Tibiotalocalcaneal Arthrodesis using a Compressive Retrograde Locking Nail with Hindfoot Valgus

Aim: The purpose of this study was to evaluate the first clinical experiences with the newest generation retrograde arthrodesis nail. Methods: 28 patients who had tibiotalocalcaneal arthrodesis between 2005 and 2007 using a retrograde compression nail fixation (T2 AAN, Stryker, Duisburg, Germany) were retrospectively reviewed. Complications, functional outcome scores, and patient satisfaction were determined and the radiographs were evaluated for bony healing. Results: The mean time interval until follow-up was 16 months (range: 7-27). All but 1 ankle showed a radiographically healed arthrodesis. 25 patients (89%) were satisfied with the outcome. The average functional scores at follow-up were 64 (38-86 points) points for the American Orthopedics Foot and Ankle Score (AOFAS) and 65 points for the Mazur Ankle Scoring System (3083 points). We recorded complications in 7 patients (25%) including 1 deep infection with breakage of the calcaneus screw, 3 reinfections, 1 deep vein thrombosis, 1 intraoperative fracture of the tibia, 1 delayed union and 1 non-union. Conclusion: Tibiotalocalcaneal arthrodesis is a salvage procedure. Using a specifically designed retrograde intramedullary nail is a reliable method to achieve fusion. Patient satisfaction is high, but the procedure is demanding and complications are frequent. After infections the indication for nail arthrodesis should be evaluated carefully in each case.