CLINICAL AND FUNCTIONAL OUTCOME AFTER PAN-TALAR NAILING FOR ANKLE ARTHRODESIS

Abstract

Introduction Pan-talar nailing for ankle arthrodesis has been advocated as a salvage procedure for post-traumatic arthrosis and Charcot’s joint. This study evaluates the outcome of pan-talar nails over a 4-year period.

Method This is a retrospective study of 11 patients (13 ankles) who underwent pan-talar nailing between 2000 and 2004. Various factors including patient demographics, indications for surgery, operation details, complications, time to fusion and need for re-operation were recorded. Nine were reviewed at a mean follow-up of 22 months for clinical and radiological assessment; two patients had died. American Orthopaedic Foot and Ankle (AOFAS) hindfoot and SF-36 scoring systems were also used for evaluation.

Results There were seven males and four females, with a mean age of 57 and 71 years, respectively. Eight patients had a pre-operative diagnosis of Charcot’s joint, one avascular necrosis of talus, one fixed deformity with polio, and one following fracture non-union.

All 13 nails were locked at both ends. The average duration of operation was 2 hours and tourniquet time 1 hour 8 minutes. All patients were kept non-weight bearing in cast post-operatively for an average of 6 weeks.

There were two cases of wound infection, one pulmonary embolism and one calcaneal fracture with infected non-union, which was treated with external fixation. There were no cases of nerve damage or septic arthritis.

All nine patients were satisfied with the operation outcome at follow-up with a mean fusion duration of 28 weeks and an average AOFAS score of 75.

Conclusion We conclude from this study that pan-talar nailing when performed for ankle arthrodesis as a salvage procedure produces a high rate of fusion with fewer complications.