Surgeons

Biography

Biography: Ashfaq Ahmed

Abstract

Background: Tibiotalocalcaneal arthrodesis is a salvage and procedure of choice for hindfoot problems that aff ect both the ankle and subtalar joints. Th e indications for this surgery are arthritis, neglected ankle trauma, osteonecrosis of the talus, severe mal-alignment deformities and signifi cant hindfoot bone loss. Objective: To determine the clinical and radiological outcome of tibiotalocalcaneal arthrodesis with retrograde intramedullary sign nail in patients with tibiotalar and subtalar joint pathologies. Materials & Methods: It was descriptive case study on 100 patients from September 2012 to December 2016 admitted either through OPD or Emergency at Orthopedics Unit of Ghurki Trust Teaching Hospital Lahore. Aft er taking detailed history, clinical examination and investigations, the patients underwent ankle arthrodesis using retrograde sign nail under image control. Patients were discharged on 2nd or 3rd post-operative day and followed in Out Patient Department. Splint was advised for 2-3 weeks and non-weight bearing for 6 weeks. Radiographs were done on follow up visit to assess the alignment and later to assess healing. Patients were allowed weight bearing aft er 6 weeks. Outcome measures were assessed in the form of radiological bony union, AOFAS score, patient satisfaction score and post-operative complications related to the procedure. Data were initially entered on preformed pro forma and later on SPSS 17.0 version were used for data analysis. Results: Th ere were 100 patients who underwent arthrodesis and fi xation. Th ere were 82% male and 18% female with mean age of 41.5±4.5 years. Th e patients who need this procedure having diff erent pathologies; among them 23 having rheumotoid arthritis, 59 were post-traumatic, 11 having degenerative osteoarthritis and 7 having neuropathic pathology. Aft er 12 months radiological union were found in 91 patients (91%), non-union in 4 patients (4.0%) and 5 patients were lost in follow up. Pain improves in all 91 (91%) patients who having radiological union and were fully satisfi ed with the procedure. Among 4 patients with non-union, 3 patients having wound infection and they need revision surgery. Mean follow up time was 4.5 months (2-7 months). 90% of the patients achieved radiological bony union at last follow up. Th e mean improvement in the AOFAS score was 73 and visual analogue score were 88±5. Conclusion: Arthrodesis is an end stage procedure should be considered only aft er all conservative treatments fails. Tibiotalocalcaneal fusion with retrograde nailing and bone graft ing is a successful salvage procedure in severe ankle and hindfoot arthrosis with deformity. Patient satisfaction rate is high, though infection is major problem and precautions should be taken to reduce its incidence.