Die Arthrodese des oberen Sprunggelenks

Zusammenfassung

Während durch Fortschritte im Bereich des künstlichen Gelenkersatzes die Arthrodese des Knie- und Hüftgelenks eher in den Hintergrund getreten ist, bietet die operative Versteifung des Sprunggelenks nach wie vor, nach Ausschöpfen aller konservativen Möglichkeiten, eine bewährte Behandlung zur Schmerzreduktion und Fußfehlformkorrektur. Bei der Wahl des Fixationsmaterials scheint die interne Schraubenfixation dem Fixateur externe überlegen zu sein. In Einzelfällen hat der Fixateur externe jedoch noch seine Berechtigung, insbesondere bei Kombinationsarthrodesen, bei voroperierten Patienten mit Weichteil- und Knochenatrophien, sowie bei septischen Arthritiden.

Summary

Ankle fusion continues to be the treatment of choice for severe primary ankle osteoarthritis, because fusion typically provides a painless, plantigrade, and stable foot. But the surgical management of tibiotalar arthritis remains a controversial subject. To date, a wide range of ankle-fusion techniques has been described, including the use of external compression devices combined with open or arthroscopic debridement of joint surfaces, fixation with fibular strut grafts, retrograde intramedullary nailing, interposition bone grafting, and various forms of internal fixation with or without interposition grafting. Hypermobility of the midtarsal joint can partially compensate for the loss of sagittal motion. Otherwise the established practice of ankle arthrodesis, while providing good pain relief, is known in the mid to long term to lead to degenerative changes in adjacent joints, such as the subtalar joint. These findings are major issues when considering treatment alternatives. The fusion rate in most of the recently published studies is 85 % or greater, and may depend on the presence of infection, deformity, avascular necrosis, and nonunion.

Schlüsselwörter

Arthrodese OSG - Vierschraubentechnik - Pseud arthrose - OSG-Fraktur - Anschlussarthrose - retrograder Nagel - Ganganalyse - AOFAS-Score - Rückfußstellung

Keywords

Ankle fusion - ankle arthrodesis - tibiotalar arthritis - retrograde intramedullary nailing - hypermobility midtarsal joint - four screw technique - secondary arthritis subtalar and talonavicular joint - rates of union - ankle and a hindfoot alignment

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