ARTHROSCOPIC ANKLE ARTHRODESIS IN A NEUROPATHIC ANKLE

Abstract

A conservative approach should be employed in the primary treatment of trauma in neuropathic feet. Patients unresponsive to an appropriate treatment of bracing and immobilization are candidates for surgical reconstruction if uncontrolled instability or deformity with impending skin breakdown exists. A 49-year-old woman with traumatic paraplegia and inversion instability of the ankle secondary to an open ankle dislocation is presented in this article. The patient had severe instability and varus deformity of the ankle with weight-bearing despite the use of an appropriate brace. An arthroscopic ankle arthrodesis fixed with a multilevel İlizarov frame was performed. Union was achieved at the 4th month resulting in a stable and plantigrade foot. No progressive deformity or destruction was observed at 40 months follow-up. This is the first report of an arthroscopic arthrodesis in a neuropathic ankle that the authors are aware of. Arthroscopic ankle arthodesis is minimally invasive and does not disturb the vascularity of bone as the extensive soft tissue dissection necessary in open techniques are avoided. This results in minimal soft tissue morbidity and an early fusion. An İlizarov frame with multi-level fixation was used to achieve stability in osteopenic bone. Surgical reconstruction is feasable in neuropathic feet for appropriate indications with careful surgical technique and adequate post-operative care.