The ankle joint is a diarthrosis between the tibia and talus, and an interosseous syndesmosis between the tibia and fibula [1]. Ankle arthritis is a frequent illness that causes a substantial socioeconomic burden to society and is linked to significant morbidity [2,3]. Ankle arthritis patients commonly appear in older adults with severe comorbidities or in younger people with previous ankle injuries leading to post-traumatic arthritis. Ankle arthritis is primarily post-traumatic [4]. The therapy of ankle arthritis following severe ankle damage might provide tough obstacles in treatment compared with other causes of arthritis [5,6]. Ankle fractures and/or persistent instability of the ankle can lead to the destruction of ankle cartilage and changed joint biomechanics, leading to the development of post-traumatic arthritis [7].

The management of ankle arthritis includes non-operative (such as activity modification, and weight reduction), intra-articular corticosteroid injections, arthroscopic ankle debridement, osteotomy, total ankle arthroplasty, and ankle arthrodesis [[8], [9], [10], [11], [12]]. Arthrodesis is usually used when pain or deformity persists, arthrodesis may be appropriate to alleviate discomfort or restore foot function. Ankle arthrodesis is a reliable treatment for ankle arthritis, with healing rates ranging from 85 to 100% when sophisticated surgical techniques are used on appropriately selected patients [13]. Sangeorzan et al. have reported that 103 patients achieved significant improvement in the pain, foot and ankle ability, and overall function at 48 months after surgey [14]. Li et al. have evaluated the postoperative outcomes of 63 patients with varus ankle osteoarthritis who underwent Ilizarov ankle arthrodesis, all ankles were achieved bony fusion, and the mean fusion time was 12.43 ± 1.99  weeks, the AOFAS score was increased, and the VAS score was decreased at the final follow-up [15]. With the continuous improvement of surgical techniques for ankle arthrodesis, various immobilization methods have been developed, such as arthroscopic fusion using screws and open reduction and internal fixation, while each method has certain disadvantages. Clinical studies have shown that 20 patients with severe comminuted tibial pilon fractures who underwent primary ankle fusion had a varus malunion rate of 10%, a fusion rate of 100%, a low complication rate, and high satisfaction [16]. Furthermore, the comparison of the outcomes of various arthrodesis for traumatic ankle arthritis therapy is unclear.

In this study, we assessed the effects of ankle arthrodesis with various internal fixation methods in treating post-traumatic osteoarthritis in the aspects of operation-related indicators, deformation recovery, bone fusion, pain relief, and complications. Our findings may reveal the advantages of different fixation methods, providing guidance for the treatment of traumatic arthritis.