[Press-fit bone dowel arthrodesis of the ankle or the subtalar joint using a diamond bone cutting system. Surgical technique and initial results in 10 patients].

Arthrodesis of the ankle (AA) or the subtalar joint (AST) is still a necessary treatment in case of painful posttraumatic arthrosis or paresis of the muscles after compartment syndrome. Today the alloplastic ankle joint replacement does not satisfy. Many treatments of arthrodesis with minimal or extended resection of the joint surface with or without bone transplantation are described in literature. We present in detail a new developed technique of press-fit dowel arthrodesis (KDA) for the ankle and subtalar joint. After adjustment of the joint position and retention with Kirschner wires the surface of both sides of the joint surface and underlying bone is removed by a cannulated diamond bone cutting device. Dowels from the anterior iliac crest are impacted in the cutted joint defect. The dowels are 1/10 mm bigger in dimension than the primary defect in the joint surface. The surgery will be completed with a compression screw osteosynthesis, at the ankle joint transarticular through the lateral and medial malleolus, at the subtalar joint from plantar. Ten patients have treated by press-fit-KDA (female 2, male 8; AA 7, 33.6 +/- 9 y; AST 3.38 +/- 10.9 y). The indication for KDA was in nine cases a severe posttraumatic arthrosis, in one case the paretic malfunction after compartment syndrome. The arthrodesis were clinically and radiologically consolidated after 8.2 +/- 1.9 weeks. At this time the patients showed no symptoms and were fully mobilised with complete weight-bearing. The advantages of KDA: preservation of the outline of joint and hindfoot, preservation of length of the leg and outline of iliac crest, no risk for the soft tissue, quick consolidation of the arthrodesis, no need of external fixation. The technique is also suitable for other indications as presented.