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Objective: The objective of this study was to evaluate the clinical results and problems associated with ankle arthrodesis using an intramedullary nail with fin.
Methods: Ankle arthrodesis was performed using an intramedullary nail with a fin to treat eight rheumatoid arthritis (RA) patients and two osteoarthritis patients. The mean age at surgery was 59.2 years and the mean follow-up time was 3 years and 6 months. All arthrodesis operations were performed by the transfibular approach. The distal portion of the fibula was removed and used as a bone graft. The articular cartilage of the talocalcaneal joint was not removed. Clinical evaluation was assessed by the patients’ pain and the union of the tibiotalar and talocalcaneal joints.
Results: Tibiotalar arthrodesis was achieved after surgery in all patients. The patients were able to bear weight fully in an average of 5.6 weeks and the preoperative pain levels were ameliorated. Talocalcaneal arthrodesis was not achieved in five cases. These patients experienced gradually increasing pain in the talocalcaneal joint; therefore the implant was surgically removed. However, two of those patients with RA showed persistent pain and another patient with RA developed a valgus deformity of the calcaneus.
Conclusion: An intramedullary nail with a fin was found to be a very useful means of arthrodesis for patients with RA requiring union of the tibiotalar and talocalcaneal joints. Careful postoperative observation of the talocalcaneal joint is necessary, because nonunion of the talocalcaneal joint can cause further pain.
