title: Tibiotalocalcaneal arthrodesis using a straight intramedullary nail.
abstract: BACKGROUND
  Tibiotalocalcaneal (TTC) arthrodesis is a proven solution for severe hindfoot arthropathy that reestablishes stability for plantigrade gait and alleviates pain, while correcting deformity. Intramedullary nailing is an effective option for fixation. The aim of this study was to determine clinical outcome, analyze the fusion rate, and determine final hindfoot alignment in a consecutive series of patients using a single-design straight intramedullary nail.
  
  
  METHODS
  This study evaluated 63 patients treated between 2006 and 2010 with at least 36 months of follow-up. Ten patients were excluded because of study inclusion criteria, and 4 were lost to follow-up, leaving 49 patients available for review. The average follow-up was 70.7 ± 15.1 months.
  
  
  RESULTS
  The American Orthopaedic Foot and Ankle Society score improved from 29.7 ± 15.1 before arthrodesis to 65.8 ± 14.6 after (P < .001) with 83.7% (41/49) of patients stating they were satisfied or very satisfied with the outcome. The hindfoot angle improved from -3 ± 15 degrees (varus) before the arthrodesis to 3.5 ± 4 degrees (valgus) after; the tibiotalar angle averaged 103 ± 4.2 degrees after the arthrodesis. Fusion occurred in both joints in 86% (42/49) of patients and in 93% (91/98) of all joints. The average time to fusion was 4.5 ± 2 months. Current smokers had a significantly (P = .03) higher risk of complications. Use of an allograft, with or without bone morphogenetic protein 2, led to comparable results even in the presence of a large bone defect.
  
  
  CONCLUSIONS
  These results are comparable to previously published studies using intramedullary nailing to achieve tibiotalocalcaneal arthrodesis. The complication concerns typically associated with straight nails were not found. We recommend using a retrograde intramedullary nail for the fixation of TTC arthrodesis and adding an allograft in cases of significant bone loss.
  
  
  METHODS
  Level IV, consecutive case series.
authors.affiliation: Bordeaux University Hospital, Centre Médico-chirurgical Universitaire du Pied, Bordeaux, France julienlucas@gmail.com.
authors.forename: Julien
authors.initials: J
authors.lastname: Lucas Y Hernandez
authors.affiliation: Bordeaux University Hospital, Centre Médico-chirurgical Universitaire du Pied, Bordeaux, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Abad
authors.affiliation: Rochefort Hospital, Rochefort, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Remy
authors.affiliation: Robert Picqué Military Hospital, Villenave-d'Ornon, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Darcel
authors.affiliation: Bordeaux University Hospital, Centre Médico-chirurgical Universitaire du Pied, Bordeaux, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Chauveaux
authors.affiliation: Bordeaux University Hospital, Centre Médico-chirurgical Universitaire du Pied, Bordeaux, France Geoffroy St Hilaire clinic, 59 rue Geoffroy St Hilaire, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Laffenetre
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001858:Bone Nails; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: ankle joint; fusion; intramedullary nailing; subtalar joint