Retrograde Intramedullary Nailing in Tibiotalocalcaneal Arthrodesis: A Short-Term, Prospective Study

In this prospective study, tibiotalocalcaneal arthrodesis was performed in 29 patients with a retrograde femur nail (Interlocking Compression Nail; Stryker Trauma, Schönkirchen, Germany) inserted through a plantar approach. Patients were evaluated by a standardized follow-up examination using the American Foot and Ankle Society ankle-hindfoot scale and the main criteria of the short-form health survey (36 items). Special emphasis was placed on surgical approach, bony consolidation, and postoperative quality of life. Solid fusion was achieved in 90% of the patients after a mean follow-up of 25 months. Twenty-two patients (76%) showed primary bone healing after an average of 5.2 months; a delayed union was observed in 7 patients. In 79% of the patients, pain was reduced effectively and quality of life substantially improved with the intramedullary nail arthrodesis. The average ankle-hindfoot score improved from 46 (range, 41-53) to 71 (range, 49-83) points. Complications occurred in 6 patients (21%), including 2 deep infections, 3 nonunions, and 1 case of postoperative flexion deformity. The authors found retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis to be an effective technique in obtaining solid fusion, an effective relief from pain, and an improvement of quality of life.