Ankle arthrodesis in Awka, Nigeria: Indications and treatment with unlocked retrograde intramedullary nailing and other methods

introduction: Ankle arthrodesis is a key treatment for severe osteoarthritis, often preceding ankle arthroplasty. Nonsurgical options include lifestyle adjustments and NSAIDs, while surgical options range from debridement to arthrodesis. In Nigeria, ankle arthroplasty availability is limited, making arthrodesis the primary solution. Various techniques exist, with open and arthroscopic approaches yielding successful outcomes but varying in complexity and recovery. This study investigates the prevalence, treatment methods, and outcomes of ankle arthrodesis in Awka, Southeast Nigeria.
Methodology: The study, conducted in an Orthopaedic Hospital in Awka, Southeast Nigeria, was a prospective cohort study spanning five years (2017-2022). It included 33 patients with various ankle pathologies screened for suitability of ORIF or arthrodesis. Surgeries were conducted under aseptic conditions, utilizing unlocked retrograde intramedullary nails, a dynamic compression plate, and an external fixator. Patients maintained non-weight bearing until radiological union, with implants removed based on individual patient preference and informed consent.
Results: Thirty-three patients requiring ankle surgery, with a mean age of 41.44 years were seen between 2017 and 2021. The causes of ankle pathologies included road accidents being the predominant cause (45.5%). The treatment methods were ORIF with intramedullary nails, dynamic compression plates and screws, and an external fixator. ORIF with intramedullary nails was the most common (57.6%). There were 8 subjects who needed ankle arthrodesis, with a mean age of 54.0 years. The prevalence rate was found to be 24.2%. The failure rate was 12.5%.
Conclusion: Ankle arthrodesis proves pivotal for severe osteoarthritis, especially in regions with limited ankle arthroplasty access like Nigeria. The prevalence of arthrodesis is 24.5%. Intramedullary nails are very effective in achieving union. Compression plates and external fixators show good results. The failure rate of fixations was 12.5%.