Revision Tibiotalocalcaneal Arthrodesis With a Pseudoelastic Intramedullary Nail

Hindfoot (tibiotalocalcaneal or TTC) arthrodesis is commonly used to treat concomitant arthritis of the ankle and subtalar joints. Simultaneous fusion of both joints can be difficult to achieve especially in patients with impaired healing due to smoking, diabetes mellitus, or Charcot neuroarthropathy. Conventional intramedullary fixation devices allow for compression to be applied at the time of surgery, but this compression can be lost due to bone resorption or settling, leading to impaired healing. In contrast, the novel pseudoelastic intramedullary nail is designed to maintain compression at the arthrodesis sites throughout the healing process by the use of an internal pseudoelastic element. We present 2 cases of revision TTC arthrodesis using the pseudoelastic intramedullary nail. In the first case, an 80-year-old diabetic man with previous ankle and failed subtalar fusion with screws underwent revision TTC arthrodesis. In the second case, a 66-year-old man with Charcot neuroarthropathy and a failed TTC arthrodesis with a static intramedullary nail underwent revision tibiotalar arthrodesis. In both cases, computed tomography scan demonstrated successful union and patients were allowed full weight bearing by 3 months after surgery. These cases provide early evidence that sustained compression via an intramedullary nail can lead to rapid successful hindfoot fusion when standard approaches have failed.

Therapeutic, Level IV: Case study.