- Discussion:
- surgical indications included osteoarthritis, posttraumatic injury, failed previous surgery, talar AVN,
osteoarthritis, and rheumatoid arthritis involving the ankle and subtalar joints;
- position for pantalar arthrodesis:
- 0-5 deg of calcaneus (not equinus) and 5 deg of valgus;
- in the report by
Chou et al (Foot and Ankle International), the authors studied 55 patients (56 ankles) who underwent simultaneous tibiotalocalcaneal
arthrodesis with severe disease involving the ankle and subtalar joints;
- average time of follow-up was 26 months after the operation;
- fusion was achieved in 48 ankles, with an average time of fusion of 19 weeks;
- 48 of the 55 patients were satisfied with the procedure;
- average leg length discrepancy was 1.4 cm;
- average amount of dorsiflexion was 2 degrees and plantar flexion was 5 degrees;
- 42 patients complained of post op pain, 40 patients required shoe modification or an orthotic device, and 34 patients had a limp;
- most common complications were nonunion (8 ankles) and wound infection (6 ankles);
- Technique Considerations:
- retrograde nails:
- which are used for pantalar fusion should have interlocking nails in the saggital plane inorder to counteract the muscular forces generated in gait;
- using the standard technique, the lateral plantar nerve and artery are at risk for injury, not to mention muscle and tendon injury (esp to the FHL tendon);
- in the study by WC McGarvery MD 1998, medial malleolar osteotomy and medial translation of the talus, reduces the risk of N/V injury,
FHL injury, and increases the strength of fixation;
The optimum position of arthrodesis of the ankle. A gait study of the knee and ankle.
Pantalar and tibiotalocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot.
Tibiotalocalcaneal arthrodesis for arthritis and deformity of the hind part of the foot.
Tibiotalocalcaneal arthrodesis: Anatomic and technical considerations.
WC McGarvey MD et al. Foot and Ankle International. Vol 19. No 6. Jun 1998. p 363;
Clinical Outcome of Arthrodesis of the Ankle Using Rigid Internal Fixation with Cancellous Screws.
MT Monroe et al. Foot and Ankle International. Vol. Vol 20. No 4. Apr 1999. p 228.
Tibiotalocalcaneal arthrodesis.
Foot Ankle Int 2000 Oct;21(10):804-8 Related Articles, Books
Chou LB, Mann RA, Yaszay B, Graves SC, McPeake WT 3rd, Dreeben SM, Horton GA, Katcherian DA, Clanton TO, Miller RA, Van Manen JW
Pantalar and tibiotalocalcaneal arthrodesis for post-traumatic osteoarthrosis of the ankle and hindfoot.
Methods and Follow-Up Statistics on Ankle *Arthrodesis--Symposium:* Arthrodesis of the Ankle and Subtalar Joints.
Limb salvage: the infected retrograde tibiotalocalcaneal intramedullary nail.
Intramedullary Rod Fixation Compared with Blade-Plate-and-Screw Fixation for Tibiotalocalcaneal Arthrodesis: A Biomechanical Investigation.
Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a biomechanical analysis of the effect of nail length.
Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail: a report of 34 consecutive patients.
Tibiotalocalcaneal Arthrodesis Using a Reamed Retrograde Locking Nail
