Retrograde Intramedullary Antibiotic Impregnated Cement Nailing for Treatment of Infected Primary Tibiotalocalcaneal Arthrodesis

Abstract

The management of infected primary tibiotalocalcaneal arthrodesis (TTCA) is a daunting task for foot and ankle surgeons. For the last 2 decades, antibiotic bone cement nails have become a method to treat intramedullary infections, such as those seen in infected TTCA, as they provide the dual benefits of eluting high amounts of antibiotics into medullary canal while providing some stability to the bone. Studies have demonstrated the effectiveness of this salvage technique in treating infected primary TTCA. Because of the lack of commercially available antibiotic impregnated nails for this procedure, there is significant variation in techniques utilized. In addition, the rarity of these cases can make execution of this technique difficult and time consuming. To date there is no comprehensive technique guide for this procedure. We present a detailed photographic record and technical details of a modified technique for employing an antibiotic spacer nail for a 64-year-old female patient undergoing revision TTCA. The patient had an uncomplicated postoperative clinical course with no evidence of wound infection. Her osteomyelitis subsequently resolved, and she was able to ambulate with minimal pain with a Charcot Restraint Orthotic Walker. Surgeons can utilize the technical pearls presented herein to help reduce the amount of time spent in the operating room performing these clinically challenging revisions. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.