Tibiotalocalcaneal Arthrodesis Research Articles

Short-Term Radiographic Results and Technique of Tibiotalocalcaneal Arthrodesis With a Posterior Anatomic Locking Plate

Tibiotalocalcaneal arthrodesis is a salvage procedure for severe hindfoot/ankle deformities, arthritis, avascular necrosis of the talus, failed total ankle replacement, and Charcot neuroarthropathy. The methods for fixation include anterior and lateral plates, screws, retrograde intramedullary nails, and external fixation. The purpose of the present report was to describe the short-term radiographic outcomes and technique using a posterior approach with an anatomic-specific locking plate for tibiotalocalcaneal arthrodesis. Nine patients underwent tibiotalocalcaneal arthrodesis using a posterior locking plate. The medical records and radiographs were retrospectively reviewed for patient demographics, fusion rate, complications, and patient satisfaction. The mean patient age was 57.89 ± 10.8 years, and the follow-up period was 11.11 ± 4.74 months for the patients undergoing posterior tibiotalocalcaneal arthrodesis. The mean time to weightbearing in a shoe with a brace was 16.68 weeks. The ankle and subtalar joints had healed within a mean duration of 13.61 ± 2.96 weeks. Two patients (22%) developed nonunion, 1 at both the ankle and subtalar joint and 1 at the ankle only. The present report demonstrates an alternative posterior approach to joint preparation and fixation. Direct visualization of both joints and soft tissue coverage provide a viable option for posterior fusion in patients with compromised anterior and/or lateral skin envelopes.

Clinical Outcome and Fusion Rate Following Simultaneous Subtalar Fusion and Total Ankle Arthroplasty.

Patients with arthritis or severe dysfunction involving both the ankle and subtalar joints can benefit from tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. TTC fusion is considered by many as a salvage operation resulting in a stiff ankle and hindfoot, considerably limiting global foot function. With the evolution of prosthetic design and operative techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. This study included 25 patients who underwent primary TAR and simultaneous subtalar fusion between May 2011 and November 2014. Sixteen males (64%) and 9 females (36%) were enrolled with a mean age of 58 years (25-82). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2 ± 11.6 months. Radiographic examination included a postoperative computed tomographic (CT) scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92%. There was a statistically significant increase in American Orthopaedic Foot & Ankle Society ankle/hindfoot score from 27.9 to 75.1. Ankle range of motion significantly increased from 12 to 32.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale pain score from 8.6 to 2.1. TAR and simultaneous subtalar joint fusion were reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopedic surgeons in determining the degree of successful fusion of subtalar arthrodesis. Level IV, case series.

Tibiotalocalcaneal arthrodesis using a humeral locking plate

ObjectiveTo describe the results of tibiotalocalcaneal arthrodesis (TTC) using a humeral locking plate. Methods and materialsA retrospective, observational study was conducted between January 2007 and December 2013 in the Hospital Militar Central de Bogotá. The study included patients with symptomatic osteoarthritis diagnosed clinically and radiologically, and who underwent TTC arthrodesis using a humeral locking plate with a minimum follow up of 6 months. ResultsThe total number patients was 35, of whom 7 (20%) were women and 28 (80%) men, with a mean age 36.3 years (19.77). Aetiology: 74% with post-traumatic arthritis, most of them secondary to gunshot wounds and fragmentation weapons, and neuropathic in 20%. An autogenous graft was used in 13 cases, and 14 cases using both, with a mean consolidation time of 4.37 months. Complications include, delayed union in 3 cases, and surgical site infection in 4. The postoperative functionality (AOFAS) mean was 66.7/100 points, with a score of 2.35 on a visual analogue pain scale. ConclusionTTC arthrodesis using a humeral locking plate is a suitable option for fixing this type of arthrodesis, with a low rate of complications, and postoperative results that revealed satisfactory improvement in pain and consolidation.

Is Subtalar Joint Cartilage Resection Necessary for Tibiotalocalcaneal Arthrodesis via Intramedullary Nail? A Multicenter Evaluation

Tibiotalocalcaneal arthrodesis with intramedullary nailing is traditionally performed with formal preparation of both the subtalar and ankle joints. However, we believe that subtalar joint preparation is not necessary to achieve satisfactory outcomes in patients undergoing tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail. The primary aim of the present retrospective study was to evaluate the outcomes of patients who had undergone tibiotalocalcaneal arthrodesis with an intramedullary nail without formal subtalar joint cartilage resection. A multicenter medical record review was performed to identify consecutive patients. Pain was assessed using a visual analog scale, and osseous union at the tibiotalar joint was defined as bony trabeculation across the arthrodesis site on all 3 radiographic views. Progression of joint deterioration was evaluated across time at the subtalar joint, using a modified grading system developed by Takakura et al. Forty consecutive patients (aged 61.9 ± 12.9 years; 17 men) met the inclusion and exclusion criteria. Compared with the pain reported preoperatively (6.4 ± 2.7), a statistically significant decline was seen in the pain experienced after surgery (1.2 ± 1.8; p < .001). The mean time to consolidated arthrodesis at the ankle joint was 3.8 ± 1.5 months. A statistically significant increase in deterioration at the subtalar joint was observed across time [t(36) = –6.200, p < .001]. Compared with previously published data of subtalar joint cartilage resection, the present study has demonstrated a similar decline in pain, with a high rate of union, and also a decrease in operative time when preparation of the subtalar joint was not performed.

The influence of footwear on functional outcome after total ankle replacement, ankle arthrodesis, and tibiotalocalcaneal arthrodesis

BackgroundGait analysis after total ankle replacement and ankle arthrodesis is usually measured barefoot. However, this does not reflect reality. The purpose of this study was to compare patients barefoot and with footwear. MethodsWe compared 126 patients (total ankle replacement 28, ankle arthrodesis 57, and tibiotalocalcaneal arthrodesis 41) with 35 healthy controls in three conditions (barefoot, standardized running, and rocker bottom shoes). Minimum follow-up was 2 years. We used dynamic pedobarography and a light gate. Main outcome measures: relative midfoot index, forefoot maximal force, walking speed. FindingsThe relative midfoot index decreased in all groups from barefoot to running shoes and again to rocker bottom shoes (p<0.001). The forefoot maximal force increased wearing shoes (p<0.001), but there was no difference between running and rocker bottom shoes. Walking speed increased by 0.06m/s with footwear (p<0.001). Total ankle replacement and ankle arthrodesis were equal in running shoes but both deviated from healthy controls (total ankle replacement/ankle arthrodesis smaller RMI p=0.07/0.017; increased forefoot maximal force p=0.757/0.862; slower walking speed p<0.001). In rocker bottom shoes, this ranking remained the same except the relative midfoot index merged to similar values. Tibiotalocalcaneal arthrodesis were inferior in both shoes. InterpretationRunners are beneficial and the benefit is greater for fusions and replacements. Rocker bottom shoes have little added benefit. Total ankle replacement and ankle arthrodesis were equal but inferior to healthy controls. Tibiotalocalcaneal arthrodesis has an inferior outcome.

Failed Agility™ LP Total Ankle Replacement Salvaged with Tibio-Talo- Calcaneal Arthrodesis and Vascularized Pedicled Medial Malleolus and Fibula Onlay Bone Grafts

Controversy exists regarding the most predictable salvage for failed total ankle replacement. Revision total ankle replacement with soft-tissue release/reconstruction or explantation with tibio-talo-calcaneal arthrodesis with bulk structural allograft are the most commonly performed approaches. Tibio-talo-calcaneal arthrodesis with bulk structural allograft has a high complication rate; however, augmentation with vascularized pedicled onlay bone grafts may improve osseous union and functional limb salvage. This manuscript presents the revision of a failed Agility™ LP total ankle replacement system with severe >45° varus ankle deformity that was salvaged with tibio-talocalcaneal arthrodesis, bulk femoral head structural allograft and vascularized pedicled medial malleolus and fibula onlay bone grafts. At short-term 1.5-years follow-up the patient had a well-balanced and painless foot/ankle and return of a functional lower limb.

Outcomes of Tibiotalocalcaneal Arthrodesis Through a Posterior Achilles Tendon-Splitting Approach.

A number of operative approaches have been described to perform a tibiotalocalcaneal (TTC) arthrodesis. Here we present the largest reported series of a posterior Achilles tendon-splitting approach for TTC fusion. With institutional review board approval, a retrospective review of the TTC fusions performed at a single academic institution was carried out. Orthopedic surgeons specializing in foot and ankle surgery performed all procedures. Eligible patients included all those who underwent a TTC fusion via a posterior approach and had at least a 2-year follow-up. Forty-one patients underwent TTC arthrodesis through a posterior Achilles tendon-splitting approach. Mean age at surgery was 56.9±15.0 years. There were 21 female and 20 male patients. Preoperative diagnoses included arthritis (n = 13 patients), failed total ankle arthroplasty (9), avascular necrosis of the talus (9), prior nonunion of the ankle and/or subtalar joint (6), Charcot neuro-arthropathy (2), and stage IV flatfoot deformity (2). In 37 patients (90.2%), a hindfoot intramedullary arthrodesis nail was used, with posterior plate or supplemental screw augmentation in 17 patients. Posterior plate stabilization alone was utilized in 4 cases (9.8%). The fusion rate was 80.4%. Eight patients developed a nonunion of the subtalar, tibiotalar, or both joints. Complications were observed in 17 patients (41.4%). Of these, ankle nonunion (19.5%), tibial stress fracture (17%), postoperative cellulitis and superficial wound breakdown (9.7%), subtalar nonunion (4.8%), and TTC malunion (2.4%) were the most frequently identified. One patient eventually underwent amputation (2.4%). We believe that posterior Achilles tendon-splitting approach for tibiotalocalcaneal arthrodesis was a safe and effective method, with similar union and complications rates to some previously described techniques. We believe the posterior approach is advantageous as it provides simultaneous access to both the ankle and subtalar joints and allows for dissection to occur between angiosomes, which may preserve blood supply to the skin. Level IV, retrospective case series.

Retrograde Intramedullary Tibiotalocalcaneal (Hindfoot) Arthrodesis With Concomitant Midfoot and Forefoot Corrections

Tibiotalocalcaneal arthrodesis is a salvage procedure. We report on the operative technique, the importance of addressing concomitant ankle and foot deformities when present and the outcomes (radiologic fusion rate, limb salvage rate, and global patient satisfaction) with a hindfoot arthrodesis nail. It was used for tibiotalocalcaneal arthrodesis on 63 consecutive patients (6 bilateral procedures). The minimum follow-up was 12 months; the mean age was 59 (range, 24 to 87) years, with 69% male. At 3 months, the fusion rate was 77.7% (49/63); 6-month fusion rate was 95% (60/63). The overall complication rate was 12.6% (8/63). There was a 100% limb salvage rate. Fifty-seven concomitant procedures were performed on 38 patients at time of nail insertion.

Tibiotalocalcaneal arthrodesis with a triple-bend intramedullary nail (A3)-2-year follow-up in 60 patients.

The aim of the study was to analyze the clinical aspects including 2-year follow-up of tibiotalocalcaneal arthrodesis (TTCA) with a triple-bend retrograde intramedullary nail (A3, Stryker, Airview Boulevard, MN, USA). All patients with TTCA with A3 between October 18, 2011 and April 29, 2013 were included. Visual Analogue Scale Foot and Anklenkle (VAS FA), indications for surgery, details of surgery, radiographic measurements, and complications were analyzed. A total of 66 patients were included. The mean VAS FA was 29.6. Most common indications were arthrosis (n=43; 65%) and deformity (n=36; 55%). The accuracy of correction and implant position was 9.4 (maximum 10) on average. Infection rate was 3% (n=2). Sixty (91%) patients completed follow-up: VAS FA 59.9, fusion rate 100%, high accuracy of correction and implant position. TTCA with the A3 implant system showed accurate correction and implant position. Two-year follow-up in 60 patients (91%) showed good clinical outcome scores and 100% fusion rate.

Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus

Retrograde intramedullary nailing for tibiotalocalcaneal arthrodesis is a salvage procedure reserved for severe cases of deformity. The aim of the present study was to compare the outcomes of this technique in patients with and without diabetes mellitus (DM). A total of 61 patients with and 56 without DM underwent retrograde intramedullary nailing and had a minimum follow-up period of 12 months. The overall incidence of complication was 45.2%; however, the overall incidence of complications between those with and without DM was not significantly different (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.38 to 1.65, p = .54). Patients with DM had a significantly greater rate of superficial infections (OR 8.3, 95% CI 1.01 to 68.67, p = .03). However, no difference was seen in the rate of deep infection (OR 0.90, 95% CI 0.34 to 2.46, p = .83) or noninfectious complications (OR 0.50, 95% CI 0.23 to 1.13, p = .09). Successful limb salvage was achieved for 96.8% of the patients with DM and 94.7% of those without DM (p = .66). A femoral head allograft was used in 32 (27.4%) of 117 patients to substitute for an osseous void. Of the 32 patients who required a femoral head allograft, 21 (67.7%) experienced a complication compared with 32 (37.6%) of 85 patients who did not require a femoral head allograft (OR 3.16, 95% CI 1.35 to 7.41, p = .008). The incidence of patient satisfaction was 80% for patients with DM and 72% for those without DM (p = .36). Despite a high incidence of complications, limb salvage was accomplished in approximately 95% of patients with complicated deformities. Four patients (6.56%) with DM experienced a tibia fracture; therefore, we now routinely use a 300-mm-long nail for this reconstruction.

Locking plate versus retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis: A retrospective analysis.

Background:Tibiotalocalcaneal arthrodesis (TTCA) surgery is indicated for the end-stage disease of the tibiotalar and subtalar joints. Although different fixation technique of TTCA has been proposed to achieve high fusion rate and low complication rate, there is still no consensus upon this point. The purpose of this study is to compare the clinical efficacy of retrograde intramedullary nail fixation (RINF) and locking plate fixation (LPF) for TTCA.Materials and Methods:Fifty four patients who underwent TTCA through the lateral approach with lateral fibular osteotomy using RINF (32 patients, 18 male/14 female, mean age: 48) or LPF (22 patients, 12 male/10 female, mean age: 51) between January 2007 and January 2010 were retrospectively analyzed. Demographic and clinical characteristics, surgery (operation time, blood loss) outcomes (postoperative fusion rates, visual analog scale and foot and ankle surgery score and complications) were compared.Results:The LPF group had a shorter operation time (72.3 ± 9.2 vs. 102.8 ± 11.1 min, P < 0.001), less blood loss (75.9 ± 20.2 vs. 140.0 ± 23.8 ml, P < 0.001) and less intraoperative fluoroscopy sessions (3.6 ± 0.9 vs. 8.4 ± 1.3, P < 0.001) than the RINF group. Patients were followed up for 12–24 months (mean of 16.2 months). Both groups had similar postoperative fusion rates (90.6% and 95.4%) and the LPF group showed a nonsignificant lower complication rate (18.2% vs. 28.1% respectively). Patients at higher risk on nonunion due to rheumatoid diseases may have a lower nonunion rate with LPF than RINF (one out of eight vs. three out of nine, P < 0.001).Conclusions:The LPF for TTCA was simpler to perform compared with RINF, but with similar postoperative outcomes and complication rates.

Plantar approach to hindfoot arthrodesis with compressed angle stable locking option

Tibiotalocalcaneal arthrodesis is indicated in severe combined arthritis of the upper and lower ankle joints and otherwise untreatable malpositioning of the hindfoot. Currently available arthrodesis nails have a hindfoot valgus bend which allows the anatomy to be more faithfully reproduced and respected. Anatomical investigations show the endangered structures during retrograde arthrodesis nailing. The valgus bend of the arthrodesis nail necessitates a corresponding correctly placed opening in the calcaneus and talus as the entry point for the nail. A locking screw in the calcaneus running from posterior to anterior increases the stability and is now taken into consideration for nearly all designs of arthrodesis medullary nails. The compression mechanism can be used for apposition and pressing the arthrodesis surfaces together and locking in the hindfoot should be carried out in an angle stable fashion. Augmentation of the locking screws in the calcaneus with bone cement can be an option as a salvage procedure in revision cases.

Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review.

Tibiotalocalcaneal arthrodesis is aimed to block the ankle joint motion in cases of severe osteoarthritis, avascular necrosis of the talus and/or failure of arthroplasty operations. This systematic review was carried out to evaluate the clinical outcome after tibiotalocalcaneal arthrodesis using intramedullary nail either open and arthroscopically assisted. Focus was on the success rate of the procedure in terms of union and complications and on the comparison between the techniques. The databases PubMed (Medline), EMBASE and Cochrane Library were searched in order to retrieve relevant studies. All therapeutic level 1-4 studies involving humans with intramedullary nail fixation technique were included. Only studies written in English, Italian, French, Spanish and German were included. Data related to the type of surgery, complications and clinical outcomes were extracted and analysed. A total of 83 studies were identified, of which 32 studies were eligible for inclusion; 31 case series and one randomized controlled trial. The main reported outcome score was the American Orthopaedic Foot and Ankle Society scale. Almost, all the included studies reported higher than 50% union rates and a significant improvement in terms of the clinical and mechanical ankle function after treatment. Results suggest that satisfactory outcomes can be achieved by tibiotalocalcaneal arthrodesis using intramedullary nailing. Low complication rates contribute to make this a safe procedure. No comparison can be done between arthroscopic and open technique, due to the lack of scientific works on the first one. IV.

Tibiotalocalcaneal arthrodesis with a compressive retrograde nail: A retrospective study of 59 nails.

Tibiotalocalcaneal arthrodesis is an important salvage method for patients with complex hindfoot problems. This study reports the elective results of combined subtalar and ankle arthrodesis using one design of retrograde intramedullary compression nail. Retrospective review identified 58 patients undergoing 59 tibiotalocalcaneal arthrodesis procedures. Mean follow up was 9.15 (3-36) months with average age 60.7 (22-89) years. A function and subjective patient satisfaction questionnaire was achieved in 89%. 53 patients (93%) achieved union at a mean time of 4.17 months. Four patients (8%) subjectively thought the procedure was of no benefit while 42 (84%) had an excellent or good result. The mean visual analogue scale (VAS) score for preoperative functional pain was 7.46 compared to 1.98 post-operatively (p<0.001). This device and technique offers an effective treatment of hindfoot pathology giving reliable compression and subsequent fusion with excellent patient satisfaction and pain relief. IV case series.

The use of the 4.5 mm 90° titanium cannulated LC-angled blade plate in tibiotalocalcaneal and complex ankle arthrodesis.

Tibiotalocalcaneal arthrodesis is used to manage end stage arthritis, often associated with severe bone loss. The goal is to relieve pain through a stable, well-aligned hindfoot and ankle. We describe our initial results and outcome of ankle and tibiotalocalcaneal arthrodesis using a 90° blade plate. We retrospectively reviewed the records of patients managed at our institution between 2010 and 2014. Twenty cases were identified who had either talocrural (n = 9) or TTC fusion (n = 11) with 1 patient having both ankle and then TTC fusion in separate sittings. Fusion occurred in 18 of the 20 cases (90%) with correction of angular deformity and restoration of hindfoot alignment. None of the 18 patients developed complications and all discharged to follow-up when independently mobile and satisfied with the outcome. This study demonstrated that using a 90° blade plate for ankle or TTC arthrodesis in a diverse group of complex primary and revision indications associated with severe deformity and bone loss resulted in a high rate of bony union and stable deformity correction.

Tibiotalocalcaneal arthrodesis using a straight intramedullary nail.

Tibiotalocalcaneal (TTC) arthrodesis is a proven solution for severe hindfoot arthropathy that reestablishes stability for plantigrade gait and alleviates pain, while correcting deformity. Intramedullary nailing is an effective option for fixation. The aim of this study was to determine clinical outcome, analyze the fusion rate, and determine final hindfoot alignment in a consecutive series of patients using a single-design straight intramedullary nail. This study evaluated 63 patients treated between 2006 and 2010 with at least 36 months of follow-up. Ten patients were excluded because of study inclusion criteria, and 4 were lost to follow-up, leaving 49 patients available for review. The average follow-up was 70.7 ± 15.1 months. The American Orthopaedic Foot and Ankle Society score improved from 29.7 ± 15.1 before arthrodesis to 65.8 ± 14.6 after (P < .001) with 83.7% (41/49) of patients stating they were satisfied or very satisfied with the outcome. The hindfoot angle improved from -3 ± 15 degrees (varus) before the arthrodesis to 3.5 ± 4 degrees (valgus) after; the tibiotalar angle averaged 103 ± 4.2 degrees after the arthrodesis. Fusion occurred in both joints in 86% (42/49) of patients and in 93% (91/98) of all joints. The average time to fusion was 4.5 ± 2 months. Current smokers had a significantly (P = .03) higher risk of complications. Use of an allograft, with or without bone morphogenetic protein 2, led to comparable results even in the presence of a large bone defect. These results are comparable to previously published studies using intramedullary nailing to achieve tibiotalocalcaneal arthrodesis. The complication concerns typically associated with straight nails were not found. We recommend using a retrograde intramedullary nail for the fixation of TTC arthrodesis and adding an allograft in cases of significant bone loss. Level IV, consecutive case series.

Posterior approach to the tibiotalocalcaneal arthrodesis utilizing an A3 intramedullary nail: A case report

Tibiotalocalcaneal arthrodesis is a technically difficult reconstructive procedure. The customary surgical approach is usually performed through an anterior, medial, or lateral incision. These incisional approaches, although most popular amongst foot and ankle surgeons, are associated with numerous complications, both intraoperatively and post-operatively. The posterior approach provides the surgeon with an unmatched visualization of the subtalar and ankle joints. We report a case in which a midline posterior incision was used for a patient who required tibiotalocalcaneal arthrodesis with intramedullary nailing and who concurrently required excision of a painful posterosuperior calcaneal enthesiopathy.

Talar body fracture nonunion and osteonecrosis with adjacent arthritis can be successfully treated with tibiotalocalcaneal arthrodesis using circular external fixation

Fractures of the talar body often result from high-energy trauma. These fractures are at risk for nonunion and put the talus at risk for avascular necrosis due to an inadequate blood supply. We present the case of a 57-year-old male that presented to our practice with talus fracture nonunion, talar body osteonecrosis, ankle and subtalar posttraumatic osteoarthritis, and deformity including a mild equinus contracture and mild hindfoot varus. Successful ankle and subtalar fusion, talus fracture union, and deformity correction were performed using a circular external fixator with fine wire fixation and compression. This is the first reported case where fusion of both the tibio-talar-calcaneal joints and the talar body nonunion was achieved using external fixation. At the time of this report, the patient is over 3 years postfusion, stands with neutral alignment, is relatively pain-free, is able to resume normal daily activities, and has no progression of talar osteonecrosis.

Early Results of a Posterolateral Polyaxial Angle-Stable Plate for Tibiotalocalcaneal Arthrodesis

Tibiotalocalcaneal arthrodesis is still considered the reference standard therapy for salvage of severe osteoarthritic deformities of the ankle and hindfoot. Because of the unique anatomy and biomechanics of the ankle, even minor injuries can progress to end-stage osteoarthritis over time. This can be debilitating to patients' general health and physiologic ambulation. Arthrodesis aims to correct the misalignment and should comply with Glissan's principles (i.e., maintenance of permanent stability and sound compression between the fused elements). Several different surgical techniques have been described in the international medical literature. Intramedullary nails can create and maintain a stable condition but lack the necessary compression. Screw fixation can generate compression but might not yield enough stability until sound union has been achieved. In the present study, we report the early results of an innovative posterolateral polyaxial angle-stable plate that combines the features that address all the principles of arthrodesis in 1 device.

Anterior Tibial Artery Injury Following Tibiotalocalcaneal Retrograde Intramedullary Nailing: A Case Report.

We report the case of a patient who sustained injury to the anterior tibial artery during tibiotalocalcaneal retrograde nailing and developed an acutely ischemic foot. Vascular injury during tibiotalocalcaneal arthrodesis with retrograde nailing is a rare but serious complication. While retrograde tibiotalocalcaneal arthrodesis nailing for end-stage ankle and subtalar arthritis has shown encouraging results, a high index of suspicion for postoperative complications is necessary in patients with risk factors for poor posterior collateral circulation.