Retrograde intramedullary nailing for ankle arthrodesis

Area of Science:

• Orthopedic Surgery
• Podiatry
• Reconstructive Surgery

Background:

• Ankle arthrodesis is a surgical procedure to fuse the bones of the ankle joint.
• Salvage procedures are necessary for complex cases where standard treatments fail.
• Retrograde intramedullary rodding offers an alternative fixation method for ankle fusion.

Purpose of the Study:

• To evaluate the efficacy of retrograde intramedullary rodding for ankle arthrodesis.
• To assess outcomes in patients with various complex ankle pathologies.
• To compare retrograde intramedullary rodding with standard ankle fusion techniques.

Main Methods:

• Retrospective study of 19 ankles in 16 patients undergoing retrograde intramedullary rodding for ankle arthrodesis.
• Patients had diagnoses including diabetic neuropathic arthropathy, rheumatoid arthritis, post-traumatic arthrosis, paraplegia, and avascular necrosis.
• Outcomes assessed via radiographic evidence of fusion and clinical parameters like ambulation and need for orthotics.

Main Results:

• Solid radiographic arthrodesis was achieved in 14 of 19 ankles.
• Pseudarthrosis occurred in 5 ankles but was not clinically significant.
• Complications included one deep infection and one broken rod. Thirteen patients were ambulatory, with nine requiring assistive devices.

Conclusions:

• Retrograde intramedullary rodding can be a successful salvage procedure for ankle arthrodesis in challenging cases.
• It is particularly considered for patients with significant bone loss, subtalar joint involvement, severe osteopenia, or neuropathic arthropathy.
• Standard ankle fusion with crossed screws remains the procedure of choice when preserving the subtalar joint is paramount.