Arthrodesis as a salvage procedure for failed open reduction internal fixation of ankle fractures

Abstract

Ankle arthrodesis is a commonly performed procedure for the treatment of end stage ankle arthritis however, it can also be valuable in lower extremity trauma. Limited literature has been reported on patients who have undergone an ankle arthrodesis as a salvage procedure because of non-compliance following multiple surgical attempts to repair a Weber C ankle fracture. The purpose of this case report was to examine how non-compliance has detrimental effects on the outcomes of surgical repair of ankle fractures. We also demonstrate the stability and reliability of ankle arthrodesis as an end stage treatment option for ankle fractures. We present a case of a 21-year-old male who reported to the Emergency Department for evaluation and treatment of his left ankle injury. Radiographs revealed a comminuted displaced Weber C ankle fracture. The patient initially underwent surgical intervention consisting of an open reduction internal fixation. Secondary to non-compliance consisting of early and excessive weight bearing, the patient required additional surgeries. Considering his age, multiple attempts were made to preserve the patient’s ankle range of motion.  Due to failure to comply with postoperative instructions, the patient developed significant valgus mal-alignment of his ankle, diastasis of the syndesmosis in addition to a comminuted displaced distal fibular diaphyseal fracture. In attempts to salvage his limb, an ankle arthrodesis was performed utilizing an intramedullary nail with the addition of a circular multiplanar external ring fixator. The external fixator was removed once consolidation was noted across the ankle arthrodesis site which was approximately 5 months following application. At his 12-month follow up, the patient was able to ambulate without assistance and was pain free.