The use of a retrograde fixed-angle intramedullary nail for tibiocalcaneal arthrodesis after severe loss of the talus

Abstract

Tibiocalcaneal arthrodesis may be the only means of obtaining a painless and stable limb when there is loss of the talus. We present the early results of a prospective study on tibiocalcaneal arthrodesis using a latest-generation retrograde intramedullary nail. In the period 2006–2007, nine patients underwent tibiocalcaneal arthrodesis with retrograde intramedullary nailing. Five of these patients had infection-related loss of the talus. SF-36, AOFAS ankle-hindfoot, and Mazur Ankle Arthrodesis scores were obtained pre-fusion, and at 6 weeks, 6 months and 1 year post-fusion. The patients were also followed up clinically and radiologically. Previous surgical procedures, chronic musculoskeletal problems and other comorbidities, and complications were recorded and analyzed. All patients were available for initial follow-up and were subjectively satisfied with their outcomes. Solid fusion was achieved and fully confirmed in nine cases. One subject died 8 weeks postoperatively of a pulmonary embolism. One patient had recurrent infection. At 1 year, only one patient still needed NSAIDs regularly for pain relief. The AOFAS score improved significantly (P = 0.012) from 32.1 pre-fusion to 71.5 points at 1 year as did the Mazur score, which rose by 31.2 to 72.5 points at 1 year (P = 0.012). The SF-36 score improved significantly in the domains physical functioning, role limitations due to physical problems, bodily pain, vitality, social functioning and mental health, as did the Physical Component Summary Score. Retrograde intramedullary nailing for tibiocalcaneal arthrodesis can produce a good outcome. However, in the presence of infection, patient selection for intramedullary procedures must be carefully considered on a case-by-case basis.

Complications of Ankle Fusion for Treating Late Sequelae of Ankle Injuries

“…However, if severe varus deformity or soft tissue contracture exists and nerve traveling is changed, the conventional nailing method might irritate the nerves. In such a case, it might be proposed to perform full bone structure processes, first recovering reasonable alignment of the hindfoot before nailing the plantar side, cutting a small skin incision, and performing a fully blunt dissection from subcutaneous tissues to bones with forceps, to minimize the possibility of plantar nerve injury [10][11][12] . The application of a new anatomical retrograde intramedullary nail could reduce the complications of nerve damage 13) .…”

Ankle Arthrodesis

“…This form of fixation allows reduction and rigid fixation of significant talocalcaneal dislocations. 25,28,29 The patient is placed on the operating table in the supine or lateral decubitus position. If placing supine, the use of a sterile, radiolucent extremity holder is recommended because posterior access to the foot during the procedure is difficult.…”

“…This situation causes difficulty inserting the posterior calcaneal screw and may cause it to be too far plantar. 29 Under intraoperative fluoroscopy, the foot is placed in position under the tibia at 90 in the sagittal plane, 5 abduction in the transverse plane, and slight valgus in the frontal plane. The drill guide wire is used to fixate, and positioning is confirmed.…”

Ankle Height Preservation with the Hind Foot Nail and Iliac Crest Bone Blocks in Patients with Sequelae of Partial or Complete Talus Bone Loss

“…When there is a complete loss of the talus or restoring the original anatomy is impossible, tibio-calcaneal arthrodesis becomes the keystone of treatment, which can be achieved by internal as well as external fixation 9 - 11 . Screws, plates, and intramedullary nails are used for internal fixation and compression 12 - 15 . External fixation devices used for tibio-calcaneal arthrodesis are uniplanar or circumferential compression frames 10 , 16 , 17 .…”