Tibiotalocalcaneal Arthrodesis Using a Femoral Locking Plate

The goal of a tibiotalocalcaneal arthrodesis is to create a pain-free, stable hindfoot and ankle. Although a reserved procedure, it is useful when simultaneous ankle and subtalar joint pathology exists. Numerous complications have been reported after tibiotalocalcaneal arthrodesis, most importantly nonunion. Locking plates have proved to be a more stable construct than alternative forms of arthrodesis. In the inverted positions, the hybrid plating of the femoral locking plate structurally aligns with the anatomy of the hindfoot. This provides an anatomically sound construct, while allowing for both locking and lag screw insertion. We describe a new technique using a 4.5-mm condylar plate for tibiotalocalcaneal arthrodesis. 2012 by the American College of Foot and Ankle Surgeons. All rights reserved. Tibiotalocalcaneal arthrodesis (TTCA) is a procedure reserved for the treatment of arthritides, avascular necrosis, and deformation of the rearfoot and ankle. It is performed when conservative treatment for concurrent ankle and subtalar joint pathology fails. The surgical options for TTCA include screw fixation, external fixation, intramedullary nailing (IM), the use of locking plates, and the use of blade plates (1). Despite application of a wide range of fixation constructs, nonunion remains a common complication associated with efforts to achieve TCCA. Chou (2), in a multicenter study of 56 ankles after TTCA, reported nonunion in 8 (14%). Frey et al (3) reported nonunion in 8 (89%) of 9 patients when performing ankle arthrodesis in the presence of avascular necrosis of the talus. Ahmad et al (1) reported a rate of nonunion of approximately 6% in 18 patients who underwent TTCA using a humeral locking plate. When using retrograde IM nailing, Pelton et al (4) reported a 12% incidence of nonunion in 33 feet, and Niinim€ aki et al (5) reported a 24% incidence in 34 patients. Malunion is another common complication experienced with efforts to achieve TTCA. Malunion can lead to genu recurvatum if in a position of equinus, lateral column overload if in a varus position, and unnecessary stress of the posterior tibial tendon, knee, and first ray if in valgus misalignment (4). A review of the published data menico, DPM, FACFAS, Private et Street, Boardman, OH 44512.