Sport and physical activity after ankle arthrodesis with Ilizarov fixation and internal fixation

External Versus Internal Fixation Techniques for Ankle Arthrodesis: A Systematic Review and Meta-analysis

Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis was conducted according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR = 0.60, CI 0.36-1.02, p = .06) however, EF was associated with greater odds of deep hardware infections (OR = 3.67, 1.97-6.83, p < .05) and amputations (OR = 3.17, CI 1.06-9.54, p = .04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD = 31.23, CI-25.11-37.34, p < .05) and intraoperative blood loss (MD = 44.1, CI 28.77-59.43, p < .05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes.

Assessment of Function in Patients after Calcaneal Fracture Treatment with the Ilizarov Method

Background: Up to 75% of calcaneal fractures are intra-articular fractures, which may severely impair foot function and lead to disability. Methods: We retrospectively analyzed 21 patients with intra-articular calcaneal fractures who had been treated with the Ilizarov method in the period 2021-2022. The mean patient age was 47 years (range 25-67 years). We analyzed the following functional parameters: foot function with a revised foot function index (FFI-R) questionnaire and the level of physical activity, with the University of California Los Angeles (UCLA) activity scale, a visual analog scale (VAS), and a Grimby physical activity level scale; and ankle range of motion. Results: We observed a significant improvement in the UCLA activity scores and Grimby activity score at long-term follow-up. Functional outcomes based on the FFI-R questionnaires showed an improvement, from 292 points prior to surgery to 127 points at follow-up, p = 0.013. The post-treatment follow-up measurements revealed a median dorsiflexion at the treated ankle joint of 20 degrees, whereas that at the intact ankle was 40 degrees, p = 0.007. The plantar flexion showed asymmetry, with a median 15 degrees at the treated ankle and 30 degrees at the intact ankle, p = 0.007. The median range of inversion at the ankle joint was 5 degrees in the treated limb and 15 degrees in the intact limb, p = 0.039. Conclusions: Patients with calcaneal fractures treated with the Ilizarov method are recommended to have a longer and more intensive rehabilitation. The range of ankle motion in the treated limb was limited in comparison with that in the intact limb; however, this did not greatly affect the patients' return to their earlier, pre-injury level of physical activity.

Arthroscopic vs. Open-Ankle Arthrodesis on Fusion Rate in Ankle Osteoarthritis Patients: A Systematic Review and Meta-Analysis

Although open surgery is the conventional option for ankle arthritis, there are some reports in the literature regarding the use of the arthroscopy procedure with outstanding results. The primary purpose of this systematic review and meta-analysis was to analyze the effect of the surgery technique (open-ankle arthrodesis vs. arthroscopy) in patients with ankle osteoarthritis. Three electronic databases (PubMed, Web of Science, and Scopus) were searched until 10 April 2023. The Cochrane Collaboration's risk-of-bias tool was used to assess the risk of bias and grading of the recommendations assessment, development, and evaluation system for each outcome. The between-study variance was estimated using a random-effects model. A total of 13 studies (including n = 994 participants) met the inclusion criteria. The meta-analysis results revealed a nom-significant (p = 0.072) odds ratio (OR) of 0.54 (0.28-1.07) for the fusion rate. Regarding operation time, a non-significant difference (p = 0.573) among both surgical techniques was found (mean differences (MD) = 3.40 min [-11.08 to 17.88]). However, hospital length stay and overall complications revealed significant differences (MD = 2.29 days [0.63 to 3.95], p = 0.017 and OR = 0.47 [0.26 to 0.83], p = 0.016), respectively. Our findings showed a non-statistically significant fusion rate. On the other hand, operation time was similar among both surgical techniques, without significant differences. Nevertheless, lower hospital stay was found in patients that were operated on with arthroscopy. Finally, for the outcome of overall complications, the ankle arthroscopy technique was a protective factor in comparison with open surgery.

Assessment of the distribution of load on the lower limbs and balance before and after ankle arthrodesis with the Ilizarov method

Ankle arthrodesis with the Ilizarov method is an accepted form of treatment of advanced degenerative changes of the ankle joint. Incorrect balance and load distribution on the lower limbs may result in pain and dysfunction. The aim of the study was to assess the change of balance and load distribution in lower extremities in patients before and after ankle arthrodesis with the Ilizarov method. Between 2013 and 2016, ankle arthrodesis using the Ilizarov method was performed on 21 patients. The evaluation of balance and percentage of load in each lower limb was performed before the surgery and during the follow-ups. The evaluation was performed using a Zebris pedobarographic platform. Before the surgery, the patients exhibited an average load of 41.9% of body weight in the affected limb, whereas the load in the healthy limb was 58.1%. The difference was statistically significant (p = 0,000031). In two years follow-up, the average load in the treated limbs was 48.19%, whereas the healthy limbs were subjected to an average load of 51.81%. In preoperative tests, the average path length of the center of gravity was 161.55 cm; postoperatively, the average path length of the center of gravity was 129.7 cm (p = 0.00003206). Preoperatively, the average area of the center of gravity was 18.85 cm²; it decreased to 6.19 cm² (p = 0.000032) postoperatively. Arthrodesis of the ankle with the Ilizarov method improved the statics of the musculoskeletal system by improving the distribution of loads in the lower limbs as well as balance. However, it failed to restore the parameters of a healthy person. Advanced degenerative changes of the ankle disturb the biomechanics of the entire lower limb.