Anterior Plating with Retention of Nail for Salvage Ankle Arthrodesis after Failed Tibiotalocalcaneal Arthrodesis
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1 Anterior Plating with Retention of Nail for Salvage Ankle Arthrodesis after Failed Tibiotalocalcaneal Arthrodesis Andrew P. Matson 1, MD Kamran S. Hamid 1, MD MPH Travis J. Dekker 1, MD James K. DeOrio 1, MD 1. Duke University School of Medicine, Durham, NC
2 Disclosure The authors have no conflicts of interest to disclose.
3 Tibiotalocalcaneal (TTC) arthodesis with retrograde intramedullary nail (RIMN) is common In the event of failure (4-48%), techniques for salvage ankle arthrodesis are not well described Anterior plating is effective for primary ankle arthrodesis Aim: 1. Establish viability and safety of this technique 2. Report clinical and radiographic outcomes
4 Methods: Retrospective case series 6 consecutive patients with ankle nonunion following failed TTC RIMN Subtalar fusion Underwent anterior plating with nail retention
5 Methods: Outcomes -Numeric pain scale (NPS) rating -Foot and Ankle Activity Measure (FAAM) score -Radiographic Union -Satisfaction
6 Patients Age, y Sex BMI (kg/m 2 ) Diagnosis Medical History Delay from 1 o fusion, m Concomitant Procedures M 31.5 AVN CAD, DM, AF, 14.3 None chronic pain, tobacco use F 53.7 DJD Anxiety, chronic 25.7 ROH pain, DM, tobacco use M 34.4 DJD GERD, HTN 6.3 ROH F 34.4 DJD HTN, chronic 19.1 None pain F 33.2 DJD GERD, RA 14.7 None F 19.9 AVN Pulm HTN, s/p 15.4 None heart transplant Mean
7 Technique
8 Technique
9 Results Patient Follow-up, m Complicatio ns Preop NPS Postop NPS Satisfaction FAAM score Time to fusion, wk Neuroma, amputation 8 8 poor n/a Swelling 9 5 good None 7 3 good None 8 7 good None 7 6 good None 8 3 excellent Mean
10 Discussion: Failure of TTCA with RIMN is a complex clinical problem Advantages of anterior plate -Minimal soft tissue dissection -Avoid scar from previous surgery Radiographic union and acceptable clinical outcomes Complications should be considered
11 Limitations: Retrospective biases No consistent postop CT Functional comparison Future directions: Long term outcomes Comparative studies
12 References Franceschi F, Franceschetti E, Torre G et al. Tibiotalocalcaneal arthrodesis using an intramedullary nail: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015:1-10. Thomas RL, Sathe V, Habib SI. The use of intramedullary nails in tibiotalocalcaneal arthrodesis. J Am Acad Orthop Surg. 2012;20(1):1-7. Boer R, Mader K, Pennig D, Verheyen CC. Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail. Clin Orthop Relat Res. 2007;463: Goebel M, Gerdesmeyer L, Mückley T et al. Retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis: a shortterm, prospective study. J Foot Ankle Surg. 2006;45(2): Moore TJ, Prince R, Pochatko D, Smith JW, Fleming S. Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int. 1995;16(7): Cooper PS. Complications of ankle and tibiotalocalcaneal arthrodesis. Clin Orthop Relat Res. 2001;391: Bibbo C, Lee S, Anderson RB, Davis WH. Limb salvage: the infected retrograde tibiotalocalcaneal intramedullary nail. Foot Ankle Int. 2003;24(5): Jeong ST, Park HB, Hwang SC, Kim DH, Nam DC. Use of intramedullary nonvascularized fibular graft with external fixation for revisional Charcot ankle fusion: a case report. J Foot Ankle Surg. 2012;51(2): Mudgal CS, Wilson MG. Revision tibiotalocalcaneal arthrodesis after a failed intramedullary rod: a technique tip. Foot Ankle Int. 1999;20(3): Guo C, Yan Z, Barfield WR, Hartsock LA. Ankle arthrodesis using anatomically contoured anterior plate. Foot Ankle Int. 2010;31(6): Mears DC, Gordon RG, Kann SE, Kann JN. Ankle arthrodesis with an anterior tension plate. Clin Orthop Relat Res. 1991;268: Rowan R, Davey KJ. Ankle arthrodesis using an anterior AO T plate. JBJS-Br. 1999;81: Brodsky JW, Verschae G, Tenenbaum S. Surgical correction of severe deformity of the ankle and hindfoot by arthrodesis using a compressing retrograde intramedullary nail. Foot Ankle Int. 2014;35(4):
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