Die tibiotalokalkaneare Arthrodese mit einem winkelstabilen Marknagel mit Rückfußvalgus und Kompressionsmöglichkeit

Abstract

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.

Anatomical Evaluation of Different Approaches for Tibiotalocalcaneal Arthrodesis

“…2,8,[11][12][13] Diverse techniques have been described in the literature. [2][3][4][5]9,[11][12][13] A modified medial approach for triple arthrodesis 6,7 and the posterolateral approach 3,4 constitute alternatives to the lateral transfibular approach.…”

“…8,2 However, severe valgus deformity of the hindfoot may mitigate against the use of this approach, since correction of the deformity may be followed by soft tissue complications and/ or delayed wound healing. 1,5,7,9 Similarly, the soft tissue envelope may be compromised from previous trauma or surgery of the lateral malleolus, restricting the feasibility of the lateral approach. 12 Primary or early-secondary plastic surgery is an option; however, flap coverage constitutes more complex surgery and increases the risk of complications.…”

“…12 Primary or early-secondary plastic surgery is an option; however, flap coverage constitutes more complex surgery and increases the risk of complications. 9 There is merit in looking at the problem in terms of surgical approaches for the simultaneous exposure of the ankle joint and the subtalar joint. The alternatives to the lateral transfibular approach are the modified medial approach used for triple arthrodesis 6,7,13 and the posterolateral approach paralleling the lateral border of the Achilles tendon.…”