Femoral retrograde IM nail can be successfully used for TTC arthrodesis: study

Complications after open reduction and internal fixation (ORIF) of ankle fractures are not uncommon, negatively impacting the postoperative outcome. Tibiotalocalcaneal (TTC) arthrodesis has been shown to be a viable treatment option in these cases. Vincenzo Giordano et al published an article to describe the operative technique and the outcome of patients presenting failed osteosynthesis of the ankle joint managed with TTC using a retrograde femoral IM nail. The article has been published in ‘Indian journal of orthopedics.’

This is a retrospective observational study of adult patients (18 years or older) operated on for failure in osteosynthesis of the ankle joint (malleolar or tibial pilon fractures) using a retrograde femoral nail to perform TTC arthrodesis, with a minimum follow-up of 24 months. Patient demographics, initial injury characterization, comorbidities, initial treatment, time from initial injury to TTC arthrodesis, time to union, secondary procedures, and complications were recorded.

Patients were evaluated clinically and radiographically at 12 and 24 months using, respectively, a modified version of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores and full-weight-bearing anteroposterior and lateral radiographs.

The key findings of the study were:

• During the study period, 17 patients were treated with TTC arthrodesis using a retrograde femoral nail.

• The initial injury was a pilon fracture in 4 patients and a malleolar ankle fracture in 13 patients.

• The time between the initial injury and TTC arthrodesis ranged from 8 to 52 months, with a mean of 14.7 months.

• Complete radiographic fusion of the tibiotalar joint occurred uneventfully in all patients, whereas in four (23.5%) cases, complete radiographic fusion of the subtalar joint was not observed, although these patients were considered to have a satisfactory outcome due to a functional, painless, and properly aligned hindfoot after TTC arthrodesis.

• The mean time to union was 8 months, with a range of 5 to 10 months.

• Secondary procedures were performed in 2 patients.

• Four patients experienced minor complications.

• There were no statistically significant differences between patients who sustained a tibial pilon fracture and a malleolar ankle fracture in all variables analysed.

• The modified AOFAS score at 24 months ranged from 64 to 94, with a mean of 81 points.

The authors concluded – “The use of a long femoral retrograde IM nail for TTC arthrodesis is a viable option for patients with sequelae of tibial pilon and ankle malleolar fractures due to fixation failure. We recommend strictly following the operative technique, such as open debridement of the tibiotalar joint and percutaneous debridement of the subtalar joint, taking into account the anatomical landmarks for performing the plantar approach for the introduction of the IM implant.”

For further details on the article refer to:

Tibiotalocalcaneal arthrodesis for failed osteosynthesis of the ankle joint using a retrograde femoral intramedullary nail: a retrospective observational study

Vincenzo Giordano et al

Indian Journal of Orthopaedics (2026) 60:1135–1147

https://doi.org/10.1007/s43465-025-01562-8