OUR EXPERIENCE OF RETROGRADE ANKLE NAILING ; PROSPECTIVE FOLLOW-UP OF 38 CASES

Abstract

Introduction: This document is our report on the prospective follow-up of 38 patients operated between May 1998 and May 2005. If the technique in itself hardly poses any difficulty, our experience of talo-crural and sub-talar arthroscopy has proved to be a major asset.

Materials and method: This involved 38 patients (23 men and 16 women) mean age 55y who received a double or triple talar arthrodesis by means of retrograde nailing. 4 patients had a septic history, and 7 an anterior sub-talar arthrodesis. In 19 cases, sub-talar refreshing was carried out in accordance with our arthroscopic principles. Whenever possible, the same procedure was followed at the talo-crural stage, despite an anterior or anterolateral approach (cartilaginous refreshing as regards the geometry of the surfaces, and careful refreshing of the splints and trans-osseous perforations).

In one case, the technique was purely bifocal arthroscopy, 26 patients had bone grafts (25 autografts, 1 allograft). Indications therefore were 7 failed talar arthroplasties, 6 ankle pseudarthrodesis with side-effects in the sub-talar joint, 5 primitive bifocal arthosis, 5 complex traumatisms in the hinde foot, 4 neurological varus equinus feet, 3 side-effects of talar laxity, 1 diabetic osteo-arthropathy and one pseudarthrosis of the leg with subjacent talo-crural arthrosis. The average follow-up is of 38 months (12–90).

Results: Complete weight bearing has always been possible, except for a paraplegic patient. 2 non-fusions (one at each level) are noted in two patients who were succesfully treated with a change of method. All of the other set within an average period of 2.6 months. We note one resolvent aseptic discharge in a looking screw, one algodystrophy, one sepsis of the iliac site, and one of a locking screw. The patients were evaluated by the AFCP, SFMCP talar score, whose average value rose from 20.7 to 66/100. 19 patients were very satisfied, 15 satisfied, 2 disappointed and 2 dissatisfied.

Discussion: This osteosynthesis, very reliable biomechanically, enabled a number of delicate situations to be recovered, using a graft, however, in 68%of cases. Applying the principle of endoscopic refreshing resulted in a fusion rate of 97.5%. In our experience, a septic history doesn’t contra-indicate nailing.

Conclusion: This technique, often reserced for difficulty cases, has proved to be extremely reliable, with an excellent fusion rate.