Minimally invasive tibiotalocalcaneal arthrodesis with a retrograde locking nail

Abstract

Objective To discuss the therapeutic effect of tibiotalocalcaneal arthrodesis for severe painful ankle diseases using a locked retrograde intramednllary nail. Methods From January 2003 to November 2007, 12 patients with severe painful ankle diseases underwent tibiotalocalcaneal arthrodesis with a retrograde locking nail in our department. Their mean age was 47.2 (range, 25 to 68) years. The preoper-ative diagnoses of the 9 male and 3 female patients included posttraumatic osteoarthritis (n=7), rheumatoid arthritis (n=3) and eqninovarus (n=2). The mean interval between the primary disease and the operation was 13.6 (range, 5 to 25) years. All patients were evaluated clinically and radiographically by means of clinical examination, questionnaire, weight-bearing radiographic assessment and the American Foot and Ankle Society(AOFAS) ankle-hindfoot scale. Results All patients were available for the follow-up with an average duration of 18.3 (range, 10 to 36) months. Complications, such as damage to neurovascular struc-tures, non-union and infection, were not seen. Solid fusion was achieved in all ankles after a mean time of 17 (range, 12 to 21) weeks. At the latest follow-up, 8 patients reported no pain and 4 mild pain; 7 patients had no limitation in recreational or daily activities while 5 had limitation in recreational but not in daily activities; 7 patients experienced no difficult walking on any surface but 5 did on uneven terrain and stairs. No patient showed obvious limp. The preoperative mean AOFAS score was 47.3 (range, 40 to 57), and the postoperative one 74.2 (range, 50 to 87) . Conclusion Locked retrograde intramedullary nailing is a minimally in-vasive, effective and safe technique in tibiotalocalcaneal arthrodesis for severe painful ankle diseases. Key words: Arthrodesis; Bone nails; Osteoarthritis