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. 2023 Mar 31;8(1):24730114231164625.
doi: 10.1177/24730114231164625. eCollection 2023 Jan.

New Method of Tibio-calcaneal-Navicular Arthrodesis After Talectomy

Chingiz Ali-Zade  1 , Huseyn Aliyev  2 , Farhad Alizada  3
Affiliations

New Method of Tibio-calcaneal-Navicular Arthrodesis After Talectomy

Chingiz Ali-Zade et al. Foot Ankle Orthop. .

Abstract

Background: After astragalectomy, patients still have a shortening of the limb, which can require various reconstructive manipulations. We have developed a simple and versatile tibio-calcaneal-navicular arthrodesis (TCNA) technique to reduce limb shortening.

Methods: The main difference from the standard method of arthrodesis between the tibia and calcaneus is that in our method after astragalectomy, the tibia rests with the anterior edge against the os navicularis, and the posterior edge against the calcaneus.We have observed 14 patients (2 were female, 12 were male) operated by a new method of tibio-calcaneal-navicular arthrodesis (TCNA) from 2003 to 2020 years with various forms of osteomyelitis, fractures, and septic necrosis of the talus. The average age of the patients was 42.2 (ranged 20-75) years. Observation results will be assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score 1-1.5 years after surgery and treatment time in the Ilizarov apparatus.

Results: In all patients, the wounds healed by primary intention. The average time of immobilization in the apparatus was 4.9 (ranged 3.5-6) months. The average limb shortening 2.0 ± 0.5 cm. AOFAS ankle-hindfoot score (n = 14) in all patients came up to 77.9 ± 6.8 (min 68, max 86) SD 12.8. Nonunion was noted in the region of the anterior edge of the tibia in 1 patient (7.1%), and in another patient a painless nonunion was formed (7.1%). Patients wore ordinary footwear without arch supporter and with heels up to 2 cm.

Conclusion: Good and satisfactory results were obtained in all patients. The new TCNA method allows restoring the supporting ability of a limb, reduces shortening, and improves the quality of life for patients.

Level of evidence: Level IV, case series, low-quality cohort or case- control studies.

Keywords: Ilizarov apparatus; ankle joint; aseptic necrosis; astragalectomy; osteomyelitis; talus; talus fracture; tibio-calcaneal-navicular arthrodesis.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Measurements made on computed tomographic scans. (A) New method of arthrodesis. (B) Old method of arthrodesis. (C) Height of the talus; the amount of movement of the anterior and posterior parts of the tibia is indicated. (D) A virtually unchanged anterior distal tibia angle of approximately 81 degrees.
Figure 2.
Figure 2.
Radiographs of examples of the results of arthrodesis after astragalectomy by the old and new methods: (A and C) during treatment; (B and D) after the removal of the devices. The yellow arrows indicate the location of the anterior end of the tibia, and the green arrows, edges of the navicular bone.
Figure 3.
Figure 3.
(A) Radiographs and (B) fistulographs of patient X. The fistulography shows that contrast material fully wraps up the necrotizing talus: (C) during treatment, and (D) after completion of treatment.
Figure 4.
Figure 4.
Radiographs of patient S: (A) closed fraction-dislocation of the talus (duration 2 days); (B) after astragalectomy; (C) after the treatment; (D) a year after the operation; and (E) 4 years after the operation.
Figure 5.
Figure 5.
(A) Radiographs and (B) ankle view of patient B with an open fracture-dislocation of the talus. (C) Radiograph after astragalectomy. (D) Radiographs and (E) ankle views after end of the treatment. (F) Radiographs after 14 years.
Figure 6.
Figure 6.
(A) Radiographs before surgery of patient A. (B and C) Intraoperative photographs. (D) Radiographs in the process of treatment. (E) Radiograph 1 year after the operation (patient 6).
Figure 7.
Figure 7.
Radiographs of patients: (A) Patient 13, 60 years old, with nonunion of the anterior edge of the tibia 22 months after surgery. (B) Patient 11, 23 years old, with painless nonunion 19 months after surgery.
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