Anterior Plating With Retention of Nail for Ankle Nonunion After Tibiotalocalcaneal Arthrodesis

Abstract

Tibiotalocalcaneal arthrodesis (TTCA) by retrograde intramedullary nailing (RIMN) may result in isolated nonunion of the ankle joint. In these cases, revision TTCA with RIMN may be technically difficult and carry some morbidity. However, if the subtalar joint has achieved union a full revision of RIMN may be unnecessary. This report describes a technique of anterior plating with retention of nail as a salvage option for patients with this problem. In addition, outcomes are reported for 6 patients who underwent anterior plating with retention of nail for isolated ankle nonunion after attempted TTCA by RIMN. All 6 patients achieved tibiotalar fusion at an average of 9.3 weeks (range, 5.4 to 16.1 wk) postoperatively and average pain scores significantly improved (7.8 to 5.3, P=0.019) postoperatively. One major complication and 1 minor complication occurred. Anterior plating with retention of nail appears to be a viable option for salvage ankle arthrodesis after failed TTCA by RIMN; however, detailed preoperative counseling regarding the potential risks of surgery should be performed. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.