A study on the practice of ankle arthrodesis at Kenyatta National Hospital

Abstract

This was a 10-year retrospective study on the practice of ankle arthrodesis at Kenyatta National Hospital. The study covered the period from January 1992 to December 2001. Medical records of 49 patients in whom 50 ankles were fused were studied. Information obtained from the files was entered in a data collection form and later entered into a computer in a coded form. This was then subjected to statistical analysis. There were 23 females and 26 males with female to male ratio of 1:1.13. The average age of the patients was 39 years with an age range of 16 to 68 years. Patients in the age group 20-50 years constituted the majority of the patients. The commonest clinical presentations were ankle pain and deformity in 39 (79.6%) and 35 (71.4%) of the patients respectively. The primary traumatic ankle injury and posttraumatic osteoarthritis contributed to 84% of the fusion. Overall trauma was associated with 96% of the fusions. Most patients with traumatic ankle injuries had previously been managed conservatively by plaster cast immobilization. Twenty-six patients were lost to follow-up, and of the remaining, a fusion rate of 87.5% was achieved. Internal screw fixation was used in 58% of the fusions and compression with Charnley clamps was used in 34% of the patients. There were 36 incidents of a complication recorded. Infection was the commonest complication occurring in 24% of the patients. Fusion by the use of Chamley clamps was significantly associated with development of infection. In this study, it was concluded that complications arising from inadequately treated bimalleolar fractures was the commonest indication for ankle fusion. However, the results of fusion with respect to rate of fusion and complications are comparable to those reported in other literature. This study recommends a thorough assessment of ankle injuries and their early and appropriate management.