Ankle arthrodesis with external fixation for septic ankle joint secondary to tuberculosis

Background: Tuberculosis (TB) of the ankle joint is a rare manifestation of musculoskeletal TB and often presents with nonspecific symptoms, leading to delayed diagnosis and treatment.Advanced cases may result in significant joint destruction, functional impairment, and long-term disability.Surgical intervention is frequently required in combination with anti-tuberculosis therapy (ATT) to maintain function and eradicate infection. Case Presentation:We report a 53-year-old woman with a history of latent TB who presented with chronic left ankle pain and swelling.Initial conservative management for presumed gout provided only partial relief.MRI demonstrated joint-space narrowing, erosions, and synovitis.Arthrocentesis confirmed TB infection.The patient was initiated on standard ATT with partial symptomatic improvement but already had severe joint destruction.Intraoperative assessment revealed mostly viable talar bone and minimal necrotic tissue, allowing a single-stage external fixation-assisted arthrodesis with autologous fibular grafting.Cultures and pathology confirmed TB with non-necrotizing granulomas.Postoperatively, ATT was continued, and the patient achieved complete fusion of the ankle joint with full pain resolution and no signs of recurrent infection at latest follow-up in May 2025 Discussion: This case highlights the diagnostic challenge of ankle TB, the importance of considering TB in chronic monoarticular joint pain, and the role of combined medical and surgical management.Single-stage external fixation arthrodesis is presented as a safe and effective technique for severe ankle TB with viable talar bone, minimizing the risks of internal hardware contamination while providing stable alignment and durable functional outcomes. Conclusion:Early recognition of ankle TB, timely initiation of ATT, and appropriate surgical intervention are critical to prevent joint collapse and restore function.Single-stage external-fixation arthrodesis represents a viable approach in advanced TB of the ankle, particularly when internal fixation poses an infection risk.