Transfibular ankle arthrodesis using burring, curettage, multiple drilling, and fixation with two retrograde screws through a single lateral incision

Purpose. To review the outcome of 23 ankle arthrodeses using burring, curettage, multiple drilling, and fixation with 2 retrograde screws through a single lateral incision. Methods. Records of 22 consecutive patients aged 39 to 79 (mean, 62.4) years who underwent 23 ankle arthrodeses for end-stage ankle arthritis were reviewed. Through a single lateral incision, articular cartilage was removed using burring and curettage, and multiple holes were drilled using a Kirschner wire, followed by fixation with 2 retrograde screws. The resected distal fibula was fixed to the distal part of the talus and tibia. The position of the ankle and subtalar joint arthrosis was assessed by 2 orthopaedic specialists. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) scores were evaluated. Results. The mean operating time was 122 minutes. The mean follow-up period was 41 months. The mean postoperative ankle alignment was suboptimal: 2.7° varus, 6.7° plantar flexion, and 2.9° internal rotation. The mean AOFAS score improved from 30 to 71 (p<0.01). The postoperative varus ankle alignment was not associated with the AOFAS score (r= -0.13, p=0.569). Of the 23 cases, one was nonunion and 22 achieved bone union after a mean of 5.4 (range, 2–16) months; 3 of them were delayed union. Despite bone union, 7 patients complained of persistent pain; 4 of them had progressive arthrosis of the adjacent subtalar joints (n=2) or subtalar and talonavicular joints (n=2). Conclusion. Ankle arthrodesis using burring, curettage, multiple drilling, and fixation with 2 retrograde screws achieved a high union rate and acceptable functional score without serious complications.