In this study, the Orthofix retrograde locking nail system was used for ankle fusion. Specifically, the tibiotalocalcaneal joints were fused. This means the ankle and subtalar joints are both fused. This type of fusion is called an arthrodesis.
The authors describe the surgical steps used to perform this procedure. The union rate was calculated when using this system. They compared cases with and without debridement of the joints. Different methods of debridement were also compared. Debridement is cleansing of the joint to remove any unnecessary or loose cartilage.
Fifty patients were followed for at least 12 months. Besides union rate, time required to fuse and function were recorded. Patient satisfaction was also measured. X-rays were taken to confirm fusion results.
The authors reported all ankle joints were successfully fused. All but two of the subtalar joints were also fused. Fusion occurred after 12 weeks. Complete healing for some patients took over a year. There were some complications but all were easily managed. Most of the patients needed a corrective shoe.
The results of this study show that a retrograde nailing system is successful in fusing the tibiotalocalcaneal joints. It provides a stiffer fusion and greater stability than screws or plates. Debridement of the subtalar joint was not necessary with this locking nail system. Debridement of the ankle was a reliable method to aid fusion.
Either open or percutaneous debridement can be used. Percutaneous refers to a needle-puncture of the skin instead of an open incision. The authors suggest percutaneous debridement of the ankle works well to preserve the soft tissues. The more invasive open debridement can be avoided with this nail design.Ronald Boer, MRCSEd, et al. Tibiotalocalcaneal Arthrodesis Using a Reamed Retrograde Locking Nail. In Clinical Orthopaedics and Related Research. October 2007. No. 463. Pp. 151-156.