踝后正中入路锁定钢板内固定行胫距跟关节融合术

目的评估踝后经跟腱正中入路植骨锁定钢板内固定行胫距跟关节融合术的手术技巧和临床效果。方法从2008年1月至2012年12月,共收治123例踝关节合并距下关节创伤性关节炎,其中13例因踝周软组织条件不佳而选用踝关节后方入路胫距、距下关节清理、植骨、4.5 mm干骺端锁定钢板内固定行胫距跟关节融合术。其中男9例,女4例,平均年龄47.8岁（30~65岁）;平均病程7年（1~15年）。术后定期随访复查X线片以明确骨愈合情况,并采用直观模拟量表（Visual Analog Scale,VAS）评估术后疼痛改善情况,美国骨科足踝外科（American Orthopaedic Foot and Ankle Society,AOFAS）踝关节与后足评分及简明健康量表SF-36评分评估恢复效果,并记录相关并发症。结果术后所有患者伤口均一期愈合,未见感染、皮肤坏死等软组织并发症。11例获得最终随访,平均随访时间24个月（12~36个月）。随访复查X线片示术后平均12周融合端骨性愈合（10~15周）。末次随访时,AOFAS踝与后足评分及SF-36评分均较术前明显改善,疼痛症状明显缓解。随访期间未见内固定失效、融合失败等并发症,2例患者术后出现距舟关节骨关节炎,伴轻度疼痛,口服药物对症治疗后缓解。结论经踝后正中入路锁定钢板内固定行胫距跟关节融合安全、有效,特别适合于踝周软组织条件不佳的病例。     

Use of implantable bone growth stimulation in Charcot ankle arthrodesis

BACKGROUND: The purpose of this study was to review the results of arthrodesis of the Charcot hindfoot when an implantable bone growth stimulator was added to the procedure. Arthrodesis of the Charcot hindfoot has a high nonunion and complication rate. METHODS: Ten patients (ages 50 to 69 years) with Charcot neuroarthropathy of the ankle, hindfoot, or both had arthrodesis with use of rigid internal fixation and an implantable bone growth stimulator. There were six tibiotalocalcaneal, two pantalar, and two tibiocalcaneal arthrodeses. An intramedullary nail was used in nine patients and a blade plate was used in one patient. All but one patient was diabetic. Four of the ten patients had preoperative osteomyelitis or postoperative infection. Another patient had purulent drainage, although cultures were negative. Four patients had a preoperative ulceration. Five patients had a two-stage procedure for debridement of infected bone, removal of hardware, and placement of antibiotic beads. Autogenous bone graft from the distal fibula or proximal tibia was used in all patients. RESULTS: One patient with a preoperative osteomyelitis developed a stable ankle pseudarthrosis. The other nine patients fused at an average of 3.7 months after surgery for a fusion rate of 90%. There were two major complications and eight minor complications. There were no amputations. All patients were ambulatory in a double upright brace or shoes for diabetic patients and were free of ulceration at the time of followup. Average American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score improved from 21 preoperatively to 59 postoperatively. CONCLUSIONS: The adjunctive use of an implantable bone growth stimulator in conjunction with rigid internal fixation, autogenous bone grafting, and sound operative technique may enhance the outcome and fusion rate in patients undergoing arthrodesis for Charcot neuroarthropathy of the ankle and hindfoot.     

The use of a 95 degree blade plate and a posterior approach to achieve tibiotalocalcaneal arthrodesis

Various types of internal fixation have been used to achieve arthrodesis of both the ankle and subtalar joints. We have investigated the use of a standard 95 degree angled blade plate as a method of more rigid internal fixation to achieve arthrodesis of these joints. The purpose of this retrospective study was to review our clinical and radiographic results in adults using a blade plate applied through a posterior approach to fuse the ankle and subtalar joints. METHODS: Between April 1995 and June 2000, 10 tibiotalocalcaneal arthrodeses were performed using a posterior approach and a blade plate for internal fixation. There were 10 adults (five men and five women) whose average age was 64 years (range, 42 to 80 years). The indication for the procedure was severe pain which was unresponsive to nonoperative management in patients with arthritic joints. Preoperative diagnoses included six patients with post-traumatic arthritis, two with primary degenerative arthritis, one with rheumatoid arthritis, and one with post-polio deformity. An average of 1.7 previous operations had been performed on the affected ankle. RESULTS: Clinical and radiographic follow-up was performed for all patients at an average of 37 months (range, 12 to 71 months) postoperatively. All 10 patients achieved a solid fusion. The mean time to radiographic fusion was 14.5 weeks (range, 9 to 26 weeks). The operation resulted in plantigrade feet in all patients with an average tibia-floor angle of 2.3 degrees of dorsiflexion and an average of 5 degrees of hindfoot valgus. Patients had excellent pain relief, however function did not improve as much. Complications occurred in three patients. One patient required a small split-thickness skin graft for wound healing, one experienced a transient posterior tibial nerve neuropraxia, and one developed a deep venous thrombosis in the nonoperative leg at six weeks postoperatively. Three patients required removal of the blade plate because of discomfort, which promptly cleared. CONCLUSIONS: Arthrodesis provides excellent pain relief for patients with painful arthritic deformities of the ankle and subtalar joints. Using a posterior approach, a blade plate for internal fixation and bone grafts resulted in a solid fusion for all our patients. This method is particularly effective in large patients with a mild-moderate hindfoot deformity.     

Treatment of displaced talar neck fractures using delayed procedures of plate fixation through dual approaches

Purpose

Treatment of talar neck fractures is challenging. Various surgical approaches and fixation methods have been documented. Clinical outcomes are often dissatisfying due to inadequate reduction and fixation with high rates of complications. Obtaining satisfactory clinical outcomes with minimum complications remains a hard task for orthopaedic surgeons.

Methods

In the period from May 2007 to September 2010, a total of 31 cases with closed displaced talar neck fractures were treated surgically in our department. Injuries were classified according to the Hawkins classification modified by Canale and Kelly. Under general anaesthesia with sufficient muscle relaxation, urgent closed reduction was initiated once the patients were admitted; if the procedure failed, open reduction and provisional stabilisation with Kirschner wires through an anteromedial approach with tibiometatarsal external fixation were performed. When the soft tissue had recovered, definitive fixation was performed with plate and screws through dual approaches. The final follow-up examination included radiological analysis, clinical evaluation and functional outcomes which were carried out according to the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS), patient satisfaction and SF-36.

Results

Twenty-eight patients were followed up for an average of 25 months (range 18–50 months) after the injury. Only two patients had soft tissue complications, and recovery was satisfactory with conservative treatment. All of the fractures healed anatomically without malunion and nonunion, and the average union time was 14 weeks (range 12–24 weeks). Post-traumatic arthritis developed in ten cases, while six patients suffered from avascular necrosis of the talus. Secondary procedures included three cases of subtalar arthrodesis, one case of ankle arthrodesis and one case of total ankle replacement. The mean AOFAS hindfoot score was 78 (range 65–91). According to the SF-36, the average score of the physical component summary was 68 (range 59–81), and the average score of the mental component summary was 74 (range 63–85).

Conclusions

Talar neck fractures are associated with a high incidence of long-term disability and complications. Urgent reduction of the fracture-dislocation and delayed plate fixation through a dual approach when the soft tissue has recovered may minimise the complications and provide good clinical outcomes.     

Wolf blade plate ankle arthrodesis

Fifteen patients, each of whom had a Wolf blade plate ankle arthrodesis, were followed for a mean of 56 months. The mean age at the time of operation was 46.7 years. The preoperative diagnosis was posttraumatic arthritis in 16 cases and one each of degenerative arthritis, rheumatoid arthritis, and avascular necrosis of the talus. Eighteen of the 19 cases fused for a fusion rate of 94.7%. The average fusion position was 2.9 degrees of plantar flexion and 5 degrees of valgus. All patients whose ankle fused were satisfied with their results. The average Mazur postoperative score was 75 (range, 33-91). Five patients had delayed wound healing. The Wolf blade plate is a simple and easy method to fuse the ankle. Minimal dissection is required and a fusion rate of 95% is obtainable.     

Transfibular ankle arthrodesis with rigid internal fixation: an assessment of outcome

BACKGROUND: Transfibular ankle arthrodesis with internal fixation and fibular onlay grafting has resulted in acceptable fusion rates. This study analyzed the results of ankle arthrodesis using one operative technique in a large series of patients with high and low risks for nonunions. METHODS: Fifty consecutive patients had a transfibular ankle arthrodesis with rigid internal fixation and fibular onlay strut grafting from 1997 to 2004. Two patients were lost to followup. The remaining 48 patients had preoperative and postoperative clinical and radiographic examinations and then were stratified into high-risk and low-risk groups for ankle nonunions. Fifteen of 48 patients were considered at high risk for nonunion. Rate of osseous fusion, satisfaction with the procedure, correction of the deformity, and relief of pain were evaluated. Thirty-five of 48 patients were evaluated with the AOFAS ankle-hindfoot scale at an average 45 months after surgery. RESULTS: Forty-six of 48 patients had bony union (96% union rate). Fourteen of 15 (93%) high-risk patients had bony fusion in an average of 83 days. Thirty-two of 33 patients (97%) in the low-risk group had bony fusion at an average of 81 days. The AOFAS ankle-hindfoot score improved from 38 to 74 in 12 of 15 patients in the high-risk group and from 34 to 69 in 24 of 33 patients in the low-risk group from preoperative to postoperative scores. CONCLUSIONS: A transfibular ankle arthrodesis with rigid internal fixation and fibular onlay strut grafting can achieve a high rate of union in both a low-risk and high-risk patient populations. This technique can be an effective approach for most primary and revision cases with or without significant deformity. In addition the AOFAS ankle-hindfoot score improved significantly both in the high-risk and low-risk groups.     

Low-profile Titanium Plate Construct for Early Weightbearing with First Metatarsophalangeal Joint Arthrodesis

First metatarsophalangeal joint arthrodesis is a useful procedure for various first ray pathologic entities. Multiple constructs for fixation have provided successful fusion. A retrospective study of 21 feet (18 patients) was performed after first metatarsophalangeal joint fusion using crossed Kirschner wires or compression fixation with cannulated screws followed by the application of a 2-hole low-profile partially locking titanium plate. The median age was 59 (range 41 to 76) years, and we had 4 smokers and 3 patients with diabetes in our series. Postoperatively, a compression dressing with a posterior splint was applied. The patients then transitioned to a controlled ankle motion walker, and all patients reported full weightbearing by 2 weeks postoperatively. The mean follow-up duration was 11.43 (range 6 to 27) months. The overall primary fusion rate was 95.24% (20 of 21). Two nonunions occurred; one was asymptomatic and successfully consolidated at 12 months. The second nonunion required revisional surgery with an autogenous bone graft to heal successfully. This patient was noncompliant with the postoperative regimen and had a 48-pack year history of tobacco usage. Our results have shown early weightbearing after first metatarsophalangeal joint arthrodesis can be successfully initiated with splintage or lag screw fixation and a 2-hole, low-profile, partially locking titanium plate.     

Ankle fusion for definitive management of non-reconstructable pilon fractures

BACKGROUND: Highly comminuted pilon fractures, especially with a compromised soft tissue envelope, present a challenging treatment scenario. This study presents our results for patients managed with ankle fusion rather than ORIF. MATERIALS AND METHODS: Fourteen patients with ankle joint incongruence after non-reconstructable tibia pilon fractures were treated with primary tibiotalar arthrodesis using a fixed-angle cannulated blade plate. Delayed metaphyseal unions due to bone defects were treated concurrently. The subtalar joint was preserved in all cases. RESULTS: Metaphyseal healing and stable arthrodesis was obtained in each case. There was one case of blade plate breakage in a patient who still achieved successful arthrodesis without reoperation. Union was achieved at an average of 15 weeks. No secondary procedures were required to obtain union. All 14 patients were ambulatory at last followup. Average followup was 39 weeks. CONCLUSION: Primary ankle arthrodesis can be achieved using a cannulated blade plate to address a non-reconstructable articular surface and metaphyseal bone defects in complex tibia pilon fractures.     

Distal tibial nonunion using a contralateral anterior L-shaped locking compression plate through a posterior-lateral approach: A retrospective case series

BackgroundDistal tibial nonunion is usually due to severe open distal tibial fractures with high energy injury. The best surgical treatment is not well established because of the poor soft tissue condition. We retrospectively analyzed a series of patients with distal tibial nonunion after severe open distal tibial fractures; our purpose was to introduce a treatment using a contralateral anterior L-shaped locking compression plate through a posterior-lateral approach with Iliac crest bone graft and evaluate the outcomes of patients.MethodsAll patients with distal tibial nonunion who received a contralateral anterior L-shaped locking compression plate fixation through the posterior-lateral approach with Iliac crest bone graft by a single surgeon from 2014 to 2016 were reviewed. 9 patients met the criteria. Five of nine patients had varus deformities (range, 9–40°) and 4 patients had valgus deformities (range, 5–30°). Postoperative radiographs, Postoperative complications, limb alignment and limb functional outcome information of AOFAS ankle-hindfoot score were recorded.ResultsAll patients were followed up for at least 8 months (range, 8–16 months). Union was achieved in all patients after the index surgery without postoperative wound complications while one patient came up with checkrein deformity. Average time to radiographic union was 16 weeks (range, 12–24 weeks). All patients had correction to neutral alignment in both coronal and sagittal planes. The average AOFAS ankle-hindfoot score was 90 (range, 77–100) at the last follow-up of patients.ConclusionsUsing a contralateral anterior L-shaped locking compression plate fixation through a posterior-lateral approach with Iliac crest bone graft to reconstruct the distal tibial nonunion is a safe and reliable method that can successfully treat patients with poor soft tissue condition of anterior portion of leg because of its adequate exposure, both tibia and fibula rigid fixation and plenty of bone graft. We believe the application of this method resulting in a high union and low complication rate.     

踝关节骨折合并下胫腓联合损伤的诊治策略

目的通过踝关节骨折伴下胫腓联合损伤临床诊断、治疗、疗效的分析,探索较为优化的诊疗方案。方法手术治疗踝关节骨折伴下胫腓联合损伤75例,其中男51例,女24例,年龄18～72岁,平均42岁。根据损伤机制、损伤类型、受伤时间、软组织情况,实施术前正确评估、术中解剖复位固定、术后渐进性康复等策略。其中急诊手术组40例,择期手术组35例。随访观察治疗效果并进行疗效评定。结果75例均获得随访,随访时间5—24个月,平均13个月。根据Baird—Jackson踝关节功能评分标准进行疗效评价,急诊手术组优良率87．5％。择期手术组优良率85．7％,总优良率86．7％。急诊手术组与择期手术组疗效评定中各项指标差异无统计学意义。结论只有非常重视软组织情况,充分利用辅助检查手段,术前仔细评估,术中解剖复位固定,术后处理到位,早期康复,才能重新获得一个无痛的、满意的踝关节。     

Arthrodesen der Sprunggelenke

Between 1994 and 1999 we treated 47 patients with 48 operations for arthrodesis of the ankle joint and/or the subtalar joint. Long-term follow-up with both clinical and radiological examination was achieved in 41 patients (41 arthrodeses); this extended over a median of 29 months (range 6–62 months) after the operation. The main indication for an arthrodesis in our patients was symptomatic posttraumatic arthrosis. Compression arthrodesis with screw fixation was the surgical technique performed in the vast majority of cases. Complications were observed in 33% of these cases: superficial postoperative wound problems were the most frequent group, but there were also deep infections in 4 cases and nonunion of the arthrodesis in 5. The clinical and radiographic results observed were evaluated according to the internationally accepted Kitaoka score. The results we recorded were very good and good in 68% of these patients, satisfactory in 22% and poor in 10%.     

Technique and early experience with posterior arthroscopic subtalar arthrodesis

BACKGROUND: Subtalar arthrodesis is a reliable procedure for pain relief and improved function in patients with isolated subtalar arthritis. Arthroscopic subtalar arthrodesis (ASTA) was designed to improve upon traditional methods by using a minimally invasive technique. However, posterior arthroscopic subtalar arthrodesis (PASTA) has not been described. The purpose of the present study was to investigate the early results of PASTA. METHODS: A retrospective review of 11 feet in 10 patients (one bilateral) that had PASTA was conducted. Inclusion criteria were isolated subtalar arthritis with no or minimal deformity and no significant bone loss. Exclusion criteria included patients requiring adjunctive open procedures or who had significant deformity. The technique involved prone positioning, two posterolateral portals and one posteromedial portal, posterior talocalcaneal facet debridement, percutaneous cancellous allografting and internal screw fixation. Outcome measures included patient satisfaction, the modified American Orthopaedic Foot and Ankle Society (AOFAS) score, union rate, time to union, and postoperative complications. RESULTS: All patients were discharged the day of surgery or stayed one night in the hospital. Eight patients were very satisfied, one satisfied, and one patient not satisfied with the results of their surgery. The average modified AOFAS score (maximum 94 points) improved from 36 points preoperatively to 86 points postoperatively. Ten joints fused by 10 weeks postoperatively, and one patient developed a nonunion. No other postoperative complications occurred. CONCLUSIONS: For surgeons familiar with posterior ankle or subtalar arthroscopy, PASTA offers superior exposure of the posterior talocalcaneal facet, high patient satisfaction, an excellent fusion rate, and less postoperative morbidity for patients with subtalar arthritis.     

External fixation use in arthrodesis of the foot and ankle

The use of external fixation in foot and ankle arthrodesis can be beneficial. Its advantages, disadvantages, and indications were reviewed in this article. External fixation offers the surgeon an opportunity to treat complex foot and ankle deformities, trauma, chronic infections, pseudoarthroses, soft tissue contractures, and limb length discrepancies in ways that were unavailable before its advent. The Ilizarov technique requires considerable experience and patient compliance for the best postoperative outcome. An understanding of musculoskeletal physiology and the biomechanics of bone and soft tissue are essential for the competent application of external fixators in general and Ilizarov frames in particular. The surgeon should be aware of all the surgical options before the application of an external complex apparatus.     

内踝解剖型钩钢板治疗粉碎性内踝骨折的疗效分析

目的 评价内踝解剖型钩钢板治疗粉碎性内踝骨折的临床疗效。方法 对2015年3月至2017年6月采用内踝解剖型钩钢板治疗粉碎性内踝骨折的30例病人进行回顾性分析,其中男18例,女12例;年龄为21~50岁,平均34.5岁。受伤原因：扭伤10例,直接暴力骨折20例。左踝12例,右踝18例。30例病人均行切开复位内固定手术,内踝应用解剖型钩钢板固定,合并外踝及后踝骨折的病人,外踝应用解剖钢板固定,后踝应用空心螺钉或钢板固定。采用美国足踝外科医师协会（American Orthopedic Foot and Ankle Society, AOFAS）踝与后足功能评分系统、踝关节活动度和疼痛视觉模拟评分量表（visual analogue scale, VAS）评价术前及末次随访时病人的踝关节功能。结果 所有30例病人的随访时间为6~18个月,平均13.1个月。术后切口均一期甲级愈合,无感染、皮瓣坏死、骨折移位、内固定松动、骨不愈合等并发症出现。手术前后的AOFAS踝-后足评分分别为（12.0±10.0）分、（90.0±3.1）分,VAS评分分别为（5.4±1.0）分、（1.3±0.3）分,差异均有统计学意义（P均＜0.05）。末次随访时平均踝关节活动度为60.2°±6.2°。结论 采用内踝解剖型钩钢板治疗粉碎性内踝骨折,固定牢固,操作方便,病人术后功能恢复好,是治疗粉碎性内踝骨折有效的固定方法。     

Ankle arthrodesis with an anterior tension plate

The incidence of complications associated with arthrodesis of the ankle has remained high, especially in wound complications and infections. A new method to achieve arthrodesis of the ankle that utilizes an anterior surgical approach and an anterior tension plate was assessed in 17 patients. This method transforms the potentially deforming force of the tendoachilles into a compressive and corrective force and facilitates realignment of the ankle in all planes. Also, dissection and subperiosteal elevation is minimized while soft tissue coverage of the hardware is maximized. Whereas the predominant preoperative diagnosis was posttraumatic degenerative joint disease, others included failed ankle arthroplasty, failed arthrodesis, and a fixed equinus deformity. A solid arthrodesis was achieved in 82% of the patients. Although complications occurred and two patients required reoperations, there were no problems with respect to wound healing or infection, which is a marked contrast to other series. This technique is recommended as a simple, safe, and effective method to achieve an arthrodesis of the ankle joint.     

Arthroscopic ankle arthrodesis: factors influencing union in 39 consecutive patients

BACKGROUND: Arthroscopic ankle arthrodesis is an effective alternative to open techniques with established advantages in select patient populations. The purpose of this study was to evaluate patients who had arthroscopic ankle arthrodesis for end-stage arthritis with minimal to no deformity of the ankle and to report factors influencing union. METHODS: Thirty-nine consecutive patients had arthroscopic ankle arthrodesis between 1994 and 2003. Clinical records and radiographs were retrospectively reviewed to evaluate variables that could predispose patients to nonunion. Union outcomes were correlated with etiology of arthritis, ankle deformity, medical co-morbidities, and the use of demineralized bone matrix or platelet-rich plasma. Arthroscopic ankle arthrodesis was accomplished with a consistent technique using crossed transmalleolar cannulated screw fixation. RESULTS: Thirty-four of 39 patients (87.2%) achieved radiographic and clinical union. The average time to fusion was 47 (range 37 to 70) days. Poor bone quality and inherent positional ankle deformity were identified as risk factors for nonunion. Patients who smoked, had diabetes mellitus, peripheral neuropathy, or other medical co-morbidities attained ankle union in nearly all cases. In obese patients, there was an observed trend towards ankle nonunion (relative risk 5.81, p = 0.049, Fisher's Exact test). The addition of demineralized bone matrix or platelet-rich plasma did not improve the rate of ankle union. Aside from nonunion, 10 patients developed minor complications. CONCLUSION: Arthroscopic ankle arthrodesis achieves high union rates, facilitates short time to union, and permits rapid patient mobility. Careful patient selection is important for the procedure. Synthetic allograft or platelet-rich plasma did not enhance the fusion rate. Obese patients showed a trend towards nonunion in this series.     

Intramedullary fibular graft for tibiotalocalcaneal arthrodesis

The intramedullary fibular graft was used in four patients for tibiotalocalcaneal fusion. There were three men and one woman. The average age was 49.7 years (range, 35-73 years). The initial injuries were three pilon fractures and one ankle fracture. Tibiotalocalneal arthrodesis was performed as a salvage procedure for patients with significant posttraumatic arthritis of the ankle, concomitant subtalar arthritis, and severe osteopenia. The average followup was 28 months (range, 24-31 months). All the patients had successful arthrodesis and were satisfied with the outcome results. The average preoperative American Orthopaedic Foot And Ankle Society ankle-hindfoot score for the whole group was 49.5 (range, 44-54) and improved postoperatively to 78.5 (range, 71-81). Three patients had a good score and one patient had a fair score. There was no postoperative infection or fracture of the graft.     

踝关节外侧入路T型接骨板固定在胫距关节融合中的应用

背景:目前踝关节融合仍是治疗踝关节创伤后关节炎的金标准。踝关节融合术后不愈合发生率较高。距骨外后侧坏死者往往难以清理。目的:探讨踝关节外侧入路腓骨下段截骨、胫距关节融合T型接骨板固定治疗踝关节创伤后关节炎的临床疗效。方法:回顾性分析2013年6月至2016年6月采用踝关节外侧入路腓骨截骨、胫距关节融合T型接骨板固定的30例创伤后关节炎患者资料。男18例,女12例,年龄56~75岁,平均67.3岁。根据Morrey-Wiedeman分期,均为3期关节炎。记录患者术后主观满意度,采用美国足踝外科协会(AOFAS)踝功能评分评价末次随访时足踝部功能。结果:30例患者随访时间12~24个月,平均20.0个月。AOFAS评分末次随访时平均为(77.9±6.5)分,与术前(51.2±9.8)分比较,差异有统计学意义(P<0.05)。末次随访时胫距关节均融合,其中1例患者损伤腓肠神经,神经相应支配区出现感觉障碍,经营养神经治疗半年后症状缓解;1例由于早期活动融合处延迟愈合,经石膏固定、口服药物后愈合;1例由于融合时距骨向踝关节前侧稍移位,行走时鞋容易脱落。27例患者对手术效果非常满意,3例一般,满意率为90%。结论:踝关节外侧入路腓骨截骨、胫距关节融合T型接骨板固定治疗创伤后关节炎创伤小,术中获取植骨来源充分,操作方便,伤口风险小,患者术后满意度高,能纠正畸形、缓解疼痛,值得临床推广。     

Arthroscopic Tibiotalocalcaneal Arthrodesis with Locked Retrograde Compression Nail

Tibiotalocalcaneal (TTC) arthrodesis is a demanding procedure. Several techniques have been described for successful fusion, including the use of plates, screws, intramedullary nails, and external fixators. Arthroscopic TTC fusion with intramedullary nailing has been recently described as an alternative method to traditional open procedures. The surgical technique and clinical and radiographic outcomes of 2 patients who had undergone arthroscopic TTC arthrodesis with intramedullary nailing are presented. The indication for surgery was symptomatic tibiotalar and subtalar post-traumatic arthritis in 1 patient and distal tibia and fibula nonunion in the other. In both cases, fusion was obtained at approximately 8 weeks postoperatively. At the final follow-up visit at 2 years postoperatively, their American Orthopaedic Foot and Ankle Society score had improved from 31 to 85 points and from 16 to 71 points, respectively. No intra- or postoperative complications developed. Arthroscopic TTC arthrodesis can be an alternative to traditional open procedures, especially in patients with soft tissue concerns or several previous surgeries. Experience with ankle arthroscopy procedures is mandatory to obtain satisfactory results and minimize the risk of complications.