[Tibiocalcaneal arthrodesis with retrograde nails. Description of a hindfoot procedure after massive talus...

Following loss of the talus, tibiocalcaneal fusion is often the only available means of obtaining weight-bearing ability in the lower limb. Length discrepancy may be managed with an allograft. This casuistic describes 6 patients with tibiocalcaneal fusion (mean age 64 years) who had received a structural femoral head allograft fusion for failed total ankle arthroplasty (3 cases), Charcot arthropathy (2 cases) and osteomyelitis (1 case). The mean follow-up was 33 months and all limbs could be salvaged. There were two cases of non-union (one with infection). The mean AOFAS score was 51 and the mean Mazur score was 37. In the SF-36 the mean PCS was 34.4 and the mean MCS was 48.4. It was shown that in the hindfoot, as at other sites, allografts may be used for the filling of major bone defects; however, the patient function will still be massively impaired. Therefore, the procedure should be confined to cases where less complex and less invasive techniques are unlikely to be of benefit.