Iliac crest bone graft with vascular pedicle for treatment of fibrous ankylosis of the ankle.

THE PROBLEM: 63-year-old man with a painful fibrous ankylosis of the left ankle in spite of two surgical attempts at arthrodesis. The subtalar joint had been fused 3 years previously during a reconstruction of the posterior tibial tendon. The severe, activity-related pain was partially due to a reflex sympathetic dystrophy. Wearing of orthopedic shoes did not relieve the symptoms; a below-knee amputation had been considered.

THE SOLUTION: Tibiotalar arthrodesis in functional position with a free pedicled iliac bone graft.

SURGICAL TECHNIQUE: Microsurgical harvesting of a pedicled iliac bone graft. Debridement of the fibrous ankylosis and transplantation of the bone graft into an anterior tibiotalar groove.

RESULT: Bony fusion within 3 months. Pain-free weight bearing. The favorable outcome persisted after 1 year.