Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction

Background:

• Tibiotalocalcaneal (TTC) fusion using straight rods risks neurovascular damage and hindfoot alignment issues.
• A novel approach utilizes a short, anatomically curved interlocking intramedullary nail for TTC arthrodesis.

Purpose of the Study:

• To evaluate the efficacy and safety of TTC arthrodesis with a short, curved intramedullary nail.
• To assess the impact on pain, function, and hindfoot alignment.

Main Methods:

• Prospective study of 45 TTC fusions in 42 patients over 6 years.
• Indications included failed previous fusions, arthroplasty, and complex deformities.
• Outcomes measured by clinical exams, AOFAS, SF-12 scores, and radiographic assessment.

Main Results:

• Achieved an 89% union rate with significant improvement in pain (82%) and function (73%).
• Satisfactory hindfoot alignment was obtained in 84% of cases.
• Complications included nonunions, delayed unions, and one case of nerve irritation.

Conclusions:

• The short, anatomically curved intramedullary nail facilitates high rates of TTC fusion.
• This technique demonstrates minimal plantar neurovascular complications and aids in maintaining hindfoot alignment.