Retrograde Tibia Intramedullary Nailing in Tibiotalocalcaneal Arthrodesis

Background: A case series demonstrating the use of a tibia intermedullary nail placed in a retrograde fashion through the calcaneus and talus as a Tibiotalocalcaneal (TTC) arthrodesis salvage technique in three separate patients. Case Presentation: The first case, an 80-year-old female with a previous Total Knee Arthroplasty (TKA) and ipsilateral open tibia shaft fracture developed a septic non-union with hardware failure. Given her multiple comorbidities, she was treated with a long TTC arthrodesis using a retrograde tibial nail to preserve her soft tissue and encourage earlier mobilisation. The second case, was a 55-year-old male with an open right pilon fracture and multiple surgeries due to non-union of his fracture, including failed TTC with hindfoot nail, he was salvaged with a TTC arthrodesis using a long TTC arthrodesis with a retrograde tibial nail. The last patient, a 30-year-old male who fell 25 feet and suffered a right open pilon fracture required multiple surgeries due to septic non-union, and eventually achieved union after a TTC arthrodesis with osteotomy for deformity correction, both of which were stabilized using a retrograde tibial nail. Conclusion: In this case series, the patients underwent revision surgery for non-union using a long TTC arthrodesis construct with a retrograde tibial nail ultimately achieving union. We found that for select patients, a retrograde tibial nail for TTC arthrodesis was a useful option to reduce complications, achieve union, and help to encourage early mobilization and return of function.