Ankle Arthrodesis Using a Vertical Steinman’s Pin in a Severely Osteopenic Bone

Background: Ankle arthrodesis is generally considered the gold standard for the treatment of a painful arthritic ankle not responding to conservative treatment. The goal is to eliminate pain and achieve a stable plantigrade foot. There are over 30 different methods of ankle fusion to date. We utilized a technique of placing one smooth Steinman’s pin across the ankle joint after excising the articular cartilage and aligning the joint in patients with severely osteoporotic bone where screws did not have good purchase.
Methods: A retrospective study was undertaken of patients done ankle fusion between 2007 and 2010 at PCEA Kikuyu Hospital. Biodata, indications for surgery, complications, and functional as well as radiological outcome were analyzed.
Results: Thirty three patients were evaluated, 17 males and 16 females. The age of the patients ranged from 11 to 80 years (mean 50). Ankle arthrodesis was done for ankle arthritis in most cases. Follow up period ranged from 2 to 5 years (mean 3 years and 2 months). At 12 weeks postoperatively 31(94%) joints were fused clinically and radiologically. The two (6%) cases of nonunion required revision surgery with bone grafting and screw fixation. However one of these patients declined further surgery. There was one case of pin site infection and one case of cellulitis. According to the Mazur ankle score at final follow-up, 22 patients (67%) had excellent results, 8 (24%) good, 2 (6%) fair and 1(3%) poor results.
Conclusion: Ankle arthrodesis using a vertical Steinman’s pin is a reliable technique in low resource settings and in patients with severely osteoporotic bone.