Orthopaedic Jobs

Tibio-Talar-Calcaneus Arthrodesis


- Discussion:
    - surgical indications include diabetic neuropathy, osteoarthritis, posttraumatic injury, talar AVN, and RA involving
           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, 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);
           - Tibiotalocalcaneal arthrodesis.

- Technique Considerations: 

    - need to keep foot plantigrade:
           - if foot cannot be positioned plantigrade, then consider need for partial or complete talectomy;
    - medial approach to ankle and subtalar joint:
           -
ensures that there will be no neurovascular injury;
           - tarsal tunnel decompression sometimes affords improved sensation to the foot;
    - 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 McGarvey WC, et al (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; 
                   - Tibiotalocalcaneal arthrodesis: Anatomic and technical considerations.
    - distal interlocking screws;
           - in most systems one of the interlocking screws will traverse in the AP direction - consider making this screw extra-long so that
                      it engages the midfoot for additional fixation;

- Complications:
        - Limb salvage: the infected retrograde tibiotalocalcaneal intramedullary nail.



    Minimally invasive ankle arthrodesis with a retrograde locking nail after failed fusion

    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

    IM 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

    Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. 

    Charcot ankle fusion with a retrograde locked intramedullary nail

    Tibiotalocalcaneal arthrodesis using a dynamically locked retrograde intramedullary nail.

    Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure.

    Ankle fractures in diabetic neuropathic arthropathy: can tibiotalar arthrodesis salvage the limb?








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Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Thursday, July 9, 2015 4:23 pm