Ankle arthritis is most commonly the result of prior trauma to the ankle joint. Ankle fractures and other injuries may damage the cartilage, which leads to accelerated arthritis. Patients with ankle injuries are also susceptible to osteonecrosis, a condition where blood flow is decreased to a portion of the bone. Osteonecrosis can also lead to ankle arthritis.

Foot and Ankle

Procedure

The Arthrex Ankle Fusion Plating System provides a complete solution for ankle fusion with a comprehensive offering of anatomy-specific titanium plates for both tibiotalar and tibiotalocalcaneal arthrodeses.
The ankle fusion set includes anterior and lateral TT fusion plates along with posterior and lateral TTC fusion plates that allow a variety of screw options, including 4.5 mm and 5.5 mm cortical and cancellous screws. Specific instrumentation designed to prepare the fusion sites is included in one comprehensive system.

J. Chris Coetzee, MD, MBChB (Minneapolis, MN), demonstrates an ankle arthrodesis using the anterolateral ankle fusion plate. The design of this plate allows for longer plate lengths for difficult revision cases or for spanning comminuted pilon fractures that require a primary fusion.

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Anterolateral Approach for Tibiotalar Arthrodesis - Anterolateral Ankle Fusion Plate

We'll look at the different options that's available with the Arthrex plate. Now for anterior plating. The new plate is the small plate for extended medial portal. And then a new addition is the plate with only two screws for the tailored neck. And that's for those cases where you feel there's a short tailored neck or you just cannot get enough talus exposed, then you can use two screws. The initial plate is with four screws in the neck. Other than that, these two plates look the same. The new plate is the anterolateral approach plate and as you can see it's significantly longer. So this will be very helpful in those cases where there's enough comminution of the distal tibia or enough deformity that you think you need to go higher than the conventional plate. So for the anterolateral plate will be for your major reconstructions where there's significant deformity to Correct or if there are significant issues with the distal tibia, maybe a comminuted fracture, a Charcot, something where you need to get higher up in the tibia to get good bone. So an incision is usually midline. You can go between extensor hallucis longus and tibialis anterior which is the safest place to go. You want to retract your neurovascular bundle medial or lateral whichever is more convenient for that specific case with the manipulator. I do not prepare the gutters. If it's a case where there's significant deformity, then you obviously need to clean the gutters as well to help correct the deformity. So with the new distractor, you can start close to the joint. You can do it medial or lateral because the split is going to be more on the lateral side I usually put the pins medial. Now you can distract it as far as you feel comfortable. You can use a fryer or something similar to give you a little better lever. On the distraction device and now it's nice and open. Makes it much easier to get to the back of the ankle. For purposes of this demonstration, I'm not going to do a complete preparation of the joint. But as you know, preparing the joint is as important, if not more important than the device you put in. So even with a strong device like this, you cannot cut back on the preparation of the joint. Easy to slide it off and you can take the pins out. At this point, you have to make sure that you can get your ankle in the position that you want, and you can either put a compression screw in from the medial side, or at least pin it from the medial side. You can have your hands free when you put the plate on, so especially with the longer plates in a post-traumatic case, it is not uncommon to have heterotopic bone formation in the front of your tibia. So the first time that you put your plate on the tibia, it slides in anterolateral. You can see how it sits in because this is a cadaver with no previous injury. The contour of the plate is perfect on the tibia, but in most of the post-traumatic ones, there will be enough heterotopic bone formation in the front of the tibia that you should take a chisel and chisel down the front until you recreate the normal contour of the tibia. And that's for two reasons. The one is to get tibial side of the plate flat on the tibia, but also to give you enough real estate on the talus to get the four screws in in the talus. If you don't do that, it pushes your plate further anterior, and the distal two screws might be too close to the navicular joint. Most important is that you want this in good position and alignment on the talus. So I will take it down with a tack. At this point. Do an x ray to make sure that it's in good position in alignment. It's a very nice contour of the plate on the tibia. If you think there's too much heterotopic bone on the neck of the talus, you can take that away as well. And if you look at the lateral view, there is a bit of bone on the neck of the talus hole. Take the plate off and then rondure that away and put the plate back again. So the first screw I usually put in non-locking just to pull the plate onto the talus, and later on we'll replace it if I want to with a locking screw. But it's really important to get it to sit right on the talus. This will measure to a 26. You can see how it pulls the plate onto the talus. And now we know it's in a good position. This is still a time where you can actually look at the plate on the tibia as well. Make sure that you are happy with your position, because once you put the second screw in, then there's no further rotation on the proximal end of the plate. This now is a locking screw because we already have the plate down onto the talus. I prefer to do all my Taylor screws before I do a tibial screw, because once you put the tibial screws in, you get compression across the joint. Good. So now we know the Taylor site is stable and we have the ankle in a good position with that initial holding pin. Now we want to get further compression on the joint in different sequences that Sequences that you can use. The way that I prefer is to use the compression hole. First and use a non-locking screw. So very nice compression over the anterior part of the joint. And next you want to compress the posterior part of the joint. So you need to have the bigger draw first. So with the first draw you go just into the joint space. It's best to do this on the floor row. But you can usually feel when you go through that hard subchondral bone and enter the ankle joint. So you can add the guide for this just to make it easier to get your correct alignment. You can. Fluoro is good for this, but you can usually feel when you hit the hard subchondral bone just before you get to the Subtalar joint. Is measured to a 60. And that gives you a really nice compression over the posterior half of the joint. And at this point your construct is stable. And now it's basically drill and fill. The one thing that I recommend is that the most proximal hole should the screw should only be 20mm long or uni cortical. Because the one complaint that we saw with these long, stiff plates is that people get a little bit of a stress reaction at the top of the plate, and you reduce that stress reaction significantly. If it's a uni cortical screw, the screw can be locking or non locking. Because it's uni cortical it doesn't really make a big difference. So the one potential advantage of the anterolateral plate over the anterior plate is because it does not sit right anterior over the crest of the tibia, but on the wider, flatter surface of the tibia. They will hopefully be less stress irritation as well. So if we look at this, you can see the contour of the plate on the tibia looks perfect. And there's more than enough soft tissue coverage to cover the plate as good contact between the plate and the tibia everywhere. And again, it sits on the white, somewhat flat, rounded surface of the tibia, not on the thin anterior crest where the anterior plate usually sits. So we will look at this under fluoro and see how it looks. And you can see the plate more on the lateral side. Ankle is well aligned. And then we'll do a mortise view again with everything very nicely aligned. Good contact between the plate and the tibia all the way up, and then on the lateral view again, very good contact between the plate and the talus and the tibia. Again, the joint was not perfectly prepared for the demonstration but a very good alignment. You can see the posterior screw, and the talus will give good compression over the posterior half of the talus, while the four screws in the front will give good stability in the anterior half of the talus. If we go further up. Again, very good contact everywhere. Even if I bring it on profile, they can see there's virtually no gap between the plate and the tibia.

Eric Giza, MD (Sacramento, CA), demonstrates the ankle compression technique for the treatment of ankle and hindfoot arthritis to increase compression across a fusion site with the use of anterior ankle plating.

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Dr. Giza Demonstrates Tips and Pearls for Hindfoot and Ankle Arthritis: Ankle Fusion Compression Using the Arthrex Fusion/Compression Device

Kaitlin C. Neary, MD, (Boise, ID) describes the advantages of a lateral approach for difficult tibiotalar (TT) fusions using the lateral TT arthrodesis plate from the Ankle Fusion Plating System. The lateral plate provides 4 points of divergent fixation in the talus as well as multiple options for compression of the joint through the plate.

Ankle Fusion Using a Lateral Tibiotalar Arthrodesis Plate

Hi, I'm Caitlin Neary from Boise, Idaho, and I will be discussing a case presentation highlighting the Arthrex lateral Tibiotalar Arthrodesis plate in the setting of an ankle fusion. The patient is a pleasant 48 year old female who presented to clinic with complaints of right ankle pain and deformity. She had a history of a trimalleolar ankle fracture that was treated operatively in another city approximately a few months prior. She admitted to being fairly noncompliant post-operatively with her weight bearing restrictions, and had experienced progressive ankle pain and deformity over the past few months. Unfortunately, her pain and deformity had progressed to the point where she was becoming minimally ambulatory. She had a past medical history significant for multiple mental health issues, as well as seizure disorder, substance abuse, and obesity. On physical exam, the patient had obvious valgus hindfoot malalignment. She had tenderness to palpation anteriorly over the ankle and pain with attempted range of motion. She had early signs of skin tenting at the medial aspect of the ankle secondary to her deformity. She otherwise had full strength and sensation throughout. She was grossly neurovascular, intact distally, and did not have any signs of peripheral neuropathy. I was able to obtain her immediate postoperative images from her previous surgeon, in which she had continued subtle lateral translation of her talus, malalignment of her mortise, and likely non anatomic reduction of her fracture. When she presented to my clinic approximately three months later, she had developed obvious displacement of her fracture. Hardware failure and valgus collapse through her ankle. I obtained a CT scan to further evaluate the extent of arthritis within her tibiotalar joint. The CT confirmed the presence of fairly significant cartilage wear and bone loss at the lateral aspect of her joint. At that point in time, I had a long discussion with the patient in which options were discussed in terms of surgery. We discussed a revision joint sparing type procedure versus arthrodesis. We discussed surgical options in clinic, including revision, open reduction, internal fixation of her ankle versus proceeding with fusion in order to avoid chronic pain and recurrence of deformity. The patient elected to proceed with a fusion when considering approaches for an ankle fusion. I elected to approach her ankle through a lateral approach. I essentially did this for two separate reasons. The first was to utilize her previous lateral incision, both for her hardware removal and for her ankle fusion. I felt that it would be advantageous to do all of the work through a single incision. I also elected to proceed with the lateral ankle fusion in order to allow the plate to essentially act as a buttress. To prevent recurrent valgus collapse of her ankle. As we know, this is an inherent tendency following this type of injury. The patient presented back to clinic six months postoperatively and overall was doing incredibly well. She appeared to have completed her fusion on radiographs and was essentially pain free. She had returned to full activity and was overall happy with the outcome of her surgery. In terms of my post-operative protocol, I kept her splinted in non-weight bearing for the first two weeks. She returned to clinic two weeks out from surgery and was placed into a short leg. Cast. She remained non-weight bearing from week two to week six and presented back to clinic, where a new short leg cast was applied. I then allowed her to weight bear for transfers and short distances only. And at 12 weeks postoperatively, she was transitioned from a cast into a boot and was allowed to start being weight bearing as tolerated. She also weaned the boot as her ankle allowed. Most patients following this type of procedure return to full activities around 4 to 6 months. Postoperatively. The Arthrex ankle fusion plate has a very well thought out design, taking in key considerations when approaching an ankle fusion. The plate has an anatomic contour that allows the plate to sit flush against the lateral aspect of the distal tibia and talus. There are also multiple options for compression across the joint, including an oblong hole oblong hole at the proximal aspect of the plate, as well as an anatomic compression hole at the mid portion of the plate. Finally, the plate allows for divergent fixation within the talus, thus increasing the strength of the construct. When approaching an ankle fusion through a lateral approach, I have found a few general indications in which I think having a lateral ankle fusion plate available is very helpful. The first situation is in the setting of a poor anterior soft tissue envelope, in which any anterior incision would place the patient at high risk for wound or other soft tissue related complications. The second indication is when a lateral incision is already required as part of the procedure. This may be the case in the setting of fibular deformity, where the deformity must be corrected prior to ankle reduction in fusion. This may also be the case, such as in this case presentation, where there is already retained hardware at the lateral aspect of the ankle that must be removed prior to fusion. Finally, I have found this plate to be helpful in the setting of a significant valgus deformity at the ankle. The plate helps to provide a buttress against recurrent valgus deformity, which we know is a risk following this type of deformity. Thank you.

Christopher Kreulen, MD (Sacramento, CA), presents a complex case of a tibiotalar fusion revision using the lateral TT ankle fusion plate. Dr. Kreulen demonstrates the benefits of the Arthrex lateral plate for soft-tissue, compression, and contour challenges when treating difficult varus or valgus deformities.

Lateral Ankle Fusion Plating

Hello, my name is Chris Cullen and today I'll be talking about a lateral ankle fusion plating case. We have a 73 year old male with ongoing ankle pain and worsening deformity. Based on the patient's deformity, we had a discussion about ankle fusion versus ankle replacement. And the patient chose to proceed with an ankle fusion based on the patient's deformity. I chose to place a lateral plate through a lateral incision, so I could place that plate at the apex of the deformity. The surgery involved a lateral incision. The distal fibula was then exposed, and then a fibula osteotomy was performed. The fibula was then removed, and because I didn't need a strut graft, I just placed it all in the bone mill and ground it up to have a great source of autograft for my fusion site. Then I exposed the ankle joint and removed any remaining cartilage. I then prepped the joint surfaces and then placed autograph and an ortho biologic protein into the fusion site. I ReDeuce the joint using the mini joint distractor compressor, and placed the talus into the medial shoulder of the ankle joint. I held this reduction with K-wires, and when you're placing the medial K-wires, it's important to remember that this can be the K-wires that guides your seven millimeter compression foot. Headless screw. The screw provides compression medially and gives you another point of fixation outside of the plate. A second K-wires is then placed from the anterolateral tibia. Then I confirm my reduction with fluoroscopy. I confirmed that I had a plantigrade foot and there was no excessive plantar or dorsiflexion. I evaluated the hind foot to make sure I had 0 to 5 degrees of valgus, and then I confirmed my rotation of the foot and I compare it to what I had seen preoperatively with the contralateral foot, I typically align the second toe with the tibial tubercle. Then the plate is placed and held in position with Vortex. I confirm that the plate is not impinging on the subtalar joint, and then I place that medial screw first. Then a few locking screws are placed into the talus, and then I compress proximally through the compression screw slot. At this point you can then place the kickstand screw if you desire. Again, here are some more pictures of the plate with all the screws in place, reminding you again to place the medial screw first. This allows for medial base compression and stability while you place your lateral screws, and helps prevent any possible distraction that may occur with that lateral compression. At six weeks, the patient had no pain and was weight bearing as tolerated in a canned boot. By six months, the patient was exercising back to playing golf, and stated that he felt like his life had been restored because he no longer had pain. At one year, the patient continued to do well, and again, these x rays show no signs of hardware failure and a great fusion mass at the ankle joint. So in summary, the lateral approach allows for an aggressive deformity correction. The lateral plating system provides a stable construct to hold that deformity correction and give you great stability for your fusion. The added stability of the medial plate screw is an important technique tip, and the seven millimeter compression foot screws are now in the updated ankle fusion system. And so you don't have to open up a second tray to get that screw out and use it. And finally, the fibula is a great source of autograph. You can use a portion of it as a strut if needed for your deformity correction, or you can place it all in the bone mill to have a great source of autograph for your fusion site. Thank you.

J. Chris Coetzee, MD, MBChB (Minneapolis, MN), demonstrates an ankle arthrodesis using the Mini-Open Anterior Ankle Fusion Plate. The design of this plate provides increased construct rigidity while decreasing micromotion at the ankle fusion interface when compared to the standard 3-screw fusion construct.

Mini-Open Approach to Tibiotalar Arthrodesis With the Minimally Invasive Anterior Ankle Fusion

Okay, so what I want to show today is for those situations where you either do an arthroscopic ankle fusion or you do a mini open fusion. And for me, it was often the case that if you just do two medial screws or even if you do a home run, screw that. The stability was just not good enough with planter and dorsiflexion, and we wanted to add a small plate in the front that you can still do your medial or your home run screw, and then add a small plate to give you excellent stability in planter and dorsiflexion. So this is especially applicable to people that do arthroscopic fusions and want to add a little bit of stability, because you can use your medial portal and just extend it a little bit. Or what I often do is I use a small medial approach for my fusions can just as well be lateral depending upon where the majority of your deformity is. So with just medial to the tibialis anterior tendon, which would be in any case where you should be for your medial portal for a scope, or if you do, a smaller ankle fusion. My approach to fusions in young people changed a lot over the past ten years, because at this point I try never to fuze the medial or lateral gutter because if you ever want to take this down and convert it back to a replacement, if they're older, it makes it much easier if your gutters are open. Okay. So I will turn it a little bit so you can see we have a pretty good exposure of the joint. And at this point, if they are osteophytes, you remove them. Before you start preparing the joint, you can use whatever method you prefer to prepare the joint. In this case, we'll use a curved osteotomy. You can use a bur. You can use motorized osteotomies Terms. Important technical tip if you do it through a small incision like this, then it's important to make sure that you clean out the lateral side as well and not only the medial side. Otherwise you will force the ankle in a few degrees. Varus. This is where an arthroscopic cleaning is actually very helpful because you can look through your scope, make sure that everything is the way that you want it, and then you can just make the incision to insert your plate. Important at this point. Also, to make sure that you can get the ankle to a few degrees valgus and at least neutral. I like to put them in 1 or 2 degrees dorsiflexion, and at this point will put my two medial screws. I personally don't use the posterior homerun screw often anymore. For one, it's a fairly difficult screw to get in, but it's a very difficult screw to take out if you want to convert this to a replacement later on. For the screws, I make a small incision. You can do it completely percutaneous as well, but I usually like to make sure I have the saphenous vein out of harm's way. And the first guide pin I want just above the joint spacer in the medial one third of the talus. The second one goes proximal to that. And I want that in the latter half of the talus. I think it's at this point good to look at your guide pins before you put screws in, just to make sure that you're happy with your position. So that's the positioning of the guide wires, which I think is about ideal. The one goes into the medial quarter of the talus and the other one goes into the lateral half on the AP view. They are parallel which I think is fine. On the lateral view you can see they are not parallel. I think it's actually good to divert them a little bit because that gives you a better purchase and better stability in fixation. Personal preference. But I prefer to put the lateral screw in first so you close the lateral side down first to prevent the slight tendency to go into various when you close it down and give me a 65. So at this point I always overdraw, especially in post-traumatic. This can be very hard bone. You can hand tighten the screws to. So at this point traditionally that's about where you were done. You can either put a home run screw in or you can put a screw in from the lateral side. But my concern always is that does not give you planter and dorsiflexion stability in the long run, especially if it's a heavy patient or somebody that finds it difficult to be non-weight bearing. So to compensate for that, we decided to use this small plate that's specifically made for small incision, whether it's arthroscopic and then open or if you do it many open. To start with, you might have to use a carb or an osteotomy just to create place for the plate to slide. If you look at the plate, there is also an hole for a wire. If you want to tack it down with a tack prior to inserting any screws, and you obviously don't have to use a tack, and it can go in any hole just to secure the plate to the tibia. I usually like to put my tailor screw in first. And the concern initially was that this screw might run into the two medial screws, but in reality those are always too far lateral for this hole. So this measure to 26. It's interesting. In almost all females the screw will be 26 and males it will be 28 or 30. Again that very nicely pulled the plate onto the talus. Now we can remove the tack. So the second screw is the compression screw. If you look at the plate there's a oval screw hole. And that will aid in getting your ankle into dorsiflexion and keep it in the correct position. So off center drilling. This is a non-locking screw 45. And you can do the proximal screw with the guide or without the guide, depending upon how small you want your incision. And because you have compression over the joint already, this will be a locking screw. Make sure everything is nice and tight and locked. We can take the two guide pins out. Wipe it off so we can talk to that now. So if you look at the length of the incision, this is a four centimeter or 1.5in incision. And with that you can see the entire plate. So as you get more comfortable and do this through a smaller incision, you can get away with about a 2 or 2.5cm incision, which is not much bigger than your medial scope portal. Very nice construct, very stable with the two screws from medial tibia into talus. So we will have a look at this under X-ray as well. See how it looks. So that's a typical appearance. You can see the two screws from medial that gives the initial compression in position. And then the plate which does not interfere with the two medial screws. And you can obviously position that plate anywhere that you want. And we'll move to a lateral view. So just a comment about the x ray. This is obviously a cadaver. So the full joint prep was not done. That's why you can still see a little bit of joint space there. Good position. You can see the positioning of the plate on the ankle. The screw goes into the neck of the talus and The contour of the plate sits very nicely on the distal tibia. This will give you excellent fixation and good stability right off the bat. And as far as post-operative protocol, I put them in a cast for two weeks. They can be toe touch weight bearing. In two weeks they go into a cam boot. And at that point they can be 50% weight bearing, flat footed. They can start with active range of motion without the boot, but not passive range of motion. At six weeks we do x rays and if that looks good they can start physical therapy. And usually by eight weeks we do a CT scan to see if the joint is actually healed enough that we can be more aggressive with therapy. On average, the healing time will be somewhere between 6 and 12 weeks, depending upon patient factors as well.

Ryan B. Rigby, DPM (Logan, UT), presents the revision of a plantar-flexed ankle fusion using the anterior minimally invasive ankle fusion plate.

Plantar-Flexed Ankle Fusion Revision Using the Minimally Invasive Ankle Fusion Plate

Hello, I'm Ryan Rigby from Logan, Utah, presenting a plantar flexed ankle fusion revision using the Arthrex Mas Ankle Fusion plate. This 40 year old female came into my office for a second opinion and as she walked in, it was obvious what her complaint would be. She walked in on her toes, her heel was not purchasing the ground, and she was complaining of the inability to walk and exercise. She had a history of multiple four foot stress fractures, and as you look at the x ray, you can see the reason why these were developing. It had been a couple of years since she had had her last surgery. She'd had multiple surgeries, and over the last couple of years she had tried Nonoperative attempts to just exercise and walk and was unable to do so because of the deformity. She tried physical therapy, which really didn't help a whole lot. She tried some custom wedge shoes and really just wanted to to be able to put her heel on the ground. And so she asked what could be done. Well, before we dive into that, it's always nice to to ask the question, how did we get here in the first place and explore that a little bit. The pathway that led. So let's rewind back. I was able to dig up some of her prior radiographs. And if we look at those and ask ourselves how did we get there? The initial injury films demonstrated a displaced, unstable trimalleolar ankle fracture. There was a fairly large posterior malleolus component to this. She underwent an open reduction internal fixation. And as we look at this, there are concerns of the techniques employed here. The fibula is still a bit short in Mao rotated. The syndesmosis is wide and lacks fixation. The posterior malleolus was not fixated, and on the medial side it appears there was some insufficient fixation for this fracture pattern. This went on to develop subsequent post-traumatic painful arthrosis for the patient, so another surgeon then took her to the operating room to fuze her ankle and used a retrograde intramedullary nail. As you look at the lateral view, you appreciate the deformity from the beginning or the position that the nail was placed with the ankle in plantar flexion. Afterwards, the patient actually consolidated the ankle. It appeared to fuze despite the positioning, but But unfortunately this became infected and Linnell required removal. Which brings us up to speed to where she presents in my office for the second opinion. And I had a conversation about her expectations. What would she like to see happen? And her main goal was just to be able to walk for her heal, to purchase the ground, and to be able to wear normal shoes. And so we had a conversation about what could be done. And after a thorough workup, clinical and laboratory findings did not find any residual signs of infection. There were no open wounds. We decided to proceed for a revision. So I took her to the operating room for an anterior closing wedge osteotomy. And it's imperative when you make these cuts, that you plan ahead and orient the cut so as to allow not only correction of the deformity in the sagittal plane, but also to be able to slide the talus back under the tibia to decrease that lever arm. If you remember her position where she was fuzed, it was not only in plantar flexion, but the talus was out in front. Or in other words, the tibia really needed to be brought forward on the talus. Taylor's, and so planning the cuts is critical in treating and correcting this kind of deformity. And as far as fixation is concerned, I employed the Arthrex miss anterior ankle fusion plate worked very well in this situation for a couple of reasons. It's very sleek in nature, it's low profile, and that was nice in this patient that had had multiple surgeries already. I did not want to breach her soft tissue any more than I needed. And so this allowed me to keep the exposure more minimal and less soft tissue stripping, which was important. The other nice thing about this plate is it does incorporate locking technology. So the first screw that I place is the distal locking screw in the talus. The middle hole is an oblong hole for compression. And as I compress this I actually achieved a few more degrees of dorsiflexion which worked well for this patient. And then you lock it in at the top with another locking screw. I supplemented this with a couple of large 7.0ft compression screws, and place these in the posterior half of the ankle for additional compression and stability. The initial post-operative films demonstrated a good Demonstrated a good reduction of the deformity and excellent healing occurring. And then as I watched this over several non-weight bearing films, it appeared she was healing well. And then, of course, the most important follow up radiographs were the weight bearing films. And comparing these to the preoperative, we were satisfied with the amount of correction and the healing of the osteotomy and overall alignment with the fixation. So in conclusion, the Arthrex ankle fusion plate is quite versatile. I use this in arthroscopic ankle fusions as an adjunct fixation to bring additional support and stability. You can use this in a mini open type ankle fusion primarily, or in this case, when we need a revision or an osteotomy to correct other deformity. This plate is very versatile and brings a lot of benefits when addressing these deformities and situations, and ultimately allow this patient to return back to her normal shoe gear, which improved her ambulation and overall function and ultimately, her quality of life. Thank you.

Ankle Fusion

Child (D)

The DualCompression hindfoot fusion nail is intended to facilitate tibiotalocalcaneal arthrodesis to treat severe foot/ankle deformity, arthritis, instability, and skeletal defects. The superelastic nitinol inner core of the nail provides sustained compression across both joints when instrumentation is removed during bone resorption or joint settling.

DualCompression Hindfoot Nail

A triple arthrodesis is the fusion of the subtalar, calcaneocuboid, and talonavicular joints. Arthrex has developed 5.0 mm Large and 7.0 mm XL Compression FT Screws and DynaNite® Nitinol staples as options for this procedure. After removing any remaining cartilage and subchondral bone and applying biologic materials to accelerate fusion, apply fixation to compress and stabilize the joint.

Ankle Arthritis

Ankle Fusion

DualCompression Hindfoot Nail

Triple Arthrodesis