Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail.
BACKGROUND
Tibiotalocalcaneal arthrodesis is an important salvage method for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of the talus, combined arthritis of the ankle and subtalar joint, and failed total ankle arthroplasty. This study evaluated the results of a dynamic retrograde intramedullary nail for fixation with posterior to anterior distal interlocking screws placed through the calcaneus for tibiotalocalcaneal fusion.


METHODS
Thirty-three consecutive tibiotalocalcaneal fusions were done by a single surgeon (DBT) and were stabilized with a dynamic retrograde intramedullary nail. Time to fusion, impaction of the nail relative to the intramedullary canal, nail-tibial angle, and complications were noted. Average followup was 14 months.


RESULTS
Twenty-nine of 33 feet (88%) fused at an average of 3.7 months after surgery. Average impaction of the nail was 2.3 (0.5 to 5.0) mm. Cortical hypertrophy at the tip of the rod or at the proximal interlocking screw was noted in 13 of 27 patients. A trend toward a higher nonunion rate was noted in patients with an increased nail-tibial angle.


CONCLUSIONS
Dynamic retrograde intramedullary nailing for fixation of the tibiotalocalcaneal fusions is a good method of stabilizing this complex fusion construct.
Pelton
Kevin
K
USC Department of Orthopedic Surgery, Los Angeles, CA 90033, USA.
Hofer
Jason K
JK
Thordarson
David B
DB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery; D000843:Ankle Joint / Q000601:surgery; D001168:Arthritis / Q000601:surgery; D001174:Arthrodesis / Q000295:instrumentation*; D001177:Arthropathy, Neurogenic / Q000601:surgery; D001178:Arthroplasty / Q000534:rehabilitation; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery*; D003025:Clubfoot / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D010020:Osteonecrosis / Q000601:surgery; D016879:Salvage Therapy; D013380:Subtalar Joint / Q000293:injuries / Q000601:surgery; D013628:Talus / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome