Arthroscopic-assisted Tibiotalocalcaneal Arthrodesis Using a Hindfoot Nail for Treatment of Ankle Fractures in Medically Complex Patients: A Technique Guide and Retrospective Case Series

Abstract

Treatment of ankle fractures in patients with severe medical comorbidities poses a significant challenge, as these patients are at high risk for major complications, including infection and amputation. Tibiotalocalcaneal arthrodesis (TTCA) is gaining popularity for the surgical treatment of ankle fractures in these medically complex patients. This is traditionally performed with open joint preparation or no joint preparation, both of which have associated postoperative complications. We present our technique for arthroscopic-assisted TTCA and provide a retrospective case series of 4 patients undergoing this technique and their outcomes. Our study showed that arthroscopically-assisted joint preparation for TTCA for ankle fractures in patients with severe medical comorbidities shows promise considering 100% limb salvage rate, successful fusion, and restoration of ambulatory status. Complications were minimal requiring only one return to the operating room for symptomatic aseptic loosening of an interlocking screw. Because this is done in a minimally invasive approach, it may be the preferred technique more widely used in the future to decrease the rate of infection and increase the rate of fusion, especially in medically complex patients. Level of Evidence: Level IV, retrospective case series.