TIBIO-TALO-CALCANEAL (HINDFOOT) ARTHRODESIS BY INTRAMEDUALLARY NAILING. RESULTS OF 54 CASES

Abstract

Aim

To report the clinical and radiological results of patients undergoing hindfoot fusion using an intramedullary nail.

Methods

Retrospective review of notes and radiographs of the patients of 2 surgeons who perform combined ankle and subtalar arthrodesis using retrograde intramedullary nailing with an ACE® humeral nail. The procedure is performed mainly for the treatment of combined ankle and subtalar arthritis or complex hindfoot deformities. Outcome was assessed by a combination of notes review, clinical examination and telephone questionnaire.

Results

Between 1995 and 2001 54 arthrodeses in 51 patients have been performed. The average follow up is 3 years. Approach to the joints was via a vertical anterolateral incision unless previous surgery dictated otherwise. All cases utilised an ACE® humeral nail which was locked proximally and distally. Most procedures utilised bone graft from the fibula, proximal tibia, iliac crest or allograft femoral head. Mean tourniquet time was 122 mins. Intra operative complications included one fractured tibia and one fractured medial malleolus. Postoperative management generally consisted of 3 months plaster immobilisation. Only 3 cases were immobilised significantly longer than this. Postoperative complications included deep infection, amputation, stress fracture, non-union & prominent metalwork. At review almost 78% of patients were satisfied with the results of surgery and approximately 80% felt the pain level & function of their foot had improved. Average postoperative AOFAS hindfoot score was 73.

Conclusion

Hindfoot fusion by intramedullary nailing is an effective technique in complex cases of deformity and in many cases is the only alternative to amputation. Patient satisfaction appears to be high but the procedure is demanding and the complication rate can be significant.