Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail

Abstract

New techniques for tibiotalocalcaneal arthrodesis ideally should improve union rate and reduce the complication rate. The purpose of this study was to evaluate the union rate of tibiotalocalcaneal arthrodesis achieved using an intramedullary nail without formal debridement of the subtalar joint and open or percutaneous debridement of the ankle joint. Consolidation time, complication and satisfaction rates, American Orthopaedic Foot and Ankle Society ankle/hindfoot score, and shoe adaptation were assessed. Fifty patients who had tibiotalocalcaneal arthrodeses with a minimum followup of 12 months (mean, 51 months; range, 12-84 months) were retrospectively reviewed. All patients completed a questionnaire and underwent physical examination and radiographic investigations. Fusion was achieved in all ankles; two subtalar joints did not fuse. The average time of fusion was 20 weeks for both joints. Observed complications were few and the satisfaction rate was 92%. The mean American Orthopaedic Foot and Ankle Society ankle/hindfoot score was 70. Tibiotalocalcaneal arthrodesis with a specifically designed retrograde intramedullary nail without formal debridement of the subtalar joint and a choice between open or percutaneous debridement of the ankle is a reliable method to achieve fusion. Opening and debriding the subtalar joint is, in our opinion, not necessary, and percutaneous debridement of the ankle is a good alternative to open debridement.