Salvage Tibiotalocalcaneal Arthrodesis Augmented With Fibular Columns and Iliac Crest Autograft: A Technical Note.
Alessio BernasconiShelain PatelKaran MalhotraDishan SinghMatthew WelckNicholas CullenPublished in: Foot & ankle specialist (2020)
Failure of ankle arthrodesis or total ankle replacement (TAR) results in a challenging clinical situation and may take the form of symptomatic nonunion following arthrodesis and aseptic or infective loosening following TAR. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required, with use of bone grafting to maintain length and reduce disability. Fibular strut grafting in the form of pillars or columns, potentially supplemented by tricortical and iliac graft, may be used in association with intramedullary TTC nailing or lateral plating and has demonstrated encouraging fusion rates. In this technical note, we review the history of this technique and report indications and surgical approach. Furthermore, of 6 cases (mean age 69.8 years) treated at our institution and followed at 13 months (range, 8 to 20 months), 5 (83%) were clinically and radiologically united, and patients were satisfied with the outcome of surgery. One patient with a background of chronic kidney disease remained dissatisfied with no union achieved, persistent pain, and awaiting a below-the-knee amputation. No other complications were observed. TTC fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and subtalar joint pathologies with significant talar bone loss.Levels of Evidence: Level V (technical note).
Keyphrases
- end stage renal disease
- chronic kidney disease
- bone loss
- total knee arthroplasty
- liquid chromatography
- minimally invasive
- newly diagnosed
- peritoneal dialysis
- endovascular treatment
- anterior cruciate ligament reconstruction
- ejection fraction
- chronic pain
- climate change
- multiple sclerosis
- risk factors
- pain management
- case report
- mass spectrometry
- coronary artery bypass
- bone mineral density
- spinal cord
- virtual reality
- soft tissue
- peripheral artery disease
- postoperative pain