J Korean Foot Ankle Soc.  2023 Dec;27(4):131-136. 10.14193/jkfas.2023.27.4.131.

Comparison of the Outcomes between the Anterior and Transfibular Approaches in Ankle Arthrodesis

• Lee J
• Kim MJ
• Chung JW

• KMID: 2552992
• DOI: http://doi.org/10.14193/jkfas.2023.27.4.131

Abstract

Purpose
This study compared the clinical and radiology results of arthrodesis between the anterior and transfibular approaches with a lateral malleolar-saving procedure in ankle arthritis.
Materials and Methods
This study was a retrospective study of 31 cases who underwent ankle arthrodesis with the anterior approach (14 cases) and trans-fibular approach (17 cases). The remnant lateral malleolus was fixed during the trans-fibular procedure. The patients included 17 females and 14 males with a mean age of 57.2 (range 41~73) years; the mean follow-up was 30.4 (range 15~68) months. The clinical and radiology outcomes, including the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and union time, were recorded. The complications and subjective satisfaction degrees were also recorded and compared between the two groups.
Results
Clinically, the preoperative mean AOFAS score and VAS in the anterior approach group were 39.3 and 7.4, respectively, which changed to 61.9 and 3.1 postoperatively. In the trans-fibular approach group, the mean AOFAS score and VAS increased from 36.6 to 64.2 and 7.1 to 2.4, respectively. On the other hand, no significant differences in the clinical results were observed between the two groups. The time to achieve union was 9.2 and 11.6 weeks in the anterior and transfibular approach groups, respectively. Three patients (21%) complained of tenderness and discomfort around the fibular tip in the anterior approach group, and seven patients (41%) showed a gap between the talus and remnant lateral malleolus in the trans-fibular approach group.
Conclusion
There was no difference in the clinical and radiological results between the anterior and transfibular approaches with a lateral malleolar saving procedure in ankle arthrodesis. Careful selection of the approach method according to the patient's preoperative condition is needed to prevent remnant discomfort or nonunion around the lateral malleolus.

Keyword

Ankle; Arthritis; Arthrodesis; Anterior approach; Trans-fibular approach

Figure

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  Figure 1 Radiographs of ankle arthrodesis using an anterior approach. Standing ankle anteroposterior and lateral radiographs at preoperative (A, B) and 12 months follow-up (C, D) of a 63-year-old female show well fused tibiotalar joint with improved clinical results. Otherwise, radiographs at preoperative (E, F) and 15 months (G, H) follow-up of a 57-year-old female also show a well-fused state, but the patient still complains of tenderness and discomfort around the fibular tip at final follow-up.

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  Figure 2 Radiographs of ankle fusion using the trans-fibular approach. Standing ankle anteroposterior and lateral radiographs at preoperative (A, B) and 12 months follow-up (C, D) of a 55-year-old male show union between tibiotalar joint and remnant lateral malleolus. Otherwise, radiographs at preoperative (E, F) and 16 months (G, H) follow-up of a 67-year-old male show a gap between the talus and remnant lateral malleolus at final follow-up.

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  Figure 3 Standing ankle anteroposterior and lateral radiographs at preoperative (A, B) of a 59-year-old male who underwent ankle arthrodesis using an anterior approach. The follow-up radiographs (C, D) at 12 months show a remnant gap at the ankle and failure of the screw indicating nonunion.

Reference

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