Background: Malunion and nonunion of an ankle fusion site are
associated with pain, osteomyelitis, limb-length discrepancy, and deformity.
The Ilizarov reconstruction has been used to treat these challenging
Methods: We reviewed the results in twenty-one ankles that had
undergone a revision of a failed fusion, with simultaneous treatment of
coexisting pathologic conditions, with use of the Ilizarov technique. Eight
patients had undergone ankle fusion only, eleven had undergone ankle and
subtalar fusion, and two had undergone pantalar fusion. Eighteen patients with
an average limb-length discrepancy of 4 cm underwent limb lengthening
simultaneously with the revision surgery. The average patient age was forty
years. Indications for treatment were malunion (eleven patients), aseptic
nonunion (eight patients), and infected nonunion (two patients). Clinical,
subjective, objective, gait, and radiographic analyses were performed after an
average duration of follow-up of 83.4 months.
Results: Solid union was achieved in all ankles. The functional
result was excellent for fifteen patients, good for three, fair for two, and
poor for one. The bone result was excellent for ten ankles, good for nine,
fair for one, and poor for one. All eighteen patients who underwent gait
analysis had a heel-to-toe progression gait, and twelve achieved normal
walking velocity with their shoes on. A plantigrade foot was achieved in each
case, and only two patients had >5° of residual deformity. During the
Ilizarov treatment, forty-one minor complications (treated conservatively) and
twenty major complications (treated surgically) occurred. After removal of the
circular frame, seven other complications, which required four additional
Conclusions: In patients with a failed ankle fusion, infection,
limb-length discrepancy, and foot deformity can be addressed simultaneously
with use of the Ilizarov apparatus to achieve a solid union and a plantigrade
foot, usually with a clinically satisfactory result.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.