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Purpose <p>Complications after open reduction and internal fixation (ORIF) of ankle fractures are not uncommon, negatively impacting the postoperative outcome. Tibiotalocalcaneal (TTC) arthrodesis has been shown to be a viable treatment option in these cases. The aim of this study was to describe the operative technique and the outcome of patients presenting failed osteosynthesis of the ankle joint managed with TTC using a retrograde femoral IM nail.</p> Methods <p>This is a retrospective observational study of adult patients (18&#xa0;years or older) operated on for failure in osteosynthesis of the ankle joint (malleolar or tibial pilon fractures) using a retrograde femoral nail to perform TTC arthrodesis, with a minimum follow-up of 24&#xa0;months. Patient demographics, initial injury characterization, comorbidities, initial treatment, time from initial injury to TTC arthrodesis, time to union, secondary procedures, and complications were recorded. Patients were evaluated clinically and radiographically at 12 and 24&#xa0;months using, respectively, a modified version of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores and full-weight-bearing anteroposterior and lateral radiographs.</p> Results <p>During the study period, 17 patients were treated with TTC arthrodesis using a retrograde femoral nail. The initial injury was a pilon fracture in 4 patients and a malleolar ankle fracture in 13 patients. The time between the initial injury and TTC arthrodesis ranged from 8 to 52&#xa0;months, with a mean of 14.7&#xa0;months. Complete radiographic fusion of the tibiotalar joint occurred uneventfully in all patients, whereas in four (23.5%) cases, complete radiographic fusion of the subtalar joint was not observed, although these patients were considered to have a satisfactory outcome due to a functional, painless, and properly aligned hindfoot after TTC arthrodesis. The mean time to union was 8&#xa0;months, with a range of 5 to 10&#xa0;months. Secondary procedures were performed in 2 patients. Four patients experienced minor complications. There were no statistically significant differences between patients who sustained a tibial pilon fracture and a malleolar ankle fracture in all variables analysed. The modified AOFAS score at 24&#xa0;months ranged from 64 to 94, with a mean of 81 points.</p> Conclusions <p>The use of a femoral retrograde IM nail for TTC arthrodesis is a viable option for patients with sequelae of tibial pilon and ankle malleolar fractures due to fixation failure.</p>

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Tibiotalocalcaneal arthrodesis for failed osteosynthesis of the ankle joint using a retrograde femoral intramedullary nail: a retrospective observational study

  • 期刊论文

  • 发表日期：

    2025年9月10日

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  • Vincenzo Giordano,
  • Felipe Serrão de Souza,
  • Daniela Ramos Rivas,
  • Paulo Frederico de Carvalho,
  • Hilton Augusto Koch,
  • Robinson Esteves Pires,
  • Alexandre Godoy-Santos

摘要

Purpose

Complications after open reduction and internal fixation (ORIF) of ankle fractures are not uncommon, negatively impacting the postoperative outcome. Tibiotalocalcaneal (TTC) arthrodesis has been shown to be a viable treatment option in these cases. The aim of this study was to describe the operative technique and the outcome of patients presenting failed osteosynthesis of the ankle joint managed with TTC using a retrograde femoral IM nail.

Methods

This is a retrospective observational study of adult patients (18 years or older) operated on for failure in osteosynthesis of the ankle joint (malleolar or tibial pilon fractures) using a retrograde femoral nail to perform TTC arthrodesis, with a minimum follow-up of 24 months. Patient demographics, initial injury characterization, comorbidities, initial treatment, time from initial injury to TTC arthrodesis, time to union, secondary procedures, and complications were recorded. Patients were evaluated clinically and radiographically at 12 and 24 months using, respectively, a modified version of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores and full-weight-bearing anteroposterior and lateral radiographs.

Results

During the study period, 17 patients were treated with TTC arthrodesis using a retrograde femoral nail. The initial injury was a pilon fracture in 4 patients and a malleolar ankle fracture in 13 patients. The time between the initial injury and TTC arthrodesis ranged from 8 to 52 months, with a mean of 14.7 months. Complete radiographic fusion of the tibiotalar joint occurred uneventfully in all patients, whereas in four (23.5%) cases, complete radiographic fusion of the subtalar joint was not observed, although these patients were considered to have a satisfactory outcome due to a functional, painless, and properly aligned hindfoot after TTC arthrodesis. The mean time to union was 8 months, with a range of 5 to 10 months. Secondary procedures were performed in 2 patients. Four patients experienced minor complications. There were no statistically significant differences between patients who sustained a tibial pilon fracture and a malleolar ankle fracture in all variables analysed. The modified AOFAS score at 24 months ranged from 64 to 94, with a mean of 81 points.

Conclusions

The use of a femoral retrograde IM nail for TTC arthrodesis is a viable option for patients with sequelae of tibial pilon and ankle malleolar fractures due to fixation failure.