Double fusion (Tibiotalocalcaneal fusion) with Intra-medullary nail
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This is the technique of choice for combined Ankle and Subtalar degenerative change with or without deformity. It should also be considered in revision ankle fusion cases without Subtalar arthritis and neurological cases presenting with ankle and hindfoot instability .
In the correct patient (and using intra-medullary nail fixation) early load bearing may be achievable. Union rates in many published series are in excess of 90%
The implant technique detailed is for the De Puy Versa-nail but the preparation of the Arthrodesis described is the same irrespective of the implant type. A number of the technical details relating to nailing are are shared with any other nailing system.
Author: Mark Herron FRCS
Institution: The Wellington Hospital , London