1. Review of ankle fusions at PCEA Kikuyu Hospital M. M Khanbhai, V. Chauhan, F. Gitonga, M. Maru

2. INTRODUCTION Ankle fusion is a procedure used for end stage arthritis of the ankle. The goal is to achieve a pain free plantigrade foot. To date many types of ankle fusions are been described and new methods are still evolving In resource poor set up many patients present late and ankle replacement remains a challenge.

3. methodology Review of files of all patients who underwent primary open ankle fusion irrespective of the cause from Jan 2013-Dec 2015 Approval from kikuyu hospital ethics committee was obtained Recruitment was case based and data from the files were used

4. following data was retrieved age Sex Reason of fusion Post fracture what treatment was used for it and contact with a medical personnel after fracture Talar shift and presnce of OA on radiograph Post operative follow up

5. results A total of 40 patients 22 male and 18 female patients Mean age group was 45 years Most common cause was previous ankle fracture 95% cast applied 36/40 90% for unstable ankle fractures and failed implant accounted 5% of all ankle fractures

6. Talar shift of more than 2mm was found in 82% of patient and evidence of OA in 95% of patients preoperatively

7. Post op 8 patients had wound complications dehiscence and surgical site infection.(20%) while 5 patients had failed implant with cut out most common (12%) 3 patients had non union of the fusion and 2 patients had adjacent OA

9. discussion While hip and knee OA is predominantly degenerative, 80% of ankle arthritis is post traumatic which was consistent with this study.(Hefti, Morrey). Hefti F, Baumann J, Morscher EW (1980) Ankle joint fusion: determination of optional position by gait analysis Morrey BF, Wiedermann GP (1980) Complications and longterm results of ankle arthrodesis following trauma. J BoneJoint Surg Am 62: 777–784

10. Most of the patients were males as compared to females which was consistent to post traumatic arthritis Majority of patients had contact to medical personnel during the initial fracture and cast applied for unstable fractures.

11. A study published in the Journal of Bone and Joint Surgery (JBJS) in 1976 revealed that in 23 dissected tibiotalar articulations, in which the talus was laterally displaced just 1 mm, the contact area decreased 42%.(Ramsey) Reduced contact area, in turn, can increase joint stress—a risk factor for cartilage damage. Our study showed majority with talar shift had osteoarthritic features.

12. Our study showed lower rates of non union and infection consistant with amny studies using screw fixation (Marcus et al, Monroe et al [61])

13. conclusion Most of the fusions conducted were secondary to inappropriate management of the ankle fractures despite passing through the hands of clinicians. There is a need of a guideline in management of these fracture. For decades, ankle arthrodesis has been the principal option for treating debilitating end- stage osteoarthrosis or arthritis of the ankle, and it may continue to be a standard operative treatment for selected cases of severe post- traumatic ankle osteoarthrosis.

14. references 1.Scranton PE, An overview of ankle arthrodesis, clin orthop. 1991 2.Gowda BSN, Kumar JM ankle outcomes of ankle athrodesis in postraumatic arthritis,2012 46(3) :317-320 3. Hefti F, Baumann J, Morscher EW (1980) Ankle joint fusion: determination of optional position by gait analysis 4.Morrey BF, Wiedermann GP (1980) Complications and longterm results of ankle arthrodesis following trauma. J BoneJoint Surg Am 62: 777–784 5.Marcus RE, Balourdas GM, Heiple KG (1983) Ankle arthrodesis by chevron fusion with internal fixation and bone grafting. J Bone Joint Surg Am 65: 833–838. 6.Morrey BF, Wiedermann GP (1980) Complications and long-term results of ankle arthrodesis following trauma. J Bone Joint Surg Am 62: 777–784. 7. Ramsey PL, Hamilton W. Changes in tibiotalar area of contact caused by lateral talar shift, journal Bone Joint Surgery (Am). 1976;58:356.