Limb salvage: the infected retrograde tibiotalocalcaneal intramedullary nail

Tibiotalocalcaneal arthrodesis utilizing a retrograde intramedullary nail has been used for nearly a decade. The indications for retrograde intramedullary nailing to achieve a tibiotalocalcaneal arthrodesis have expanded from systemic arthritides and post-traumatic arthritis to use in diabetic patients with severe Charcot neurarthropathy and hindfoot malalignment. Results with this procedure have been good, with low infection rates when used in nonimmunocompromised hosts. As indications have expanded to include diabetic deformities, infection rates may increase. We report on the results of a salvage technique and management plan utilized in the treatment of infected tibiotalocalcaneal arthrodesis in five high-risk (immunocompromised) patients. The majority of these patients had diabetes with Cierny-Mader IVB osteomyelitis, and would have required an above-knee or below-knee amputation due to their infection.