[Hindfoot arthrodesis resulting from retrograde medullary pinning].
BACKGROUND
Simultaneous arthrodesis of the ankle and subtalar joints and correction of axial malalignment of the hindfoot in cases of bony defects and/or circulatory disturbances of the talus after multiple previous interventions. Internal stabilization with a short distal femur nail. Restoration of pain-free weight bearing. Failure of arthrodesis of the ankle and subtalar joint in patients with severely altered bone structure particularly at the level of the talar dome. Malalignment of hind- and/or forefoot after previous arthrodesis of the ankle and subtalar joint. Poor skin or soft-tissue condition. Acute osteitis/osteomyelitis.


METHODS
Posterolateral approach. Resection of the articular cartilage and the areas of sclerosis of the ankle and posterior facet of the subtalar joint. Interposition of bone grafts harvested from the posterior iliac crest. Correction of malalignment of the hind- and forefoot. Locked nailing with a short distal femur nail.


RESULTS
All 21 prospectively enrolled patients were followed-up clinically and radiographically at an average of 1.2 years (0.6-2.1 years) postoperatively. The average age of the 4 women and 17 men at the time of surgery was 53.4 years (38.9-73.7 years). The goal of the surgery was achieved in all patients. Subjective assessment was good in 14 patients and satisfactory in 3 patients. Complications occurred in 5 patients; these included loss of nail purchase (2), dislocation of locking screw (1), breakage of locking screw (1), and nonunion (1).
Grass
R
R
Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Dresden. Rene.Grass@uniklinikum-dresden.de
Rammelt
S
S
Heineck
J
J
Zwipp
H
H
D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods*; D001858:Bone Nails; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome