Sub-optimal location of locking screw positioning in tibio-talo-calcaneal arthrodesis with an intramedullary device

BackgroundThe intramedullary ankle nail for tibio-talo-calcaneal (TCC) fusion has been noted in clinical practice to have locking screw holes that do not correspond to the ideal screw placement for bony purchase.MethodsRetrospective review identified 23 patients who had undergone 25 TCC arthrodeses. A retrospective study of the patient radiographs and records were undertaken.ResultsThe distal PA locking screw hole is significantly too high up the nail itself to facilitate placement of the screw in the optimal position within the calcaneum. The inferior hole should be placed lower and the superior hole placed higher to allow placement of the screws within the calcaneus and talus, respectively.ConclusionsFuture designs of intramedullary nailing systems may consider our findings when deciding on screw positions to facilitate the attainment of a solid, pain-free arthrodesis. Future study is required into different designs with different screw options for different operative indications.