Ankle Arthrodesis Using an Ilizarov External Fixator in Patients Wounded by Landmines and Gunshots

Background: We evaluated the results of ankle arthrodesis performed with circular external fixators (CEF) in those patients who had developed tibiotalar arthritis secondary to a landmine or a gunshot injury. Materials and Methods: Nineteen ankles in 19 patients were fused using CEF. All patients had approximately 3 (range, 1 to 5) operations for bone and soft tissue reconstruction preceding the arthrodesis. Ankle arthrodesis was performed an average of 2.3 (range, 1 to 7) years after the initial trauma. The mean age at operation was 22 (range, 20 to 31) years old and all patients were male. Results: The average time spent in the CEF was 3.5 (range, 2 to 7) months. The mean followup was 59 (range, 31 to 90) months. Successful arthrodesis was achieved in all patients in an acceptable position. Clinically, 6 patients were assessed as excellent, 9 patients as good, 3 patients as fair, and 1 patient had a poor result. Twelve patients reported no pain postoperatively, 4 patients reported reduced to mild and/or occasional pain, 2 patients reported moderate pain, and 1 patient reported persistent pain. Sixteen patients described their outcome as satisfactory, one was somewhat satisfied, and two were dissatisfied. There were pin track infections in 10 patients and ring sequestration in one patient. Conclusion: Patients who have degenerative ankle arthritis due to gunshot wounds and landmine injuries with poor bone quality and soft tissue conditions at the distal tibia can be successfully managed by using CEF.