title: Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach.
abstract: BACKGROUND
  A number of operative approaches have been described to perform a tibiotalocalcaneal (TTC) arthrodesis. Here we present the largest reported series of a posterior Achilles tendon-splitting approach for TTC fusion.
  
  
  METHODS
  With institutional review board approval, a retrospective review of the TTC fusions performed at a single academic institution was carried out. Orthopedic surgeons specializing in foot and ankle surgery performed all procedures. Eligible patients included all those who underwent a TTC fusion via a posterior approach and had at least a 2-year follow-up. Forty-one patients underwent TTC arthrodesis through a posterior Achilles tendon-splitting approach. Mean age at surgery was 56.9±15.0 years. There were 21 female and 20 male patients. Preoperative diagnoses included arthritis (n = 13 patients), failed total ankle arthroplasty (9), avascular necrosis of the talus (9), prior nonunion of the ankle and/or subtalar joint (6), Charcot neuro-arthropathy (2), and stage IV flatfoot deformity (2). In 37 patients (90.2%), a hindfoot intramedullary arthrodesis nail was used, with posterior plate or supplemental screw augmentation in 17 patients. Posterior plate stabilization alone was utilized in 4 cases (9.8%).
  
  
  RESULTS
  The fusion rate was 80.4%. Eight patients developed a nonunion of the subtalar, tibiotalar, or both joints. Complications were observed in 17 patients (41.4%). Of these, ankle nonunion (19.5%), tibial stress fracture (17%), postoperative cellulitis and superficial wound breakdown (9.7%), subtalar nonunion (4.8%), and TTC malunion (2.4%) were the most frequently identified. One patient eventually underwent amputation (2.4%).
  
  
  CONCLUSIONS
  We believe that posterior Achilles tendon-splitting approach for tibiotalocalcaneal arthrodesis was a safe and effective method, with similar union and complications rates to some previously described techniques. We believe the posterior approach is advantageous as it provides simultaneous access to both the ankle and subtalar joints and allows for dissection to occur between angiosomes, which may preserve blood supply to the skin.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Santiago, Chile.
authors.forename: Manuel J
authors.initials: MJ
authors.lastname: Pellegrini
authors.affiliation: Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Schiff
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: DeOrio
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Easley
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA james.nunley@duke.edu.
authors.forename: James A
authors.initials: JA
authors.lastname: Nunley
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D002111:Calcaneus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D012189:Retrospective Studies
keywords: arthrodesis; posterior approach; tibiotalocalcaneal