Salvage Tibiotalocalcaneal Arthrodesis Augmented With Fibular Columns and Iliac Crest Autograft: A Technical Note

Abstract

Failure of ankle arthrodesis or total ankle replacement (TAR) results in a challenging clinical situation and may take the form of symptomatic nonunion following arthrodesis and aseptic or infective loosening following TAR. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required, with use of bone grafting to maintain length and reduce disability. Fibular strut grafting in the form of pillars or columns, potentially supplemented by tricortical and iliac graft, may be used in association with intramedullary TTC nailing or lateral plating and has demonstrated encouraging fusion rates. In this technical note, we review the history of this technique and report indications and surgical approach. Furthermore, of 6 cases (mean age 69.8 years) treated at our institution and followed at 13 months (range, 8 to 20 months), 5 (83%) were clinically and radiologically united, and patients were satisfied with the outcome of surgery. One patient with a background of chronic kidney disease remained dissatisfied with no union achieved, persistent pain, and awaiting a below-the-knee amputation. No other complications were observed. TTC fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and subtalar joint pathologies with significant talar bone loss. Levels of Evidence: Level V (technical note)

Fibular Strut Autograft as an Augmented Biological Plate: A New Modified Technique for Tibiocalcaneal Arthrodesis With Intramedullary Nail

“…They sectioned the distal fibular fragment into 3 or 4 columns and placed them in the ankle joint to regain the height and fill the void. 5 Derek Ley and Hassan 3 used a fibular biological plate for augmentation of tibiocalcaneal arthrodesis with crossed screws. The authors mentioned that the aforementioned technique could provide stable fixation, reduce hardware requirement, and subsequently decrease the infection rate.…”

“…Alessio Bernasconi and colleagues used the distal fragment of fibular osteotomy as strut interposition bone graft during tibiocalcaneal arthrodesis procedure with retrograde intramedullary nail. They sectioned the distal fibular fragment into 3 or 4 columns and placed them in the ankle joint to regain the height and fill the void 5. Derek Ley and Hassan3 used a fibular biological plate for augmentation of tibiocalcaneal arthrodesis with crossed screws.…”