title: Tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail with a valgus curve.
abstract: OBJECTIVE
  Many different techniques have been described for performing tibiotalocalcaneal arthrodesis (TTCA) in patients with severe hindfoot disorders such as failed ankle arthroplasty and failed ankle joint arthrodesis with subsequent subtalar arthritis. The use of straight retrograde intramedullary nails is extremely limited because they may interfere with normal heel valgus position and risk damaging the lateral plantar neurovascular structures. Curved retrograde intramedullary nails have been designed to overcome these shortcomings. The purpose of this single surgeon series was to investigate the outcomes of TTCA using a curved retrograde intramedullary nail.
  
  
  METHODS
  From June 2009 to January 2012, 22 patients underwent TTCA using intramedullary nails with a valgus curve by the same senior surgeon. All patients were available for analysis, the mean follow-up being 22.3 months (range, 6.8-38 months). The main outcome measurements included EQ-5D functional scores, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale, radiologic assessment and clinical examination.
  
  
  RESULTS
  Bony union and a plantigrade foot were achieved in 100% of subjects, the mean time to union being 3.9 months (range, 2.4 to 6.2 months). Structural bone graft was used in all patients. Postoperative radiologic results showed a good hindfoot alignment in all patients. The only complication was one case of delayed wound healing without deep infection. The mean postoperative EQ-5D functional and AOFAS ankle-hindfoot scores were 69.33 (range, 20 to 90) and 69.9 (range, 45 to 85) points, respectively. No revision surgery was necessary in our cohort.
  
  
  CONCLUSIONS
  The results of the present study indicate that TTCA using a short, retrograde, curved intramedullary nail is an acceptable technique for obtaining solid fusion and good hindfoot alignment inpatients with severe hindfoot disorders.
authors.affiliation: Department of Orthopaedics, Puai Hospital, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Fang
authors.affiliation: Department of Orthopaedics, Hannover Medical School, Hannover, Germany.
authors.forename: Leif
authors.initials: L
authors.lastname: Claaßen
authors.affiliation: Department of Orthopaedics, Hannover Medical School, Hannover, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Windhagen
authors.affiliation: Department of Orthopaedics, Hannover Medical School, Hannover, Germany.
authors.forename: Kiriakos
authors.initials: K
authors.lastname: Daniilidis
authors.affiliation: Department of Orthopaedics, Hannover Medical School, Hannover, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Stukenborg-Colsman
authors.affiliation: Clinic for Foot and Ankle Surgery, Hessing Foundation, Augsburg, Germany.
authors.forename: Hazibullah
authors.initials: H
authors.lastname: Waizy
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: Intramedullary nail; Tibiotalocalcaneal arthrodesis; Union