Regardless of the method used, open ankle arthrodesis is known to have a high rate of nonunion, reported to range from 4% to 25%. Salvage of failed ankle fusion is thus a relatively common procedure. Further, in cases of bone loss after distal tibial trauma, necrosis of the talus, Charcot joints and severe deformities of the ankle, there are known to be increased incidences of delayed union and nonunion.

Since 1997, 25 salvage ankle arthrodesis procedures have been performed, using a retrograde interlocking intramedullary nail as fixation. In this paper we discuss the indications, surgical techniques and results.

At a mean of nine weeks postoperatively, union was achieved in all cases. Complications included one case of late sepsis, which presented four years after surgery. During the operation one tibial fracture occurred. One distal screw backed out. The fixation was removed from three patients, one for late sepsis, one for septic nonunion, and the patient in whom the tibia fractured.