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Ankle salvage surgery with autologous circular pillar fibula augmentation and intramedullary hindfoot nail.
Journal article

Ankle salvage surgery with autologous circular pillar fibula augmentation and intramedullary hindfoot nail.

  • Paul J Orthopaedic Department, University Hospital Basel, Basel, Switzerland.
  • Barg A Orthopaedic Department, University Hospital Basel, Basel, Switzerland.
  • Horisberger M Orthopaedic Department, University Hospital Basel, Basel, Switzerland.
  • Herrera M Orthopaedic Department, University Hospital of Canary Island, Tenerife, Spain.
  • Henninger HB Harold K. Dunn Orthopaedic Research Laboratory, University Orthopaedic Center, University of Utah, Salt Lake City, UT.
  • Valderrabano V Orthopaedic Department, University Hospital Basel, Basel, Switzerland. Electronic address: victor.valderrabano@usb.ch.
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  • 2014-05-06
Published in:
  • The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. - 2014
bone graft
failed total ankle replacement
internal fixation
retrograde hindfoot nail
tibiotalocalcaneal arthrodesis
Adult
Aged
Ankle Injuries
Ankle Joint
Arthroplasty, Replacement, Ankle
Bone Nails
Bone Resorption
Bone Transplantation
Female
Fibula
Fracture Fixation, Intramedullary
Humans
Male
Middle Aged
Prosthesis Failure
Salvage Therapy
Subtalar Joint
Transplantation, Autologous
English Tibiotalocalcaneal arthrodesis with an intramedullary hindfoot nail is an established procedure for fusion of the ankle and subtalar joints. In cases involving ankle bone loss, such as in failed total ankle replacement, it can be difficult to salvage with sufficient bone restoration stability and a physiologic leg length and avoiding below the knee amputation. In addition to the alternatives of using a structural allograft or metal bone substitution, we describe the use of autologous ipsilateral circular pillar fibula augmentation in tibiotalocalcaneal retrograde nail arthrodesis combined with a ventral (anterior) plate in a prospective series of 6 consecutive cases with a mean follow-up duration of 26 ± 9.95 (range 12 to 34) months. The 6 patients (3 female and 3 male), with a mean age of 55 ± 13.89 (range 38 to 73) years were treated with revision surgery of the ankle (1 after talectomy, 5 [83.33%] after failed ankle replacement). The visual analog scale for pain and the American Orthopaedic Foot and Ankle Society hindfoot score were used to assess functional outcome, and radiographs and computed tomography scans were used to determine the presence of fusion. All patients improved clinically from pre- to postoperatively in regard to the mean pain visual analog scale score (from 7.5 to 2.0) and American Orthopaedic Foot and Ankle Society hindfoot score (from 29 to 65 points, of an 86-point maximum for fused joints). Radiologically, no loss in the reduction or misalignment of the hindfoot was detected, and all cases fused solid. One patient (16.67%) required hardware removal. The fixation construct provided good clinical and radiologic outcomes, and we recommend it as an alternative to structural allografts or metallic bone grafts for revision ankle surgery with severe bone loss.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.rero.ch/global/documents/150002
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