The Effect of Screw Position and Number on the Time to Union of Arthroscopic Ankle Arthrodesis

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• 作者：Ichiro Yoshimura ; M.D. ; Ph.D. ; ^{ichiroy@cis.fukuoka-u.ac.jp} ; Kazuki Kanazawa ; M.D. ; Akinori Takeyama ; M.D. ; Takahiro Ida ; M.D. ; Tomonobu Hagio ; M.D. ; Chayanin Angthong ; M.D. ; Masatoshi Naito ; M.D. ; Ph.D.
• 刊名：Arthroscopy: The Journal of Arthroscopic & Related Surgery
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：28
• 期：12
• 页码：1882-1888
• 全文大小：1006 K

文摘

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Purpose

This study aimed to investigate the factors that influence the time to union after arthroscopic ankle arthrodesis.

Methods

From June 2005 to October 2010, 46 patients (50 ankles) underwent arthroscopic ankle arthrodesis with 6.0-mm cannulated cancellous screws. There were 22 men and 24 women (mean age, 63 years). Medical records and radiographs were retrospectively reviewed. Screw configurations used were as follows: 3 transmedial and translateral malleolar screws (ML3) in 12 ankles (24 % ), 2 transmedial and translateral malleolar screws (ML2) in 4 ankles (8 % ), 3 transmedial malleolar screws (M3) in 23 ankles (46 % ), and 2 transmedial malleolar screws (M2) in 11 ankles (22 % ).

Results

Radiographic fusion was achieved in 46 (92 % ) of the 50 ankles. The mean time to fusion was 11.0 ¡À 4.5 weeks for ML3, 13.1 ¡À 3.3 weeks for ML2, 9.7 ¡À 2.7 weeks for M3, and 12.5 ¡À 3.5 weeks for M2 (P < .05). The mean American Orthopaedic Foot & Ankle Society scores were 81.3 ¡À 2.2 for ML3, 83.5 ¡À 4.4 for ML2, 88.3 ¡À 1.5 for M3, and 85.3 ¡À 2.2 for M2. The mean time until radiographic fusion was 10.2 ¡À 3.4 weeks for correction angles of less than 10¡ã and 13.2 ¡À 3.4 weeks for angles of 10¡ã or greater (P < .01). In obese patients a significant difference in ankle fusion time was observed (12.6 ¡À 3.5 weeks for patients with body mass index ¡Ý25 v 9.4 ¡À 2.9 weeks for patients with body mass index <25, P < .01).

Conclusions

Overall, this study showed that arthroscopic ankle arthrodesis achieves a high rate of union, with fastest union achieved with 3 parallel screws placed medially from the distal tibia into the talus. Care should be taken when one is designing treatment strategies for obese patients and/or patients with large correction angles.

Level of Evidence

Level IV, retrospective case series.