Tibiotalar Arthrodesis with the Tibial Compression Nail

Area of Science:

• Orthopedic Surgery
• Podiatric Surgery
• Trauma Surgery

Background:

• Ankle osteoarthritis significantly impacts quality of life, often proving resistant to conservative treatments.
• Poor bone quality, post-pilon fractures, and osteoporosis present surgical challenges for ankle fusion.
• Previous internal fixation failures necessitate alternative arthrodesis methods.

Purpose of the Study:

• To evaluate the efficacy of ankle arthrodesis with compression nailing in patients with severe ankle osteoarthritis.
• To assess the rates of bony fusion, complications, and patient-reported outcomes.
• To determine the suitability of this technique for cases with compromised bone quality.

Main Methods:

• A cohort of 137 patients underwent ankle arthrodesis via a lateral approach with malleolar resection.
• Compression nailing of the tibia and talus was performed, often with cancellous bone grafting.
• Surgical technique involved cartilage removal or wedge resection for axial correction, followed by medullary canal preparation.

Main Results:

• Successful bony fusion was achieved in 90% (99/110) of patients followed for an average of 42 months.
• Revision surgery with recompression and bone grafting was successful in an additional 5.5% of cases.
• Nonunion occurred in 4.5% of patients, with various complications including infections and subtalar osteoarthritis reported.

Conclusions:

• Ankle arthrodesis with compression nailing is a highly effective procedure for achieving bony fusion in severe ankle osteoarthritis.
• The technique demonstrates good outcomes even in patients with poor bone quality and previous surgical failures.
• While complications exist, the overall success rate supports its use in indicated cases.