The dorsolateral approach to the ankle for arthrodesis.

OBJECTIVE

Bony fusion of the ankle in functional position. Restitution of a pain-free use of the limb.

INDICATIONS

Joint destruction not amenable anymore to conservative treatment modalities. Chronic instabilities of diverse causes.

CONTRAINDICATIONS

Severe general and metabolic diseases. Extensive scarring at the posterior aspect of the ankle.

SURGICAL TECHNIQUE

Posterolateral approach to the ankle. Fibular osteotomy and resection of a 1 cm long bone block from its diaphysis. Removal of articular cartilage of tibia, talus, and lateral malleolus. Plantigrade positioning of the talus under the tibia in slight external rotation. Internal tibiotalar screw fixation. Fixation of the lateral malleolus to tibia and talus with screws.

POSTOPERATIVE MANAGEMENT

Plaster cast for 2 weeks without weight bearing followed by partial weight bearing in an ankle-foot orthesis with a rocker-bottom sole until radiologic evidence of bony fusion.

RESULTS

26 patients (21 men, five women, average age 55 years (21-83 years) underwent a total of 29 ankle arthrodeses. Minimum clinical and radiologic follow-up of 1 year. All patients were able to bear full weight between the 2nd and 3rd postoperative month. All patients could be reached by telephone 1-14 years after surgery. Screws had been removed in six of the patients. The activities of daily living were assessed on a visual analog scale (0-10 points); they had improved from 2.5 points preoperatively to 8.3 points postoperatively. All patients stated they would undergo this operation again. 16 patients were physically active and participated in sports such as bicycling, hiking and swimming.