van den Heuvel SBN, et al. - Studies have described a wide variation of surgical options, complications and union raters in the treatment of end-stage ankle arthritis. However, the golden standard for ankle arthritis remains open ankle arthrodesis. In this single-center retrospective study, the union rate and complication rate were investigated in patients with end-stage ankle arthritis of different etiology. In addition, potential risk factors for different methods of fixation were sought. In total, they included 42 ankles of 41 patients with ankle osteoarthritis; mean age: 50 years (range, 22-75 years). Screw-fixation was done for treating 20 patients, 14 were treated with plate(s) and 8 with intramedullary nail. An overall union rate of 97.6% (41 of the 42 operated ankles) and an overall complication rate of 21.4% (9 events) were identified. Significantly higher infections were observed in the plate-fixation group when compared with screw and plates. No other significant variables were identified for incidence of complications between patients in the uncomplicated and complicated group. Good clinical results were achieved for various methods of fixation in open ankle arthrodesis. In specific, the use of intramedullary nail resulted in excellent outcomes for end-stage ankle arthritis with high union rate and a low complication rate.