The union rate of ankle arthrodesis using double-column plating

Background: Bone graft substitutes are often required in patients at risk for nonunion, and therefore, an allograft that most closely mimics an autograft is highly sought after. This study explored the utility and efficacy of a cellular bone allograft used for foot and ankle arthrodesis and revision nonunion procedures in a patient population at risk for nonunion. Methods: An institutional review board–approved retrospective review of consecutive patients who underwent arthrodesis and revision nonunion procedures with a cellular bone allograft was performed at a single academic institution. No external sources of funding were provided for this study. Inclusion criteria included patients who were more than 1 year after surgery or less than 1 year after surgery if they had undergone a second operative procedure for nonunion or if they had computed tomography–documented union. Forty operative procedures in 36 patients with a mean follow-up of 13 months (range, 6-25 months) were included for data analysis. All patients had at least one of the following risk factors associated with nonunion: current smoker, diabetes, avascular necrosis (AVN) of the involved bone, active same-site operative infection, history of nonunion, previous same-site surgery, or gap of 5 mm or greater after joint preparation. The primary outcome was radiographic union. Results: The union rate in this high-risk population was 83% (33/40). Univariate analysis demonstrated that the use of a cellular bone allograft helped mitigate the presence of risk factors known to cause nonunion. There was no significant difference in fusion rates among groups with current smoking, AVN of the involved bone, active same-site operative infections, history of nonunion, rheumatoid arthritis on medication, previous same-site operative procedures or infections, or a gap of 5 mm or greater after joint preparation. However, in this population, diabetic and female patients remained at a high risk of recurrent nonunion ( P = .0015), despite the use of a cellular bone allograft. Chi-square analysis of patients with increasing numbers of risk factors directly correlated with an increased risk of nonunion ( P = .025). Four wound complications were reported in this cohort that required irrigation and debridement (10%). Conclusion: These data demonstrated a union rate of 83% in patients with risk factors known to cause nonunion. The benefits of the use of a cellular bone allograft allowed for the avoidance of morbidity associated with autograft harvesting while still improving the local biology to facilitate fusion in a difficult patient population to attain a successful fusion mass. Level of Evidence: Level IV, retrospective case series.

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PO 18188 - Ankle arthrodesis via a transfibular approach and circular external fixation

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1026 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 37S

Author(s):

Rodrigo Yuzo Masuda ◽

Vinícius Felipe Pereira ◽

Nacime Salomão Barbachan Mansur ◽

Hilário Boatto ◽

Hélio Pereira da Cunha Neto ◽

...

Keyword(s):

Ankle Arthrodesis ◽

Functional Restoration ◽

Ilizarov Method ◽

Union Rate ◽

Aofas Score ◽

Circular External Fixator ◽

Ilizarov Apparatus ◽

Vas Scores ◽

The Mean

Objective: To present the radiographic and functional outcomes of a series of 11 cases of ankle arthrodesis operated on with a circular external fixator using the Ilizarov method and a transfibular approach from January 2017 to June 2018. Methods: The patients were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) scores. Anteroposterior and profile views of the ankle radiographs were evaluated. All patients underwent a similar procedure in terms of the surgical approach and assembly of the Ilizarov apparatus. Results: During the study period, 11 cases underwent surgery; the mean age was 44.81 years (28-70 years). The mean follow-up time was 50.81 weeks (13-90 weeks). The main indication for surgery was posttraumatic secondary arthritis. The mean functional AOFAS score was 55.72 (45-64) points. Soft-tissue evaluation revealed surgical wound healing of the transfibular approach in 9 patients (81%). All patients showed signs of superficial pin- or wire-tract infection. Union was reported in 10 patients (90.9%), and the radiographic varus deformities found in 2 patients did not exceed 7º. No additional surgical procedure was required during follow-up. Conclusion: Ankle arthrodesis using a transfibular approach and fixation using the Ilizarov method were efficient, promoted functional restoration considering the complexity of the cases, and resulted in a high union rate.

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Combined Transfibular and Anterior Approaches Increase Union Rate and Decrease Non-Weight-Bearing Periods in Ankle Arthrodesis: Combined Approaches in Ankle Arthrodesis

Journal of Clinical Medicine ◽

10.3390/jcm10245915 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5915

Author(s):

Jeong-Jin Park ◽

Whee-Sung Son ◽

In-Ha Woo ◽

Chul-Hyun Park

Keyword(s):

Weight Bearing ◽

Good Method ◽

Clinical Results ◽

Ankle Arthrodesis ◽

Ankle Arthritis ◽

Union Rate ◽

Anterior Plate ◽

Hindfoot Alignment ◽

Additional Surgery ◽

End Stage

The transfibular approach is a widely used method in ankle arthrodesis. However, it is difficult to correct coronal plane deformity. Moreover, it carries a risk of nonunion and requires long periods of non-weight-bearing because of its relatively weak stability. We hypothesized that the transfibular approach combined with the anterior approach in ankle arthrodesis wound yield a higher fusion rate and shorter non-weight-bearing period. This study was performed to evaluate the clinical and radiographic results and postoperative complications in ankle arthrodesis using combined transfibular and anterior approaches in end-stage ankle arthritis. Thirty-five patients (36 ankles) with end-stage ankle arthritis were consecutively treated using ankle arthrodesis by combined transfibular and anterior approaches. The subjects were 15 men and 20 women, with a mean age of 66.5 years (46–87). Clinical results were assessed using the visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) scores, and the ankle osteoarthritis scale (AOS) preoperatively and at the last follow-up. Radiographic results were assessed with various radiographic parameters on ankle weight-bearing radiographs and hindfoot alignment radiographs. All clinical scores significantly improved after surgery. Union was obtained in all cases without additional surgery. Talus center migration (p = 0.001), sagittal talar migration (p < 0.001), and hindfoot alignment angle (p = 0.001) significantly improved after surgery. One partial skin necrosis, two screw penetrations of the talonavicular joint, and four anterior impingements because of the bulky anterior plate occurred after surgery. In conclusion, combined transfibular and anterior approaches could be a good method to increase the union rate and decrease the non-weight-bearing periods in ankle arthrodesis.

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Does Open versus Arthroscopic Surgical Technique Affect the Union Rate of Tibiotalar Arthrodesis?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00092 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Surgical Technique ◽

Arthroscopic Surgery ◽

Wound Complication ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Union Rate ◽

Significant Difference ◽

Tibiotalar Arthrodesis ◽

Open Versus

Category: Arthroscopy Introduction/Purpose: To date, there are only a handful of studies directly comparing outcomes of open versus arthroscopic ankle arthrodesis. Major limitations of these studies are small patient cohorts, lack of long-term follow-up, lack of assessment pre-operative patient demographics and imaging, and post-operatively evaluation of clinical outcomes but not union rates. The purpose of this clinical study is to compare the rate of union in ankle fusions in patients that underwent open arthrodesis to those that underwent arthroscopic arthrodesis. The hypothesis of this study was that there would be no difference in union rate in patients that underwent open versus arthroscopic arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. One hundred twenty-five ankles from 121 patients met inclusion criteria. These patients underwent primary tibiotalar arthrodesis without the use of autograft. Fifty-nine patients underwent open tibiotalar arthrodesis and 66 patients underwent arthroscopic tibiotalar arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: One hundred twenty-one patients (125 ankles) were available for final follow-up. Average age of the patients was 55.3 +/- 17.2 years. Mean follow-up time was 35.4 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had open surgery was 10/59 (17%) and nonunion rate of those who had arthroscopic surgery was 13/66 (20%) (p=0.69) [Table 1]. There was a statistically significant difference between those who had open versus arthroscopic surgery in wound complication rate (39% vs 6%, p=<0.001) and DVT rate (7% vs 0%, p=0.047). There was no statistically significant difference in rate of return to the operating room. No major complications occurred in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had open versus arthroscopic ankle arthrodesis. In this study, no significant association was found between surgical technique and union rate in patients undergoing ankle arthrodesis. Additionally, use of the arthroscopic technique has significantly lower rates of wound complication and post-operative DVTs.

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Union of Foot/Ankle Arthrodesis: A Registry Study of Low-Intensity Pulsed Ultrasound (LIPUS)

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00488 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0048

Author(s):

Neil J. White ◽

Johnny T. Lau ◽

Kevin Ong ◽

Steven M. Kurtz ◽

Sheldon S. Lin

Keyword(s):

Risk Factors ◽

Treatment Success ◽

Ankle Arthrodesis ◽

Current Smoker ◽

X Rays ◽

Union Rate ◽

Pulsed Ultrasound ◽

Chi Square ◽

Non Union ◽

Post Market

Category: Ankle; Hindfoot; Midfoot/Forefoot; Trauma. Introduction/Purpose: To aid in healing and avoid costly revision surgery, bone grafts, growth factors, and bone stimulation devices are used as adjuncts to foot/ankle arthrodesis. This study evaluated the union rates of LIPUS as an adjunct to foot/ankle arthrodesis and the corresponding factors associated with improved healing. Methods: Foot/ankle arthrodesis patients were identified retrospectively from a prospective post-market arthrodesis/fracture registry for EXOGEN (Bioventus LLC, Durham, NC). Inclusion criteria were males or non-pregnant females 18 years of age or older at time of enrollment, known date of fracture, known start and end dates of LIPUS treatment, and known treatment success outcome. Treatment success was defined by both clinical (solid and pain-free on manual stress) and radiological (at least 3 of 4 cortices bridged on x-rays) criteria. Association between union rates and surgical treatments, comorbidities, and medications was tested with Chi-square tests. Results: A total of 235 primary and 16 revision foot/ankle arthrodesis patients used EXOGEN. 41.4% used EXOGEN within 90 days of the fracture/arthrodesis. Overall union rate was 86.9% (primary: 86.4%; revision: 93.8%). Having the comorbidity of diabetes, obesity, or current smoker was not associated with a higher non-union rate (p=0.779). Other comorbidities were also not associated with increased non-union rates (e.g., Charcot disease p=0.614, NSAID p=0.862, steroids p=0.647). EXOGEN use within 90 days of the fracture/procedure date was associated with improved union rates for the overall (p=0.004, odds ratio (OR) 3.7 (95% CI: 1.5-9.3)) and primary (p=0.007, OR 3.4 (95% CI: 1.3-8.6)) groups. For the overall group, union rates were 94.2% (EXOGEN use <=90 days post-fracture/procedure), 80.6% (91 to 365 days), and 84.6% (>365 days). Conclusion: Union rates for foot/ankle arthrodesis with adjunctive LIPUS were comparable to other therapies with and without other adjuncts (Table 1). Known risk factors for non-union, such as smoking and Charcot disease, were not found to be associated with healing for the LIPUS patients. This suggests the possibility that LIPUS was able to mitigate potential patient risk factors and may offer a low risk post-operative adjunct in difficult healing scenarios. [Table: see text]

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Does Use of Demineralized Bone Matrix Affect the Union Rate in Arthroscopic Ankle Fusions?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00368 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0036

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Chong Zhang ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Operating Room ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Secondary Outcome ◽

Wound Complications ◽

Union Rate ◽

Demineralized Bone

Category: Ankle Introduction/Purpose: Despite DBM having positive effects on union rates in other subspecialties of orthopaedics, there is a general lack of evidence about bone graft substitutes in foot and ankle surgery. To our knowledge, orthopaedic surgeons have never evaluated the use of demineralized bone matrix (DBM) as it pertains to the union rate of arthroscopic ankle fusions. The purpose of this clinical study is to compare the rate of union in arthroscopic ankle fusions in patients that have had DBM to those without DBM. The hypothesis of this study was that use of DBM would increase the union rate in all patients undergoing arthroscopic ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. Seventy-one ankles from 68 patients met inclusion criteria. These patients underwent primary arthroscopic ankle arthrodesis. Forty patients had DBM and 31 patients did not have DBM. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of arthroscopic ankle arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Seventy-one patients were available for final follow-up. Average age of the patients was 55.3 +/- 17.6 years. The mean follow-up time was 39.5 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. Nonunion rate of patients who did have DBM was 7/40 (18%) and nonunion rate of those who did not have DMB was 8/31 (26%) (p=0.40). There was no statistically significant difference between those who did have DBM and those who did not have DBM in wound complication rate (5% vs 6%, p=1.0), rate of return to the operating room (35% vs 39%; p=0.75), and DVT rate (0% vs 0%), respectively. There were no major complications in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had DBM versus those who did not in the setting of arthroscopic ankle fusion. In this study, use of DBM does not affect union rate in patients undergoing arthroscopic ankle arthrodesis. Additionally, use of DBM does not affect the rate of wound complications, return to the operating room, and development of post-operative DVT.

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PO 18164 - Subtalar arthrodesis with bone graft

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1023 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. S34

Author(s):

Henrique Mansur ◽

Gil Galvão Bernardes Silveira ◽

Isnar Moreira De Castro Junior

Keyword(s):

Bone Graft ◽

Donor Site ◽

Ankle Arthrodesis ◽

Foot And Ankle ◽

Union Rate ◽

Subtalar Arthrodesis ◽

Significant Difference ◽

Different Types ◽

Bone Autograft

Introduction: The bone graft is an important component of foot and ankle arthrodesis and is used in conditions in which the biological system is known to be unfavorable and scraping the joint will cause a considerable structural defect. The objective was to evaluate the union rate of subtalar arthrodesis in smokers and nonsmokers and to determine the effect of the use of different types of bone autografts. Methods: Retrospective study with radiological evaluation of patients diagnosed with subtalar arthrosis who underwent primary arthrodesis from January 2008 to December 2014. All patients with a minimum follow-up period of 12 months were included and were divided into smokers and nonsmokers treated with or without autologous bone grafting. Results: In total, 235 patients with a mean age of 47 years were evaluated; whom 90 (40%) were smokers, and 141 (60%) were nonsmokers. In 221 (94%) cases, the indication for arthrodesis was sequelae of calcaneal fractures. A bone graft was used in 27.7% patients. The overall union rate was 85.4%, and 14.6% of the patients developed pseudarthrosis. A significant difference was found in the nonunion rate of smokers versus nonsmokers (p=0.015), especially in those who did not receive a bone graft (p=0.014). However, no significant difference was found between smokers who received a bone graft and those who did not (p=0.072). The union rate was related to the donor site, with pseudarthrosis observed in 33.3% of surgeries involving a calcaneal autograft (p=0.011). Conclusion: Smoking increased the likelihood of pseudarthrosis in subtalar arthrodesis by 2.5 fold, and pseudarthrosis was related to the bone autograft donor site.

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Union of foot/ankle Arthrodesis: A Registry Study of Low-intensity Pulsed Ultrasound (LIPUS)

10.21203/rs.3.rs-150269/v1 ◽

2021 ◽

Author(s):

Neil White ◽

Johnny Lau ◽

Kevin Ong ◽

Steven Kurtz ◽

Sheldon Lin

Keyword(s):

Risk Factors ◽

Treatment Success ◽

Ankle Arthrodesis ◽

Current Smoker ◽

Primary Group ◽

Union Rate ◽

Pulsed Ultrasound ◽

Non Union ◽

Low Intensity Pulsed Ultrasound ◽

Low Intensity

Abstract Background: Bone grafts and bone stimulation devices are used as adjuncts to foot/ankle arthrodesis to improve healing and reduce revision risk. Union rates of low-intensity pulsed ultrasound (LIPUS) and the factors associated with improved healing were evaluated. Methods: From a prospective arthrodesis/fracture registry for EXOGEN (Bioventus LLC), treatment success for foot/ankle arthrodesis patients were was evaluated, based on both clinical (solid and pain-free on manual stress) and radiological (3 of 4 cortices bridging) criteria. Associations between union rates and surgical treatments, comorbidities, and medications were tested.Results: EXOGEN was used by a total of 235 primary and 16 revision foot/ankle arthrodesis patients. Of these, 41.4% used EXOGEN within 90 days of the fracture/arthrodesis. EXOGEN use within 90 days of the fracture/arthrodesis was associated with improved union rates (overall group (p=0.004, odds ratio (OR) 3.675 (95% CI: 1.459-9.258)); primary group (p=0.007, OR 3.383 (95% CI: 1.335-8.574))). The overall union rate was 86.9% (primary: 86.4%; revision: 93.8%). Patients with the comorbidity of diabetes, obesity, or current smoker were not associated with a higher non-union rate (p=0.779). Other comorbidities were not associated with increased non-union rates (Charcot disease p=0.614, NSAID p=0.862, steroids p=0.647). For all patients, union rates were 94.2% (EXOGEN use ≤90 days post-fracture/arthrodesis) and 81.6% (>90 days). Conclusions: Union rates for foot/ankle arthrodesis with adjunctive LIPUS were comparable to other therapies. Known patient risk factors for non-union were not found to be associated with impaired healing for the LIPUS patients, suggesting the possibility that LIPUS may mitigate these known risk factors.

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Comparison of Non-Union and Complication Rates in Primary versus Revision Tibiotalar Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00091 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Julie Neumann ◽

Maxwell Weinberg ◽

Charles Saltzman ◽

Alexej Barg

Keyword(s):

Operating Room ◽

Ankle Arthrodesis ◽

Rate Of Return ◽

Wound Complications ◽

Complication Rates ◽

Ankle Arthritis ◽

Union Rate ◽

Tibiotalar Arthrodesis ◽

Complications Rate

Category: Ankle Arthritis Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. Patients with a nonunion often undergo revision ankle arthrodesis, as it is the most common salvage procedure in this situation. To date, only a few studies have evaluated outcomes in patients with revision ankle arthrodesis. The purpose of this clinical study is to directly compare the rate of union and complications in primary versus revision tibiotalar arthrodesis. The hypothesis of this study was that there would be no difference in rate of union and complications between primary and revision ankle arthrodesis. Methods: This is a retrospective review of 455 consecutive patients that underwent either primary or revision tibiotalar arthrodesis between March 2002 to November 2014. Three-hundred eighty-five patients underwent primary arthrodesis and 70 patients underwent revision arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: Average age of the patients was 56 +/- 15 years (range 18-89). The mean follow-up time was 38.3 +/- 27.4 months (range 12-150.4 months). All patients had a minimum follow-up of 12 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, patients were further assessed with a computerized tomography scan. The nonunion rate of patients who had primary arthrodesis was 37/385 (9.6%) and revision arthrodesis was 6/70 (8.5%) (p=0.74) (Table 1). Additionally, there was not a significant difference between those who had primary versus revision ankle arthrodesis surgery in rate of wound complication, return to the operating room, and post-operative DVT (Table 2). There were no major complications in this study. Conclusion: This is the largest study to directly compare union rates and complication rates in patients who underwent primary versus revision ankle arthrodesis. In this study, primary versus revision tibiotalar arthrodesis does not affect union rate, time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative DVT.

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Vitamin D Management and Nonunion in Elective Foot and Ankle Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00197 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0019

Author(s):

Benjamin J. Ebben ◽

Andrew E. Brooks ◽

Natalie M. Gaio ◽

Kathryn L. Williams

Keyword(s):

Vitamin D ◽

Bone Health ◽

Perioperative Period ◽

Hypovitaminosis D ◽

Ankle Arthrodesis ◽

Senior Author ◽

Vitamin D Status ◽

Foot And Ankle ◽

Union Rate ◽

Vitamin D Levels

Category: Other; Ankle; Ankle Arthritis; Bunion; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Bone health and more specifically, vitamin D status, have become a focus across multiple orthopedic subspecialties as a modifiable determinant of health. Improved bone health and nutritional optimization can function preventatively by curtailing problems such as osteoporotic fractures but can also function to optimize operative outcomes contingent upon successful bone-to-bone healing, such as arthrodesis. Investigations on this topic are relatively lacking in the orthopedic foot and ankle literature and to date, are limited mostly to epidemiologic study designs that have reported on prevalence of hypovitaminosis D. To the best of our knowledge, there have been no attempts to associate vitamin D status with nonunion and no inquiries into the perioperative management strategies for hypovitaminosis D in the elective foot and ankle arthrodesis population. Methods: Records from all elective foot and ankle arthrodesis procedures performed by the senior author between 2013 and 2019 were obtained. These procedures ranged in complexity from single joint hallux interphalangeal arthrodesis to multiple joint deformity correction arthrodesis. It has been standard practice for the senior author to obtain a preoperative vitamin D level on all patients indicated for arthrodesis and treat accordingly during the perioperative period for cases of hypovitaminosis D (<30 ng/mL). We retrospectively reviewed the medical records for a total of 113 arthrodesis procedures. We recorded patient demographics, comorbidities, BMI, arthrodesis type, vitamin D level, perioperative vitamin D supplementation and the outcome as union or nonunion. We reviewed all postoperative radiographs and computed tomography when available. We defined nonunion as reoperation or planned reoperation for revision arthrodesis or definitive clinical or radiographic evidence of nonunion with ongoing symptomatic treatment. All other cases were considered to have achieved union. Results: A total of 113 arthrodesis procedures (105 patients) were reviewed. The mean preoperative vitamin D level was 33. Vitamin D levels were normal in 56.6% (64/113) of patients. Forty-nine patients had hypovitaminosis D. Thirty-two (28.3%) were considered insufficient and the other 17 (15.1%) deficient (<20 ng/mL). All patients with hypovitaminosis D were prescribed a 4- week regimen of ergocalciferol during the perioperative period and then maintenance doses, thereafter. Of the 113 procedures, 106 (93.8%) were determined to achieve union by the time of last follow up. There were 7 (6.2%) nonunions. Patients treated for hypovitaminosis D went on to achieve union at a rate of 93.9% (46/49) which was similar to the union rate of 93.8% (60/64) observed in patients with normal preoperative vitamin D levels. Conclusion: The prevalence of hypovitaminosis D in this population was high but consistent with previous literature in foot and ankle patients. The overall nonunion rate of 6.2% was also consistent with previous investigations. We found no difference in union rate when including all elective foot and ankle arthrodesis procedures between patients with preoperative hypovitaminosis D and those with normal vitamin D levels. The perioperative vitamin D management protocol employed by the senior author appears to be an effective approach for nonunion risk modification. Hypovitaminosis D, alone, should not be a reason to deny or delay elective foot and ankle arthrodesis surgery.

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