title: [Tibiocalcaneal arthrodesis using retrograde insertion of a compression nail].
abstract: OPERATION GOAL:                          Arthrodesis of the upper and lower ankle joint because of problematic bone positioning or failed arthrodesis. Osteosynthesis procedure using a retrograde compression nail. To achieve stable, fully weight-bearing osteosynthesis for early, pain-free mobilization.
  
  
  METHODS
  Rearthrodesis because of failure of the conventional arthrodesis technique and development of osteoarthritis of the lower ankle joint. Painful osteoarthritis of the upper ankle joint because of inadequate perfusion or a major bone defect because of sclerosis or necrosis. Primary arthrodesis because of facture of the lower leg (pilon tibial) with joint involvement and preexisting osteoarthritis.
  
  
  METHODS
  Acute osteitis/osteomyelitis, sclerosis in the marrow of the distal tibia, malalignment of the distal tibial shaft and local soft tissue inflammation.
  
  
  METHODS
  Preparation of the articular surface of the upper and lower ankle for arthrodesis using a transfibular approach. If necessary, correction of bone defects with iliac crest spongiosa. Stabile osteosynthesis by retrograde insertion of a compression nail.
  
  
  METHODS
  A split lower leg cast on the 2nd postoperative day, mobilization of the patient with underarm crutches with floor contact for 2 weeks, then with application of a lower leg walking cast for 8 weeks with partial weight-bearing for 4 weeks and full weight-bearing for the last 4 weeks of cast fixation. X-ray controls immediately postoperatively, then after 6 and 12 weeks.
  
  
  RESULTS
  From 2006 to 2008, 12 patients (7 men, 5 women; mean age 59 years) with various indications were treated with retrograde insertion of a compression nail. All patients were routinely controlled radiologically and clinically after 2, 4, 8 and 12 weeks. Follow-up was carried out at 6, 12 and 24 months. All arthrodeses showed osseous consolidation 16 weeks postoperatively. Ten patients were able to use full weight-bearing without pain after 12 weeks. Two patients reported experiencing pain after walking for 2 h. In total three complications occurred: one hindfoot healed with varus malalignment; one patient fell, fracturing the lower leg above the nail; one distal locking screw loosened.
authors.affiliation: Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich. andreas.boelderl@i-med.ac.at
authors.forename: A
authors.initials: A
authors.lastname: Bölderl
authors.forename: C
authors.initials: C
authors.lastname: Dallapozza
authors.forename: M
authors.initials: M
authors.lastname: Wille
mesh_terms: D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001858:Bone Nails; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome