Ankle Arthrodesis using Ilizarov Ring Fixator: A Primary or Salvage Procedure? An Analysis of Twenty Cases

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients.

Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in treatment by loss of preoperative symptoms and radiological union on plain radiographs of the ankle.

Results: Fusion was achieved in all patients (100%). Immediate post-operative ambulation was with full weight bearing (FWB) in 16 (83%) of the participants and non-weight bearing (NWB) in 3 patients (17%). Post-procedure 11 patients (67%) of the participants who were full weight bearing required some form of support for walking for 2-3 weeks. Post-operatively three patients had pin tract infection requiring intravenous antibiotics. Radiological union took range of 6-12 weeks, mean union time was 8 weeks. Only one patient required bone grafting due to bone loss. Average follow-up period was 10-45 months.

Conclusion: The Ilizarov technique has a high union rate and leads to general favourable clinical outcome and may be considered for any ankle arthrodesis but is especially useful in complex cases such as for revisions, soft-tissue compromise, infection and in patients with risk for non-union. Early weight bearing is an extra benefit.

Floral induction in Eucalyptus nitens

Eucalyptus nitens (Deane & Maiden) Maiden takes at least five years to initiate flower buds from seed and is an infrequent and light flowerer. Because this behavior constitutes a major impediment to breeding programs, we examined the mechanisms controlling floral induction in E. nitens, with the long-term aim of reducing generation time and increasing seed yield. Application of paclobutrazol reduced the concentration of endogenous gibberellic acid (GA) in apical tissue and enhanced the reproductive activity of grafted trees maintained outside over winter in Canberra, Australia. Grafts maintained in a warm greenhouse over winter did not produce flower buds, despite the paclobutrazol-induced reduction in GA concentration of the apical tissue. Exposing untreated grafts, which had been maintained over winter in a warm greenhouse, to low temperature the following spring reduced growth but did not induce flower bud production. Addition of GA(3) to paclobutrazol-treated grafts reduced the effect of paclobutrazol on reproductive activity.