Gradual Correction of Malunited Ankle Arthrodesis with the Taylor Spatial Frame

A 64 year old woman presented with pain and swelling in her right ankle. She had a closed ankle fracture that was corrected with open reduction and internal fixation 4 years prior to presentation. She underwent ankle fusion for post-traumatic arthritis, but her talus collapsed and a hindfoot fusion was then performed with a hindfoot fusion rod. After hindfoot fusion, the ankle developed a chronic infected nonunion. Ankle range of motion was within normal limits even though the ankle was supposed to be fused. She had a 5-cm limb length discrepancy (LLD) on her right side. Treatment included removal of the radiographically loose hindfoot fusion rod (locked only distally) and application of the Taylor Spatial Frame (TSF) (Smith & Nephew, Memphis, TN) for approximately 6 months to distract the nonunion. Two casts were applied sequentially, and then the patient transitioned to a custom ankle foot orthosis (AFO) with weight-bearing as tolerated. After treatment, she was given a 1-in. shoe lift to address the 3-cm LLD. Radiographs obtained 1 year after removal showed progressive bony healing at the fusion site. She did not have any appreciable range of motion at the ankle joint. Minimal dorsiflexion and plantarflexion were possible through the midtarsal joint, but this motion did not cause pain. She had limited inversion and eversion of the right subtalar joint (approximately 15 degrees of inversion and 15 degrees of eversion), but this motion was not painful.