Tibio(-talo-)calcaneal Arthrodesis With the Versanail

Arthrodesis of the ankle and subtalar joints is rarely indicated. Besides patients with arthritis at both hind foot joints, this challenging procedure is mostly indicated as a salvage operation in patients with pseudarthrosis or malunited fractures, neuroarthropathic hind foot deformity, failure of endoprosthetic replacement, or avascular necrosis of the talus. Internal stabilization of this extensive hind foot fusion can be performed with crossed screws, blade plate (95 degrees), or an intramedullary nocking nail. As huge cortico-cancellous bone grafts are often required, the intramedullary nail offers some advantages. The Versanail is a straight nail presenting with 3 distal and 2 proximal locking screws. All screws can be placed either in the frontal plane (lateromedial or vice versa) or in the sagittal plane (posteroanterior). One of the proximal holes in the nail is designed as a dynamic slot allowing dynamic or static fixation. With respect to the severe hind foot deformities and the mostly impaired bone quality, osseous healing will last 4 months as a minimum, and the pseudarthrosis rate has to be estimated between 10% and 15%. Because of the impaired range of motion, the American Orthopaedic Foot and Ankle Society score is less than 70 points.