Salvage Tibial-Talocalcaneal Arthrodesis with Retrograde Intramedullary Nail Fixation in Elderly with Posttraumatic Secondary Arthritis: Limb Salvage Reconstruction in Two Cases with Review of Literature

INTRODUCTION: Posttraumatic secondary arthritis (SA) in the elderly with diabetes mellitus, osteoporosis, and neuromuscular affections has poor healing potential, leading to poor clinical and functional outcomes. Tibial talocalcaneal arthrodesis (TTCA) has been used to salvage for resultant hindfoot deformation. Retrograde intramedullary nailing (RIMN) has achieved reasonable fusion rates with improved functional outcomes. CASE REPORT: We report two cases of failed ankle surgery with progressive SA managed with curved RIMN to achieve TTCA. The American Orthopaedic Foot and Ankle Society Hindfoot scale, visual analog scale, radiologic assessment, and clinical examination were used to assess outcome measures. We achieved good ankle scores with pain-free independent mobilization at 4 months. At minimum 1-year follow-up, all had good hindfoot alignment, good fusion, and no implant loosening or failure. CONCLUSION: Salvage TTCA with RIMN for a hindfoot SA can be a reliable technique to obtain good fusion, high satisfaction rate, and functional improvement following post-traumatic failed ankles in the elderly. The complex procedure has marked clinical improvement with the pain-free walking ability in an arthritic ankle, even with associated medical comorbidity.