Abstract
This prospective study compares the clinical results of antegrade and retrograde intramedullary arthrodesis of the upper and lower ankle joint using dynamic interlocking nails with the possibility of axial compression. In 13 patients combined arthrodesis was performed using a retrograde femur nail inserted through the heel, whereas in 18 patients tibiotalocalcaneal arthrodesis was performed using a distal tibia nail through an antegrade approach. Patients were evaluated in a standardized examination using criteria of SF 36 focussing on approach, osseous consolidation and quality of life. Both techniques yielded good results: bony consolidation was achieved in 85-89 % after the mean follow up time. In 74-81 % pain was reduced effectively using the intramedullary nail arthrodesis, quality of life was improved drastically. 3 non-unions occurred, 1 implant failure was reported and there were 2 infections. The
advantage of the retrograde technique is the non-invasivity of the proximal tibial. Using antegrade as well as plantar approach, intramedullary nail arthrodesis of the ankle is a suitable technique with very good results for combined arthrodesis of the upper and lower ankle joint.
Key words
Tibiotalocalcaneal - arthrodesis - intramedullary nailing - ankle arthrodesis
References
-
1
Berend M E, Glisson R R, Nunley J A.
A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis.
Foot Ankle Int.
1997;
18
639-643
-
2
Carrier D A, Harris C M.
Ankle arthrodesis with vertical Steinmann's pins in rheumatoid arthritis.
Clin Orthop.
1991;
268
10-14
-
3
Casadei R, Ruggieri P, Giuseppe T. et al .
Ankle resection arthrodesis in patients with bone tumors.
Foot Ankle Int.
1994;
15
242-249
-
4
Cracchiolo A.
Arthrodesis of the ankle in patients who have rheumatoid arthritis.
J Bone Joint Surg.
1992;
74 A
903-909
-
5
Fleming S S, Moore T J, Hutton W C.
Biomechanical analysis of hindfoot fixation using an intramedullary rod.
J South Orthop As.
1998;
7(1)
19-26
-
6
Fox I M, Shapero C, Kennedy A.
Tibiotalocalcaneal arthrodesis with intramedullary interlocking nail fixation.
Clinics in podiatric medicine and Surgery, Volume 17.
2000;
1
19-31
-
7
Kile T A, Donnelly R E, Gehrke J C, Werner M E, Johnson K A.
Tibiotalocalcaneal arthrodesis with an intramedullary device.
Foot Ankle Int.
1994;
15
669-673
-
8 Küntscher G. Combined arthrodesis of the ankle and sub-talar joints. In: Practice of intramedullary nailing. Charles C Thomas, Springfield, IL 1967; 207-209
-
9
Maurer D, Cimino E, Cox C.
Transarticular cross screw fixation. A technique of ankle arthrodesis.
Clin Orthop.
1991;
268
56-64
-
10
Mears D, Gordon R, Kann S.
Ankle arthrodesis with an anterior tension plate.
Clin Orthop.
1991;
268
70-77
-
11
Moore T J, Prince R, Pochatko D. et al .
Retrograde intramedullary nailing for ankle arthrodesis.
Foot Ankle Int.
1995;
16
433-436
-
12
Mudgal C S, Wilson M G.
Revision of tibiotalocalcaneal arthrodesis after failed intramedullary rod: a technique tip.
Foot ankle Int.
1999;
20
210-211
-
13
Pinzur M S, Kelikian A.
Charcot ankle fusion with a retrograde intramedullary rod.
Foot Ankle Int.
1997;
16(9)
542-548
-
14
Quill G E.
Tibiotalocalcaneal arthrodesis.
Tech Orthop.
1996;
11
269-273
-
15
Stephenson K A, Kile T A, Graves S C.
Estimating the insertion site during retrograde intramedullary tibiotalocalcaneal arthrodesis.
Foot Ankle Int.
1996;
17
781-782
Dr. med. M. Goebel
Abteilung für Unfallchirurgie
Berufsgenossenschaftliche Unfallklinik Murnau
Professor-Küntscher-Str. 8
82418 Murnau/Staffelsee
Germany
