We evaluated the cases of twenty-six patients (twenty-six ankles) who
had had revision of an ankle arthrodesis with external fixation for a
nonunion, to determine the reasons for the failure of the previous
arthrodesis. Eighteen patients had had supplemental bone-grafting in
addition to the external fixation. The failure of the previous arthrodesis
was related to inadequate fixation technique in seven patients and to
technical problems in two patients; in the other seventeen patients at
least one risk factor was identified. We also determined the functional
results of the revision operation with external fixation for all patients.
The average duration of follow-up was five years (range, two to ten years)
in the twenty-two patients who did not have a reoperation for a persistent
nonunion. The results were excellent in eleven patients, good in five, fair
in four, and poor in six. The over-all rate of union was twenty (77 per
cent) of twenty-six, comparable with that after primary arthrodesis;
however, supplemental bone-grafting is usually necessary. In the current
series, rigid fixation, precise apposition of bone and alignment of the
foot, and early treatment of perioperative infection gave satisfactory
results.