Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: General Orthopaedics
Abstract number: 23995
STRESS FRACTURES OF THE TIBIA FOLLOWING ANKLE / SUBTALAR
ARTHRODESIS
Rajeshkumar KAKWANI, A MURTY
Wansbeck Hospital, Newcastle-Upon-Tyne (UNITED KINGDOM)
Introduction: The goal of arthrodesis around the ankle / triple arthrodesis is a
painless, plantigrade, and stable foot. Stress fracture is a differential diagnosis for
pain following an ankle/subtalar arthrodesis. Management of stress fractures
following sound ankle/subtalar fusion is extremely difficult Methods and materials: 33
patients underwent ankle/subtalar arthrodesis at our institute from 2000-2008. The
average age of the patients was 69 years and the male: female ratio was 2:1.The
minimum follow-up was for one year. Although there were some variations in
technique, all the arthrodesis were performed by removal of articular cartilage, bone
grafting of any defects and rigid internal fixation. Results: 2/33 patients developed a
stress fracture of the distal tibia following successful ankle/subtalar fusion. An angle
of ankle /subtalar fusion showed an average of 0 degrees +/- 3 degrees in the sagital
plane, except for the two cases that developed the stress fracture. The angles in
these cases were 13 and 11 degrees. The stress fractures occurred proximal to the
level of the previous arthrodesis internal fixation devices (arthrodesis nail/ cancellous
screws). Intramedullary and extramedullary devices were utilised to obtain union
across the stress fracture sites, without success. Discussion: Equinus of more than
10 degrees following ankle / subtalar arthrodesis is a high risk factor for developing a
stress fracture of the distal tibia following ankle / subtalar arthrodesis. Stress fracture
following successful ankle/subtalar arthrodesis causes severe morbidity. They are
extremely difficult to treat, hence are best avoided if possible.
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