Tibiotalocalcaneal (TTC) arthrodesis using an intramedullary hindfoot nail is a common procedure for deformity correction and the treatment of combined tibiotalar and subtalar end-stage arthritis. Nonunion at one or both fusion sites is a difficult complication that can result in reoperation, significant morbidity, and below-knee amputation. There is currently a need for sustained compression across fusion sites using a TTC hindfoot nail with good mechanical stability. The DynaNail TTC Fusion System (MedShape, Inc, Atlanta, GA) uses an internal nitinol compression element to apply sustained compression across the tibiotalar and subtalar joints after surgery. In preliminary clinical cases, we have found that the nail is safe, reliable, and has promising clinical and radiographic results in settings of hindfoot arthritis, complex deformity, Charcot arthropathy, and talar avascular necrosis.
LucasYHernandezJAbadJ. Tibiotalocalcaneal arthrodesis using a straight intramedullary nail. Foot Ankle Int. 2015;36:539-546.
2.
TenenbaumSColemanSCBrodskyJW. Improvement in gait following combined ankle and subtalar arthrodesis. J Bone Joint Surg Am. 2014;96:1863-1869.
3.
BrodskyJWVerschaeGTenenbaumS. Surgical correction of severe deformity of the ankle and hindfoot by arthrodesis using a compressing retrograde intramedullary nail. Foot Ankle Int. 2014;35:360-367.
4.
RammeltSPyrcJAgrenPH. Tibiotalocalcaneal fusion using the hindfoot arthrodesis nail: a multicenter study. Foot Ankle Int. 2013;34:1245-1255.
5.
TenenbaumSStocktonKGBariteauJTBrodskyJW. Salvage of avascular necrosis of the talus by combined ankle and hindfoot arthrodesis without structural bone graft. Foot Ankle Int. 2015;36:282-287.
6.
HsuARSzatkowskiJP. Early tibiotalocalcaneal arthrodesis intramedullary nail for treatment of a complex tibial pilon fracture (AO/OTA 43-C). Foot Ankle Spec. 2015;8:220-225.
7.
BussewitzBDeVriesJGDujelaMMcAlisterJEHyerCFBerletGC. Retrograde intramedullary nail with femoral head allograft for large deficit tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2014;35:706-711.
8.
JengCLCampbellJTTangEYCerratoRAMyersonMS. Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013;34:1256-1266.
9.
DeVriesJGBerletGCHyerCF. Predictive risk assessment for major amputation after tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2013;34:846-850.
10.
FloerkemeierTStukenborg-ColsmanCWindhagenHWaizyH. Correction of severe foot deformities using the Taylor spatial frame. Foot Ankle Int. 2011;32:176-182.
11.
WaizyHWindhagenHStukenborg-ColsmanCFloerkemeierT. Taylor spatial frame in severe foot deformities using double osteotomy: technical approach and primary results. Int Orthop. 2011;35:1489-1495.
12.
PinzurMS. The role of ring external fixation in Charcot foot arthropathy. Foot Ankle Clin. 2006;11:837-847.
13.
PinzurMS. Simple solutions for difficult problems: a beginner’s guide to ring fixation. Foot Ankle Clin. 2008;13:1-13.
14.
JonesCPYoungbloodCSWaldropNDavisWHPinzurMS. Tibial stress fracture secondary to half-pins in circular ring external fixation for Charcot foot. Foot Ankle Int. 2014;35:572-577.
15.
BerendMEGlissonRRNunleyJA. A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 1997;18:639-643.
16.
ChiodoCPAcevedoJISammarcoVJ. Intramedullary rod fixation compared with blade-plate-and-screw fixation for tibiotalocalcaneal arthrodesis: a biomechanical investigation. J Bone Joint Surg Am. 2003;85-A:2425-2428.
17.
JehanSShakeelMBingAJHillSO. The success of tibiotalocalcaneal arthrodesis with intramedullary nailing—a systematic review of the literature. Acta Orthop Belg. 2011;77:644-651.
18.
De VriesJGBerletGCHyerCF. Union rate of tibiotalocalcaneal nails with internal or external bone stimulation. Foot Ankle Int. 2012;33:969-978.
19.
ThomasRLSatheVHabibSI. The use of intramedullary nails in tibiotalocalcaneal arthrodesis. J Am Acad Orthop Surg. 2012;20:1-7.
20.
MannMRParksBGPakSSMillerSD. Tibiotalocalcaneal arthrodesis: a biomechanical analysis of the rotational stability of the Biomet Ankle Arthrodesis Nail. Foot Ankle Int. 2001;22:731-733.
21.
MeansKRParksBGNguyenASchonLC. Intramedullary nail fixation with posterior-to-anterior compared to transverse distal screw placement for tibiotalocalcaneal arthrodesis: a biomechanical investigation. Foot Ankle Int. 2006;27:1137-1142.
22.
YakackiCMKhalilHFDixonSAGallKPacaccioDJ. Compression forces of internal and external ankle fixation devices with simulated bone resorption. Foot Ankle Int. 2010;31:76-85.
23.
YakackiCMGallKDirschlDRPacaccioDJ. Pseudoelastic intramedullary nailing for tibio-talo-calcaneal arthrodesis. Expert Rev Med Devices. 2011;8:159-166.
24.
RoukisTS. A 1-piece shape-metal nitinol intramedullary internal fixation device for arthrodesis of the proximal interphalangeal joint in neuropathic patients with diabetes. Foot Ankle Spec. 2009;2:130-134.
25.
SandhuJSDeCarboWTHofbauerMH. Digital arthrodesis with a one-piece memory nitinol intramedullary fixation device: a retrospective review. Foot Ankle Spec. 2013;6:364-366.
