EgyOrth , Orthopaedic Unit - October 6 University Hospital

The Use Of Acetabular Reamer To Harvest Bone Graft In Ankle Arthrodesis

Authors: Mahmoud A Hafez,? Ahmed M Elmorsy
October 6 University hospital, Cairo, Egypt

Bone grafting is usually required to enhance bone fusion in ankle arthrodesis. Autogenous cancellous bone from iliac crest is popular and provides an ideal bone graft material but the use of iliac crest as a donor is an additional surgical procedure and it has its own morbidity.
A simple technique for harvesting cancellous bone from the lateral malleolus is described here. This technique can be applied when transfibular lateral approach is used for ankle arthrodesis with or without medial approach. After exposure of the lateral malleolus, the outer aspect of the bone is cleared of soft tissue attachments. A small size (38 or 40 mm) powered acetabular reamer is used to harvest cancellous bone. Care must be taken to avoid damage to the skin and soft tissue around. The outer cortex of the malleolus can be stripped to expose the cancellous bone and facilitate the reaming technique. The malleolus is osteomised at the required level and removed to expose the joint surface. The desired technique of ankle fusion and the method of internal fixation are then used along with the harvested bone graft. The remaining part of the malleolus can be used as a supplementary on-lay graft if needed. This technique saves the time usually used to crush the osteomised lateral malleolus using bone nibbler, it is easy to use and readily available for every orthopaedic surgeon. Also, the osteotomy of lateral malleolus creates a better cosmetic result as it narrows the ankle and prevents bony abutment on the shoe.
The technique was used in a 35 year old male who had an old trauma resulted in a severe osteoarthritis of his left ankle and a traumatic fusion of the subtalar joint. A transfibular lateral approach was used and the above described technique was applied. An adequate amount of coticocancellous bone graft was obtained and inserted to the site of fusion. The ankle was fixed using 2 cross screws, the remaining part of the crushed malleolus was used as a supplementary on-lay graft. We did not encounter any complications and the outcome of this procedure was satisfactory. ?The patient was seen at 6-month follow up, ankle fusion was clinically and radiologically sound and he returned to work as a lorry driver. At that time he had no symptoms and he was discharged.
This technique was reported before (1) by the first author (MAH) during his work in UK but this is the first time to be used in Egypt.

1. Hafez MA, Nihal A. Fibular bone graft in ankle arthrodesis: the application of the harvested in situ technique?. Foot and Ankle Surgery. 2003;9:225-7