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Abstract
Purpose:
The purpose of this study was to evaluate the radiological and clinical outcomes of tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail for patients with complex hindfoot problems, including Charcot arthropathy, osteonecrosis of talus, combined arthritis of the ankle and subtalar joint, failure of previous ankle arthrodesis, and failed total ankle arthroplasty.
Materials and Methods:
Eighteen consecutive patients (10 men and 8 women) with an average age of 54 years (range, 42∼72 years) underwent tibiotalocalcaneal arthrodesis using retrograde compressive intramedullary nail fixation. The mean duration of follow-up was 16 months (range, 12∼23 months). Radiological evaluation included assessment of the union status of ankle and subtalar joints. Clinical evaluations included visual analogue scale (VAS) for pain and patient satisfaction, and postoperative complications were analyzed.
Results:
Radiological union was achieved in 14 ankle joints (77%) and 16 subtalar joints (88%) at an average of 16 weeks (range, 14∼40 weeks) and 14 weeks (range, 12∼24 weeks), respectively. The preoperative VAS were 4.6 (range, 4∼8) at rest and 8.2 (range, 7∼10) during walking, and the postoperative VAS were 2.2 (range, 0∼3) and 4.6 (range, 4∼6), respectively (p<0.05). There were 6 nonunions (4 ankle joints and 2 subtalar joints), 3 tibia fractures, 2 delayed union of ankle joints, and 2 breakage of the implant.
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Figure 1.
This photograph shows lateral (A), posterior (B), and distal oblique (C) views of retrograde compressive intramedullary nail. The talar locking screw with talar compression cap (arrow) is offered for the compression of ankle joint, and calcaneal locking screw with calcaneal compression cap (arrowhead) is offered for the compression of subtalar joint.
Figure 2.
The standing anteroposterior (A) and lateral (B) radiographs of right ankle of a 62-year-old man showing severe osteoarthritic changes in the joint with hindfoot varus deformity. The anteroposterior (C) and lateral (D) radiographs of right ankle at postoperative 12 months show complete union of the joints.
Figure 3.
(A) Immediate postoperative anteroposterior radiograph of a 57-year-old female demonstrating cortical breakage at the tip of the rod. (B, C) Anteroposterior and lateral radiograph at postoperative 28 weeks show ankle and subtalar joint fusion and cortical hypertrophy at the tip of the rod.
Figure 4.
(A) Anteroposterior radiograph of a 70-year-old female at 6 months postoperatively demonstrating breakage of the implant (arrow). (B) Anteroposterior radiograph after revision surgery with plate and screws following nail removal.
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