Ankle Arthrodesis (Fusion): Using Arthrex anterior ankle fusion plate
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Ankle arthrodesis is an established treatment for painful, end-stage ankle arthritis. Over the last century, a number of operative techniques have been popularised, with modifications reflecting technological advances. These have ranged in methods of fixation from the Charnley external clamps through to all manner of crossed/parallel screw fixation techniques implanted via open or arthroscopic means. This latter technique has gained wide popularity and has excellent results in terms of high rates of union and rapid return to function.
However, managing deformity, poor bone quality or bone loss remain difficult issues to resolve using traditional techniques. As a result, biomechanical studies into the properties of angle-stable devices such as blade plates and anatomic locking plates have found some mechanical advantages over screws in stabilising an ankle arthrodesis, thus potentially offering a solution.
In cases with the presence of deformity, I much prefer to use open methods of arthrodesis as it is easier to gauge the intra-articular deformation and prepare the joint surfaces. In this case, a tall person with Marfan’s syndrome and isolated ankle arthritis, I elected to use an Arthrex anterior fusion plate because it provides very robust fixation , two methods of application of compression and an excellent hold that locking screws afford within the plate. The Arthrex range of plates offers a lateral ankle arthrodesis plate which requires the removal of the fibula to apply. In this instance, I wanted to preserve as much of the mortise as possible to preserve inherent ankle stability given the degree of correction needed, and so opted for an anterior approach and plating option.
In general terms, my experience with using the Arthrex systems for either anterior or lateral ankle fusion surgery has been that the plates are very well engineered and that the trays are thoughtfully constructed with useful instruments that are easy to use. Additionally, Arthrex have recently expanded the range of plates to allow a choice of plate lengths. Previously a limiting step in using the kit was that the surgeon was confined to using one plate size per approach – for example, one anterior plate size. In large patients and in those with good soft tissue coverage, this range does offer very robust fixation for an ankle arthrodesis. However, one needs to be aware if using this plate in patients with poor soft tissue envelopes and also in smaller individuals that the dimensions of the plates are bulky and it can be difficult to close the soft tissues over them.
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Author: Mark Davies FRCS (Tr & Orth)
Institution: The Northern General Hospital, Sheffield, UK.
Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.