title: Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail: a report of 34 consecutive patients.
abstract: BACKGROUND
  Tibiotalocalcaneal arthrodesis is a treatment modality for severe arthrosis and malalignment of the hindfoot. Complications, such as delayed union and nonunion, are well-known risks of the procedure. Arthrodesis can be done with a plate, screws, an external fixator, or an intramedullary nail. Compression with an intramedullary nail was the focus of this report.
  
  
  METHODS
  Thirty-four consecutive patients (23 men and 11 women) with an average age range of 57 (range 25-77) years had tibiotalocalcaneal arthrodesis using retrograde intramedullary compression nail fixation. Mean followup was 24 (range 6 to 43) months. One patient died of an unrelated cause, but 30 (91%) of the remaining 33 patients answered the questionnaire.
  
  
  RESULTS
  Bony consolidation was achieved in 26 (76%) patients, the mean time to fusion being 16 weeks. Five patients (15%) had complications and seven (20%) had repeat surgery. Of the 30 patients who responded to the questionnaire, three patients (10%) evaluated the overall result subjectively as being of no benefit and 27 (90%) as improved. The visual analog scale (VAS) score for preoperative pain was 66 at rest and 83 when walking, and the mean postoperative scores were 19 and 32, respectively (p<0.001).
  
  
  CONCLUSIONS
  Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail is an effective and safe procedure for patients with severe malalignment or arthrosis of the hindfoot. It is essentially a salvage procedure, and most patients benefit from it, but excellent results are rare.
authors.affiliation: Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital PL21, FIN-90029 OYS, Oulu, Finland. tuukka.niinimaki@ppshp.fi
authors.forename: Tuukka Timo
authors.initials: TT
authors.lastname: Niinimäki
authors.forename: Tero-Matti
authors.initials: TM
authors.lastname: Klemola
authors.forename: Juhana Ilmari
authors.initials: JI
authors.lastname: Leppilahti
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D013628:Talus / Q000601:surgery; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome