Background:Salvage surgery for a nonunion around the ankle is challenging. Poor bone
stock, stiffness, scarring, previous (or persistent) infection, and a
compromised soft tissue envelope are common in these patients. We describe
15 cases that underwent blade plate fixation as salvage for a nonunion
around the ankle, including patient/nonunion characteristics, Nonunion
Scoring System (NUSS), surgical technique, healing rate, complications, and
long-term follow-up with 2 patient-reported outcome measures.Methods:This is a retrospective case series from a level 1 trauma referral center. We
included all patients that underwent blade plate fixation for a
long-standing nonunion of the distal tibia, talus, or failed subtalar
fusion. All patients had autogenous bone grafting, including 14 with
posterior iliac crest grafts and 2 with femoral reamer irrigator aspirator
grafting. Median follow-up was 24.4 months (interquartile range [IQR],
7.7-40). Main outcome measures were (time to) union, and functional outcomes
using the 36-item Short Form Health Survey (SF-36) physical component
summary (PCS) and mental component summary (MCS), and the Foot and Ankle
Outcome Score (FAOS).Results:We included 15 adults with a median age of 58 years (IQR, 54-62). The median
NUSS score at the time of index surgery was 46 (IQR, 34-54). Union was
achieved after the index procedure in 11 of 15 patients. Additional surgery
was performed in 4 of 15 patients. Union was achieved in all patients at a
median of 4.2 months (IQR, 2.9-11). The median score for the PCS was 38
(IQR, 34-48, range 17-58,P= .009), for the MCS 52 (IQR,
45-60, range 33-62,P= .701), and for the FAOS 73 (IQR,
48-83).Conclusion:In this series, our use of blade plate fixation with autogenous grafting was
an effective method for managing a nonunion around the ankle allowing for
alignment correction, stable compression and fixation, union, and fair
patient-reported outcome scores.Level of Evidence:Level IV, therapeutic.