Ankle arthrodesis with intramedullary compression nailing

Abstract

Tibiotalar arthrodesis still remains the primary choice of treatment for disabling ankle arthropathy since the results of ankle arthroplasty are not yet convincing. Numerous operative techniques have been described, with an increasing trend towards the use of internal fixation and compression. Using an intramedullary compression nailing technique, 137 tibiotalar fusions were performed at our hospital. The special design of the nail allows distal interlocking in the talus and dynamic axial compression with high primary stability. With correct joint axis, only the cartilage joint surfaces were removed. For axis correction the corresponding bony joint surfaces were also resected. We also performed a dowel technique with bone grafting from the lateral malleolus. We examined 110 of the 137 patients during follow-up. A primary union could be achieved in 99 cases (90.0%). A further six cases (5.5%) healed after recompression and bone grafting. Nonunion remained in five cases (4.5%). Operative complications included one tibial shaft fracture and one hematoma. Septic complications were three superficial and eight deep infections. Sufficient pain relief after arthrodesis was reported by 70 (63.6%) patients; in 37 (33.6%) patients the symptoms remained unchanged and 3 (2.7%) patients found their pain to be worse than before the procedure. Intramedullary compression nailing is shown to be an effective technique for tibiotalar arthrodesis in severe ankle arthropathy. The main advantages of the technique are limited soft tissue damage in the ankle area and high primary stability allowing early weight bearing.