Case Report: Tibiotalocalcaneal Arthrodesis Utilizing a Titanium Mesh Implant for Limb Salvage after Failed Charcot Reconstruction

CATEGORY: Other; Ankle; Diabetes; Trauma INTRODUCTION/PURPOSE: Tibiotalocalcaneal (TTC) arthrodesis has been employed as a mean to achieve hindfoot fusion and limb salvage. A particular challenge in limb salvage is achieving successful fusion in the setting of massive bone deficit. Several augmentation strategies have been trialed in this setting, such as structural allografts, 3D printed implants, fibular strut grafts, to name a few. METHODS: We present a case describing TTC fusion for limb salvage utilizing a titanium mesh implant, combined with bone graft in the setting of massive bone deficit in an individual with Charcot arthropathy from Diabetes Mellitus and HIV after Pilon fracture, performed as revision procedure after failed Charcot reconstruction with a ringed external fixator and femoral head allograft with subsequent nonunion. RESULTS: At last follow-up (22 months postoperative) patient is weight bearing as tolerated in Charcot Restraint Orthotic Walker boot. CT imaging at 18 months postoperative demonstrates stable implant and arthrodesis. CONCLUSION: Use of a titanium mesh implant is a reasonable option combined with bone graft for augmentation of TTC fusion in the setting of massive bone deficit.