Removal of Broken Tibiotalocalcaneal Nail: Case Report and Technical Tip

Abstract

Tibiotalocalcaneal (TTC) arthrodesis is an established procedure for treating patients with end-stage ankle joint arthritis combined with subtalar joint arthritis. In addition, it has gained popularity as a salvage operation for cases of previously failed ankle surgery.6 Although various implants have been developed, retrograde intramedullary nailing is a widely used method with advantages in bending, torsional forces, and dynamic compression.3,4,8 However, metalwork-related complications are one of the most common problems encountered after TTC arthrodesis.6 Such complications may lead to nonunion and persistent pain for the patients as well as present a difficult challenge during removal in revision operations. Although previous studies have reported various methods for removing broken intramedullary nails in femoral or tibial fractures, very few studies are available regarding the removal of failed hindfoot fusion nails in TTC arthrodesis settings.1,2,9 To our knowledge, this is the first report to detail the removal of a broken TTC intramedullary nail followed by subtalar fusion in a 1-stage operation. Herein, we present a clinical tip for the removal of a broken intramedullary hindfoot fusion nail, which involves drilling a hole through the nail and using roll wires, and report the successful outcome of simultaneously performed subtalar fusion. This study was approved by Seoul National University Hospital Institutional Review Board (IRB no. H-1806-151-953) and carried out in accordance with the World Medical Association Declaration of Helsinki. Verbal informed consent was obtained from the patient for the use of patient information and images for publication, which was documented in the patients hospital record.