Introduction: Posttraumatic painful osteoarthritis of the ankle joint
after fracture-dislocation often has to be treated with arthrodesis. In
the presence of major soft tissue lesions and important bone loss the
technique to achieve arthrodesis has to be well chosen in order to
prevent hardware failure, infection of bulky implants or non-union.
Methods: We present the case of a 53 year-old biker suffering of a
fracture-dislocation of the ankle associated with a mayor degloving
injury of the heel. After initial immobilization of the lesion by external
fixation in Spain the patient was transferred to our hospital for further
treatment. The degloving injury of the heel with MRSA infection was
initially treated by repeated débridement, changing of the configuration
of the Ex Fix and antibiotic therapy with favourable outcome. Because
of the bony lesions reconstruction of the ankle-joint was juged not to
be an option and arthrodesis was planned. Due to bad soft-tissue
situation standard open fixtion with plate and/or screws was not
wanted but an option for intramedullary nailing was taken. However the
use of a standard retrograde arthrodesis nail comes with two
problems: 1) Risk of infection of the heel-part of the calaneus/nail in an
unstable soft tissue situation with protruding nail. And 2) talo-calcaneal
arthrodesis of an initially healthy subtalar joint. Given the situation of
an unstable plantar/heel flap it was decided to perform anklearthrodesis
by means of an anterograde nail with static fixation in the
talus and in the proximal tibia.
Results:This operation was performed with minimal opening at the
ankle-site in order to remove the remaining cartilage and improve
direct bone to bone contact. Arthrodesis was achieved by means of
an anterograde T2 Stryker tibial nail.One year after the anterograde
nailing the patient walks without pain for up to 4 hours with a heel
of good quality and arthrodesis is achieved.
Conclusion: Tibiotalar arthrodesis in the presence of mayor soft
tissue lesions and bone loss can be successfully achieved with
antegrade nailing.