Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints

ABSTRACT Introduction When ankle and subtalar joints are arthritic and painful they both need fusion. Principles of treatment by fusion are removal of cartilage till bleeding of subchondral bone, keeping the joint surfaces congruous, proper positioning of the foot and ankle and stable fixation. Materials and methods During the last 10 years, 16 cases of retrograde nailing were done. Eight cases were post-traumatic, one was tuberculosis, three for Charcot joint and three for osteoarthritis of the ankle joint, and one case of rheumatoid arthritis. All patients had severe pain instability, varying degrees of deformities and antalgic gain. Two cases were treated with supracondylar femoral interlocking nail. Nine cases were treated with antegrade tibial nail as retrograde nail. Nine cases were treated with retrograde tibial nails with posteroanterior calcaneal screws. Two cases were treated with special nails newly designed by Smith and Nephew. Initially, older the calcaneus had two latero-medial screws. Newer designs of nail have two posteroanterior screws, passing from calcaneal tuberosity through the nail—one towards cuboid and the other towards talus. These two screws have increased the stability of the construct and improved the outcome. Mann's technique of ankle fusion was used. Fibular strut was used as bone graft and fixed by one screws into the tibia and the other into talus. Indian tibia is smaller in diameter with a narrow intramedullary canal. Indian tibia need to have a nail with a smaller diameter. Results When supracondylar femoral and antegrade tibial nails were used, 4 out of 5 failed. When newer design nails with posteroanterior calcaneal screws were used, outcome improved 2 out of 11 failed. Conclusion Newer design of retrograde tibial nails with two posteroanterior screws have greatly improved the outcome of pantalar arthrodesis. How to cite this article Kulkarni GS, Kulkarni MG, Kulkarni SG, Kulkarni VS, Kulkarni RM. Retrograde Tibial Nailing for Arthrodesis of Ankle and Subtalar Joints. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):60-70.