Strategies in Trauma and Limb Reconstruction

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VOLUME 4 , ISSUE 2 ( October, 2009 ) > List of Articles

Original Article

The use of a retrograde fixed-angle intramedullary nail for tibiocalcaneal arthrodesis after severe loss of the talus

Kajetan Klos, Thomas Drechsel, Florian Gras, Claudia Beimel, Andreas Tiemann, Gunther O. Hofmann, Thomas Mückley

Keywords : Talectomy, Tibiocalcaneal arthrodesis, Retrograde, Intramedullary nail, Ankle arthrodisis, Hindfoot

Citation Information : Klos K, Drechsel T, Gras F, Beimel C, Tiemann A, Hofmann GO, Mückley T. The use of a retrograde fixed-angle intramedullary nail for tibiocalcaneal arthrodesis after severe loss of the talus. 2009; 4 (2):95-102.

DOI: 10.1007/s11751-009-0067-y

License: CC BY-NC-SA 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2009; The Author(s).


Tibiocalcaneal arthrodesis may be the only means of obtaining a painless and stable limb when there is loss of the talus. We present the early results of a prospective study on tibiocalcaneal arthrodesis using a latest-generation retrograde intramedullary nail. In the period 2006–2007, nine patients underwent tibiocalcaneal arthrodesis with retrograde intramedullary nailing. Five of these patients had infection-related loss of the talus. SF-36, AOFAS ankle-hindfoot, and Mazur Ankle Arthrodesis scores were obtained pre-fusion, and at 6 weeks, 6 months and 1 year post-fusion. The patients were also followed up clinically and radiologically. Previous surgical procedures, chronic musculoskeletal problems and other comorbidities, and complications were recorded and analyzed. All patients were available for initial follow-up and were subjectively satisfied with their outcomes. Solid fusion was achieved and fully confirmed in nine cases. One subject died 8 weeks postoperatively of a pulmonary embolism. One patient had recurrent infection. At 1 year, only one patient still needed NSAIDs regularly for pain relief. The AOFAS score improved significantly (P = 0.012) from 32.1 pre-fusion to 71.5 points at 1 year as did the Mazur score, which rose by 31.2 to 72.5 points at 1 year (P = 0.012). The SF-36 score improved significantly in the domains physical functioning, role limitations due to physical problems, bodily pain, vitality, social functioning and mental health, as did the Physical Component Summary Score. Retrograde intramedullary nailing for tibiocalcaneal arthrodesis can produce a good outcome. However, in the presence of infection, patient selection for intramedullary procedures must be carefully considered on a case-by-case basis.

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  1. Coltart WD (1952) Aviator's astragalus. J Bone Joint Surg [Br] 34:545-566
  2. Penny JN, Davis LA (1980) Fractures and fracture-dislocations of the neck of the talus. J Trauma 20:1029-1037
  3. Reckling FW (1972) Early tibiocalcaneal fusion in the treatment of severe injuries of the talus. J Trauma 12:390-396
  4. Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). Med Care 30:473-483
  5. Blair HC (1943) Comminuted fractures and fracture dislocations of the body of the astragalus. Am J Surg 59:37-43
  6. Harnroongroj T, Vanadurongwan V (1997) The talar body prosthesis. J Bone Joint Surg [Am] 79:1313-1322
  7. Koller H, Assuncao A, Kolb K, Holz U (2007) Reconstructive surgery for complete talus extrusion using the sandwich block arthrodesis: a report of 2 cases. J Foot Ankle Surg 46:493-498
  8. Thomason K, Eyres KS (2008) A technique of fusion for failed total replacement of the ankle: Tibio-allograft-calcaneal fusion with a locked retrograde intramedullary nail. J Bone Joint Surg [Br] 90:885-888
  9. Günal I, Atilla S, Araç S, Gürsoy Y, Karagözlu H (1993) A new technique of talectomy for severe fracture-dislocation of the talus. J Bone Joint Surg [Br] 75:69-71
  10. Liener UC, Bauer G, Kinzl L, Suger G (1999) Die tibiokalkaneare Arthrodese. Eine Analyse von 21 Fällen. Unfallchirurg 102:848-854
  11. Dennison MG, Pool RD, Simonis RB, Singh BS (2001) Tibiocalcaneal fusion for avascular necrosis of the talus. J Bone Joint Surg [Br] 83:199-203
  12. Kolker D, Wilson MG (2004) Tibiocalcaneal arthrodesis after total talectomy for treatment of osteomyelits of the talus. Foot Ankle Int 25:861-865
  13. Rochman R, Jackson Hutson J, Alade O (2008) Tibiocalcaneal arthrodesis using the Ilizarov technique in the presence of bone loss and infection of the talus. Foot Ankle Int 29:1001-1008
  14. Myerson MS, Alvarez RG, Lam PW (2000) Tibiocalcaneal arthrodesis for the management of severe ankle and hindfoot deformities. Foot Ankle Int 21:643-650
  15. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281-284
  16. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hind foot, midfoot, hallux and lesser toes. Foot Ankle Int 15:349-353
  17. Mazur JM, Schwartz E, Simon SR (1979) Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg [Am] 61:964-975
  18. Papaioannou NA, Kokoroghiannis CG, Karachalios GG (1998) Traumatic extrusion of the talus (missing talus). Foot Ankle Int 19:590-593
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