Tibiotalar nonunion corrected by hindfoot arthrodesis.

Eric Giza, Annahita K. Sarcon, Christopher Kreulen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

A 65-year-old man without significant comorbidities was referred to the senior author (EG) 9 months after an ankle arthrodesis procedure with complaints of pain, swelling, and progressive hindfoot valgus. The patient had elected to have the index surgery because of severe ankle arthritis due to longstanding lateral ankle instability. Physical examination revealed a well-healed anterior, midline ankle incision with normal pulses and sensation. Painful, limited ankle and subtalar range of motion was noted along with 20 degrees of hindfoot valgus and subfibular impingement. Radiographs of the ankle revealed an attempted ankle fusion using a knee arthroplasty trabecular metal augment placed vertically at the tibiotalar joint. There were no screws or other hardware present to provide compression and stability of the fusion. A computed tomography scan showed a tibiotalar nonunion, erosion of the talar body, and severe tibiotalar and subtalar arthritis. Inflammatory markers were within normal range. Based on the findings of a failed fusion and progressive painful hindfoot deformity, it was determined that the patient would benefit from removal of the hardware and revision fusion surgery. Tibiotalocalcaneal (TTC) hindfoot fusion was planned because of the patient's talar collapse and tibiotalar/ subtalar arthritis. The TTC procedure was performed with a retrograde intramedullary nail, femoral head allograft, and morselized fibular autograft enriched with platelet-rich plasma. The femoral head was used as a structural allograft to fill the large bone defect, prevent limb shortening, and assist in correction of the hindfoot deformity. Intraoperative findings revealed severe metallic synovitis of the ankle and subtalar joints, metal debris at the site of the trabecular implant, and segmental defects of the distal tibia and talus. Weight bearing was permitted after 16 weeks when evidence of successful ankle fusion was confirmed radiographically. At 24 months, the patient was pain free and ambulating without difficulty.

Original languageEnglish (US)
Pages (from-to)76-79
Number of pages4
JournalFoot & ankle specialist
Volume3
Issue number2
DOIs
StatePublished - Apr 2010

Fingerprint

Arthrodesis
Ankle
Arthritis
Thigh
Allografts
Metals
Subtalar Joint
Talus
Knee Replacement Arthroplasties
Platelet-Rich Plasma
Synovitis
Ankle Joint
Autografts
Weight-Bearing
Articular Range of Motion
Nails
Tibia
Reoperation
Physical Examination
Comorbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Tibiotalar nonunion corrected by hindfoot arthrodesis. / Giza, Eric; Sarcon, Annahita K.; Kreulen, Christopher.

In: Foot & ankle specialist, Vol. 3, No. 2, 04.2010, p. 76-79.

Research output: Contribution to journalArticle

@article{51537ca7e52647369eb80ec5c0d25c2d,
title = "Tibiotalar nonunion corrected by hindfoot arthrodesis.",
abstract = "A 65-year-old man without significant comorbidities was referred to the senior author (EG) 9 months after an ankle arthrodesis procedure with complaints of pain, swelling, and progressive hindfoot valgus. The patient had elected to have the index surgery because of severe ankle arthritis due to longstanding lateral ankle instability. Physical examination revealed a well-healed anterior, midline ankle incision with normal pulses and sensation. Painful, limited ankle and subtalar range of motion was noted along with 20 degrees of hindfoot valgus and subfibular impingement. Radiographs of the ankle revealed an attempted ankle fusion using a knee arthroplasty trabecular metal augment placed vertically at the tibiotalar joint. There were no screws or other hardware present to provide compression and stability of the fusion. A computed tomography scan showed a tibiotalar nonunion, erosion of the talar body, and severe tibiotalar and subtalar arthritis. Inflammatory markers were within normal range. Based on the findings of a failed fusion and progressive painful hindfoot deformity, it was determined that the patient would benefit from removal of the hardware and revision fusion surgery. Tibiotalocalcaneal (TTC) hindfoot fusion was planned because of the patient's talar collapse and tibiotalar/ subtalar arthritis. The TTC procedure was performed with a retrograde intramedullary nail, femoral head allograft, and morselized fibular autograft enriched with platelet-rich plasma. The femoral head was used as a structural allograft to fill the large bone defect, prevent limb shortening, and assist in correction of the hindfoot deformity. Intraoperative findings revealed severe metallic synovitis of the ankle and subtalar joints, metal debris at the site of the trabecular implant, and segmental defects of the distal tibia and talus. Weight bearing was permitted after 16 weeks when evidence of successful ankle fusion was confirmed radiographically. At 24 months, the patient was pain free and ambulating without difficulty.",
author = "Eric Giza and Sarcon, {Annahita K.} and Christopher Kreulen",
year = "2010",
month = "4",
doi = "10.1177/1938640010361381",
language = "English (US)",
volume = "3",
pages = "76--79",
journal = "Foot and Ankle Specialist",
issn = "1938-6400",
publisher = "SAGE Publications Ltd",
number = "2",

}

TY - JOUR

T1 - Tibiotalar nonunion corrected by hindfoot arthrodesis.

AU - Giza, Eric

AU - Sarcon, Annahita K.

AU - Kreulen, Christopher

PY - 2010/4

Y1 - 2010/4

N2 - A 65-year-old man without significant comorbidities was referred to the senior author (EG) 9 months after an ankle arthrodesis procedure with complaints of pain, swelling, and progressive hindfoot valgus. The patient had elected to have the index surgery because of severe ankle arthritis due to longstanding lateral ankle instability. Physical examination revealed a well-healed anterior, midline ankle incision with normal pulses and sensation. Painful, limited ankle and subtalar range of motion was noted along with 20 degrees of hindfoot valgus and subfibular impingement. Radiographs of the ankle revealed an attempted ankle fusion using a knee arthroplasty trabecular metal augment placed vertically at the tibiotalar joint. There were no screws or other hardware present to provide compression and stability of the fusion. A computed tomography scan showed a tibiotalar nonunion, erosion of the talar body, and severe tibiotalar and subtalar arthritis. Inflammatory markers were within normal range. Based on the findings of a failed fusion and progressive painful hindfoot deformity, it was determined that the patient would benefit from removal of the hardware and revision fusion surgery. Tibiotalocalcaneal (TTC) hindfoot fusion was planned because of the patient's talar collapse and tibiotalar/ subtalar arthritis. The TTC procedure was performed with a retrograde intramedullary nail, femoral head allograft, and morselized fibular autograft enriched with platelet-rich plasma. The femoral head was used as a structural allograft to fill the large bone defect, prevent limb shortening, and assist in correction of the hindfoot deformity. Intraoperative findings revealed severe metallic synovitis of the ankle and subtalar joints, metal debris at the site of the trabecular implant, and segmental defects of the distal tibia and talus. Weight bearing was permitted after 16 weeks when evidence of successful ankle fusion was confirmed radiographically. At 24 months, the patient was pain free and ambulating without difficulty.

AB - A 65-year-old man without significant comorbidities was referred to the senior author (EG) 9 months after an ankle arthrodesis procedure with complaints of pain, swelling, and progressive hindfoot valgus. The patient had elected to have the index surgery because of severe ankle arthritis due to longstanding lateral ankle instability. Physical examination revealed a well-healed anterior, midline ankle incision with normal pulses and sensation. Painful, limited ankle and subtalar range of motion was noted along with 20 degrees of hindfoot valgus and subfibular impingement. Radiographs of the ankle revealed an attempted ankle fusion using a knee arthroplasty trabecular metal augment placed vertically at the tibiotalar joint. There were no screws or other hardware present to provide compression and stability of the fusion. A computed tomography scan showed a tibiotalar nonunion, erosion of the talar body, and severe tibiotalar and subtalar arthritis. Inflammatory markers were within normal range. Based on the findings of a failed fusion and progressive painful hindfoot deformity, it was determined that the patient would benefit from removal of the hardware and revision fusion surgery. Tibiotalocalcaneal (TTC) hindfoot fusion was planned because of the patient's talar collapse and tibiotalar/ subtalar arthritis. The TTC procedure was performed with a retrograde intramedullary nail, femoral head allograft, and morselized fibular autograft enriched with platelet-rich plasma. The femoral head was used as a structural allograft to fill the large bone defect, prevent limb shortening, and assist in correction of the hindfoot deformity. Intraoperative findings revealed severe metallic synovitis of the ankle and subtalar joints, metal debris at the site of the trabecular implant, and segmental defects of the distal tibia and talus. Weight bearing was permitted after 16 weeks when evidence of successful ankle fusion was confirmed radiographically. At 24 months, the patient was pain free and ambulating without difficulty.

UR - http://www.scopus.com/inward/record.url?scp=77954940158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954940158&partnerID=8YFLogxK

U2 - 10.1177/1938640010361381

DO - 10.1177/1938640010361381

M3 - Article

C2 - 20400417

AN - SCOPUS:77954940158

VL - 3

SP - 76

EP - 79

JO - Foot and Ankle Specialist

JF - Foot and Ankle Specialist

SN - 1938-6400

IS - 2

ER -