Tibiotalar arthrodesis with the tibial compression nail.

OBJECTIVE

Arthrodesis of the ankle joint in proper position (neutral position in respect to flexion/extension, 5 degrees external rotation, 0-5 degrees of valgus). Pain-free weight bearing of the affected limb.

INDICATIONS

Painful osteoarthritis of the ankle joint resistant to conservative approaches even in the presence of poor bone quality of the distal tibia such as after pilon fractures and osteoporosis. Failure of other methods of internal fixation.

CONTRAINDICATIONS

Osteitis. Partial necrosis of the talar dome. Medullary canal of tibia not patent.

SURGICAL TECHNIQUE

Lateral approach and resection of lateral malleolus. If the joint position is normal, removal of articular cartilage of tibia and talus. If axial correction is necessary, wedge resection of articular surfaces with underlying bone. Opening of proximal tibial medullary canal, insertion of compression nail into tibia and talus. Compression osteosynthesis and cancellous bone grafting. Alternatively, the arthrodesis can be achieved with the dowel technique.

RESULTS

Between September 1993 and March 2001, 137 patients (43 women, 94 men, average age 49 years [21-79 years]) were operated. Follow-up of 110 patients after 42 months: successful bony fusion in 99 patients (90%). In six patients (5.5%) the goal of treatment was obtained after revision with recompression of the nail and bone grafting. Nonunion in five patients (4.5%).

COMPLICATIONS

one tibial shaft fracture, one hematoma needing evacuation, three superficial infections, and eight deep infections. Three patients developed an osteoarthritis of the subtalar joint. 70 patients (63.6%) reported an improvement, 37 (33.6%) no notable change of symptoms, and three (2.7%) a deterioration.