and September 1993, 35 tibiotalar arthrodeses in 34 patients with primary and secondary osteoarthritis of the ankle were performed. Two different surgical techniques were employed. Internal screw fixation according to Wagner and Pock [20] and an external fixation method according to the resection compression arthrodesis by Charnley and Muller [14]. Twenty patients with 21 fusions could be investigated retrospectively. For evaluation we used self-assessment, clinical examination and radiographic analysis in combination with the score described by McGuire et al. [12]. In 80% the results were good and satisfactory with a median improvement of 23 score points on a scale of 100% 95 points, respectively. The most important advantages were pain relief and increase of walking distance. The fusion rate was 95%. We found osteoarthritis in the neighbouring joints did not have any influence on the surgical result. With respect to the two surgical techniques, the internal screw fixation method achieved fusion earlier with fewer complications and better improvement according to the McGuire score. Tibiotalar fusion is a safe therapy with reproducible good results involving pain relief, full weight-bearing and increase of walking distance.