Tibiocalcaneal arthrodesis using retrograde insertion of a compression nail

Abstract

OPERATION GOAL: Arthrodesis of the upper and lower ankle joint because of problematic bone positioning or failed arthrodesis. Osteosynthesis procedure using a retrograde compression nail. To achieve stable, fully weight-bearing osteosynthesis for early, pain-free mobilization. Rearthrodesis because of failure of the conventional arthrodesis technique and development of osteoarthritis of the lower ankle joint. Painful osteoarthritis of the upper ankle joint because of inadequate perfusion or a major bone defect because of sclerosis or necrosis. Primary arthrodesis because of facture of the lower leg (pilon tibial) with joint involvement and preexisting osteoarthritis. Acute osteitis/osteomyelitis, sclerosis in the marrow of the distal tibia, malalignment of the distal tibial shaft and local soft tissue inflammation. Preparation of the articular surface of the upper and lower ankle for arthrodesis using a transfibular approach. If necessary, correction of bone defects with iliac crest spongiosa. Stabile osteosynthesis by retrograde insertion of a compression nail. A split lower leg cast on the 2nd postoperative day, mobilization of the patient with underarm crutches with floor contact for 2weeks, then with application of a lower leg walking cast for 8weeks with partial weight-bearing for 4weeks and full weight-bearing for the last 4weeks of cast fixation. X-ray controls immediately postoperatively, then after 6 and 12weeks. From 2006 to 2008, 12patients (7men, 5women; mean age 59years) with various indications were treated with retrograde insertion of a compression nail. All patients were routinely controlled radiologically and clinically after 2, 4, 8 and 12weeks. Follow-up was carried out at 6, 12 and 24months. All arthrodeses showed osseous consolidation 16 weeks postoperatively. Tenpatients were able to use full weight-bearing without pain after 12 weeks. Twopatients reported experiencing pain after walking for 2h. In total three complications occurred: one hindfoot healed with varus malalignment; one patient fell, fracturing the lower leg above the nail; one distal locking screw loosened.