This video is on the four main ways you can do an ankle fusion. To help demonstrate that i'm going
to draw an ankle just here on the left. I'm going to mark up the anatomy again, so the big bone
there is the tibia, the bone next to it is the fibula. It takes about an eighth of your weight
and then the bone below those two bones is called the talus. It's the square type of bone
just there. Underneath that is your heel bone and the two bones that are involved
in the ankle fusion are the tibia bone and the talus. So the square bone and the shin bone.
We're just going to draw that on a diagram just here, so you can see that there's no longer a gap
between the talus and the tibia, marked there by the red arrow. That means that those two
bones are brought together and the bone basically crosses the area. Those two bones become one now.
Just to demonstrate that further in the photo on the left. That there is cartilage. Looking
at the ankle from the direction of the eyes and into the front there. So that pearly stuff that
you see on the diagram there is going to have to be removed, on the left where the arrow is.
That has to go in order to allow the bone to be exposed so that the bone crosses the tibia and
the talus, so that there is no longer a gap there. Those two bones become one. Now the first way of
actually doing this type of operation is something called a fibular osteotomy method. That's probably
the most common. What that means is actually taking part of the fibula off, in order to
gain access to the joint, so the cartilage can be removed. We can see that in the left diagram, the
fibula end has been removed and that allows access to the joint, where the arrow is there.
Then screws are placed across the tibia and the talus, in order to make them one bone. Now to
demonstrate that better, here's the diagram again, but this is what it looks like on an x-ray. So
you can see part of the fibula is missing there, although that diagram does have an extra screw.
Now the cuts for this procedure. One is on the little toe side of the ankle and then another
one over the big toe side of the ankle, at the front. As you see on the diagram on the right,
the second way of doing this procedure is something called an arthroscopic ankle fusion,
which means putting a camera into the ankle and burring away the cartilage.
So the wounds are pretty small. The same bones are fused as we saw in the previous method,
it's just the way of doing it has changed, in order to have smaller cuts. So you can see here,
the cuts are much smaller, there's two sort of one centimetre cuts at the front.
Sometimes it's technically more challenging procedure for the surgeon.
Once again we see on the diagram on the left here, which shows the cartilage. I'm just going to mark
out sequentially what that corresponds to each part on the diagram. So that's the tibia, where
I've marked there. Then the next one i'm going to mark is the talus. So the talus is a square bone.
Then the next one is the fibular bone. So the picture on the left is actually looking at the
ankle from the front and the fibula is just there. We're going to mark it on the picture just there,
so all those white pearly areas are going to have to be removed with something called a burr, which
is at the bottom of the page there. That takes away that cartilage, and that means you have a
fairly small wound, but the fixation or the screws we put in are exactly the same. What you'll notice
is the fibula remains intact, which is different to the procedure we previously described. That
is an advantage because the wounds are smaller and the fibula is left intact. Now the third method is
something called an anterior ankle fusion and that involves a cut right over the front of the ankle,
mostly over the center. That means we're going to try and avoid nerves and arteries on our way
into the ankle. So the method of getting there is different, usually it's a plate and screws rather
than screws itself put into the ankle. This is what it looks like from the front. If you look at
it from the side, this is what it looks like from the side. There's a plate, a big bulky plate going
over the front there, but often it is a very solid construct and very solid fusion and works actually
very well. It's just a little bit harder to get into the ankle because you've got to go near some
dangerous structures. The fourth method of getting in there is something called a posterior ankle
fusion, and it's the least likely to be used. It's really only used in patients that have got
some sort of issue with the wound or problems at the front of the ankle. As you can see, there's
a cut over the back. Now this plate here, that we can see on the left, is at the back, and this is
looking at it from the side. The plate there is sitting right at the back of the ankle and that's
how it would be held together. So you can see that the bones that we fuse are the same in all four
approaches but it's just the way of getting there that's different. I hope you enjoyed this video,
so please take a look at our other video here on ankle fusion. Alternatively, please subscribe to
the foot and ankle orthopedic surgeon, we really appreciate your listening and thanks once again.