Intramedullary hindfoot fusion as salvage procedure following distal tibia peri-hardware failure in a neuropathic patient: a case report

Background: Tibotalocalcaneal arthrodesis is a salvage procedure reserved for severe tibiotalar and subtalar arthritis, hindfoot deformities, failed ankle arthroplasty, talar osteonecrosis, acute trauma, charco arthropathy, and other hindfoot pathologies. Multiple methods are described including intramedullary arthrodesis. We report the use of a long nail for concurrent tibial plateau and shaft fixation and hindfoot fusion in a neuropathic patient who experienced osseous failure at the level of ankle status-post index tibial nailing.

Case Report: A 52-year-old, neuropathic female, previously treated with open reduction and intramedullary fixation for tibial plateau and tibial shaft fractures, respectively, experienced bony failure at the level of the ankle with hardware protrusion through the plafond, abutting the talus. Anterograde intramedullary fixation with an extended nail was used to support her initial tibial shaft and plateau fractures and provide simultaneous salvage hindfoot fusion.

Conclusion: Anterograde intramedullary nailing with a long standard tibial nail is a viable treatment option to provide proximal tibia fixation and hindfoot arthrodesis in neuropathic patients that have experienced distal failure around existing intramedullary hardware.