Tibiotalocalcaneal nailing: Indications and technique

Tibiotalocalcaneal fusion is a salvage procedure for severe arthrosis and deformity of both the tibiotalar and subtalar joints. The use of an intramedullary nail for this procedure has the advantages of providing immediate rigid internal fixation and compression at the fusion site, and offers load-sharing capacity. Tibiotalocalcaneal nailing can be used to reduce pain and improve function in patients with posttraumatic arthrosis, avascular necrosis, neuropathic arthropathy, and neuromuscular disease, and in revision situations such as nonunion and failed total ankle arthroplasty. Despite this, tibiotalacalcaneal fusion has limited indications as a result of the morbidity associated with having fused subtalars and tibiotalar joints. Results with this procedure are more often considered satisfactory rather than excellent, and it should be considered an alternative to amputation. The history, indications, contraindications, technique, and results of tibiotalocalcaneal nailing are discussed.