«Uso de la fijación externa con alambre circular en el tratamiento de la artrodesis consrvadora de tobillo.»
Eugene Zarutsky DPM1, Shannon M. Rush DPM2, FACFAS and John M. Schuberth DPM3, , , FACFAS
1Post Graduate Year 3, San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Permanente Medical Center, San Francisco, Oakland, and Walnut Creek, CA; Veterans Affairs Medical Center, San Francisco, CA. 2Attending Staff, Department of Orthopedics, Kaiser Permanente Medical Center, Walnut Creek, CA. Attending Staff, San Francisco Bay Area Foot and Ankle Residency Program. 3Attending Staff, Department of Orthopedics, Kaiser Permanente Medical Center, San Francisco, CA. Attending Staff, San Francisco Bay Area Foot and Ankle Residency Program
The authors retrospectively reviewed their experience with circular wire external fixation in the treatment of salvage ankle arthrodesis during the past 9 years. The results of 43 cases in a difficult patient population are presented with an average follow-up of 27.0 months. Thirty-three patients (80.5%) went on to achieve a solid fusion or stable pseudarthrosis. A minimum of a 4-ring frame construct was applied for an average of 96.1 days. The major complication rate was 51.2%, including 3 below-knee amputations (7.3%), 7 unstable nonunions (17.1%), 7 cases of osteomyelitis and/or deep-space infection (16.3%), 3 malunions (7.3%), and 2 tibial stress fractures (4.7%). The incidence of complications occurred similarly in patients with Charcot arthropathy, failed total ankle arthroplasty, septic fusion, posttraumatic deformity, or avascular necrosis of the talus, whereas it was relatively higher in patients who were diabetics, smokers, or had an increased body mass index. In addition, the incidence of a nonunion tended to increase with longer follow-up, suggesting that early presumption of a solid union may be erroneous. Based on our defined criteria of a stable, well-aligned fusion without severe pain or activity restrictions, 28 patients (68.3%) had a good result. Circular wire external fixation can be a viable treatment for complex ankle salvage pathology; however, it is difficult to predict the prospects of success or failure.
The Journal of Foot and Ankle Surgery Volume 44, Issue 1 , January-February 2005, Pages 22-31.