title: Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail.
abstract: BACKGROUND
  Tibiotalocalcaneal fusion with a straight rod has a risk of damaging the lateral plantar neurovascular structures and may interfere with maintaining normal heel valgus position.We report the results of a prospective study of tibiotalocalcaneal (TTC) arthrodesis with a short, anatomically curved interlocking, intramedullary nail.
  
  
  METHODS
  Forty-five arthrodesis in 42 patients, performed between Jan 2003 and Oct 2008, were prospectively followed. The mean followup was 48 (range, 10 to 74) months. The main indications for the procedure were failed ankle arthrodesis with progressive subtalar arthritis, failed ankle arthroplasty and complex hindfoot deformity. The outcome was measured by a combination of pre and postoperative clinical examination, AOFAS hindfoot scores, SF-12 scores and radiological assessment.
  
  
  RESULTS
  Union rate was 89% (40/45). Eighty-two percent (37/45) reported improvement in pain and 73% (33/45) had improved foot function. Satisfactory hindfoot alignment was achieved in 84% (38/45). Postoperatively there was a mean improvement in the AOFAS score of 37. Complications included a below knee amputation for persistent deep infection, five nonunions, and three delayed unions. Four nails, six proximal and six distal locking screws were removed for various causes. Other complications included two perioperative fractures, four superficial wound infections and one case of lateral plantar nerve irritation.
  
  
  CONCLUSIONS
  With a short, anatomically curved intramedullary nail, we had a high rate of tibiotalocalcaneal fusion with minimal plantar neurovascular complications. We believe a short, curved intramedullary nail, with its more lateral entry point, helped maintain hindfoot alignment.
authors.affiliation: Avon Orthopaedic Centre, Orthopaedics, Southmead Hospital, Bristol, Avon BS10 5NB, United Kingdom. vijbud@yahoo.com
authors.forename: Vijaya M
authors.initials: VM
authors.lastname: Budnar
authors.forename: Steve
authors.initials: S
authors.lastname: Hepple
authors.forename: William G
authors.initials: WG
authors.lastname: Harries
authors.forename: James A
authors.initials: JA
authors.lastname: Livingstone
authors.forename: Ian
authors.initials: I
authors.lastname: Winson
mesh_terms: D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D013640:Tarsal Joints / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome