Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 11 , ISSUE 2 ( April-June, 2024 ) > List of Articles


Tibiotalocalcaneal Arthrodesis Following a 20-year-neglected Retained Bullet Foreign Body Removal in Ankle Joint: A Case Report

Andre Prawiradinata, Ricky Wibowo

Keywords : Bullet foreign body, Case report, Retrograde intramedullary nail, Tibiotalocalcaneal arthrodesis

Citation Information : Prawiradinata A, Wibowo R. Tibiotalocalcaneal Arthrodesis Following a 20-year-neglected Retained Bullet Foreign Body Removal in Ankle Joint: A Case Report. J Foot Ankle Surg Asia-Pacific 2024; 11 (2):84-88.

DOI: 10.5005/jp-journals-10040-1336

License: CC BY-NC 4.0

Published Online: 02-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aims and background: A bullet foreign body, especially if embedded in joint space, can cause multiple complications. Although there is still no standard treatment for retained bullet foreign bodies, we found in some literature that bullet removal is the best treatment option for intra-articular involvement. Achieving ankle stability is considered a priority after foreign body removal. Case description: We present a 48-year-old male with swelling and pain in his right ankle after falling from a parked motorcycle. The drop-foot gait pattern was also found. We later found from an X-ray examination that the patient had an untreated bullet foreign body embedded in his right ankle from an incident 20 years ago. Foreign body removal and tibiotalocalcaneal arthrodesis (TTCA) using retrograde intramedullary nail were performed to achieve ankle stability. Conclusion: Tibiotalocalcaneal arthrodesis (TTCA) using retrograde intramedullary nail performed in this particular case showed good clinical outcomes and a good return-to-work rate. Clinical significance: This case report revealed that bullet removal in the tibiotalar joint is a great treatment option for patients experiencing abnormal gait pattern and chronic pain. The utilization of retrograde intramedullary nail along with bone graft can be a promising option in cases with avascular necrosis of the talus to achieve a stable ankle fusion.

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  1. Rehman MA, Umer M, Sepah YJ, et al. Bullet-induced synovitis as a cause of secondary osteoarthritis of the hip joint: a case report and review of literature. J Med Case Rep 2007;1:171. DOI: 10.1186/1752-1947-1-171
  2. McAninch SA, Adkison J, Meyers R, et al. Bullet fragment-induced lead arthropathy with subsequent fracture and elevated blood lead levels. Proc (Bayl Univ Med Cent) 2017;30(1):88–91. DOI: 10.1080/08998280.2017.11929543
  3. Nguyen MP, Reich MS, O'Donnell JA, et al. Infection and complications after low-velocity intra-articular gunshot injuries. J Orthop Trauma 2017;31(6):330–333. DOI: 10.1097/BOT.0000000000000823
  4. Baum GR, Baum JT, Hayward D, et al. Gunshot wounds: ballistics, pathology, and treatment recommendations, with a focus on retained bullets. Orthop Res Rev 2022;14:293–317. DOI: 10.2147/ORR.S378278
  5. Mazotas IG, Hamilton NA, McCubbins MA, et al. The long-term outcome of retained foreign bodies in pediatric gunshot wounds. J Trauma Nurs 2012;19(4):240–245. DOI: 10.1097/JTN.0b013e31827757a7
  6. Burks JB. Tibiotalocalcaneal arthrodesis. Clin Podiatr Med Surg 2012;29(4):529–545. DOI: 10.1016/j.cpm.2012.08.002
  7. Kulkarni GS, Kulkarni MG, Kulkarni SG, et al. Retrograde tibial nailing for arthrodesis of ankle and subtalar joints. J Foot Ankle Surg (Asia-Pacific) 2015;2(2):60–70. DOI: 10.5005/jp-journals-10040-1031
  8. Goebel M, Gerdesmeyer L, Mückley T, et al. Retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis: a short-term, prospective study. J Foot Ankle Surg 2006;45(2):98–106. DOI: 10.1053/j.jfas.2005.12.001
  9. Tolli JJ, LaPorta GA. Posterior approach to the tibiotalocalcaneal arthrodesis utilizing an A3 intramedullary nail: a case report. Clin Case Rep Rev 2015;1(7):139–142. DOI: 10.15761/CCRR.1000146
  10. Maqungo S, Swan A, Naude P, et al. The management of low velocity transarticular gunshot injuries: a pilot study. SA Orthop J 2018;17(3):25–27. DOI: 10.17159/2309-8309/2018/v17n2a4
  11. Reilly M, Luginbuhl J, Thoder J. Retained missile to the foot and ankle: when should they come out? Foot Ankle Orthop 2019;4(4):2473011419S0035. DOI: 10.1177/2473011419S00355
  12. Ramu TK, Bajuri MY, Hayyun MF, et al. Outcome of pantalar fusion with femoral head allograft in avascular necrosis of talus. Front Surg 2021;8:658788. DOI: 10.3389/fsurg.2021.658788
  13. Backus JD, Ocel DL. Ankle arthrodesis for talar avascular necrosis and arthrodesis nonunion. Foot Ankle Clin 2019;24(1):131–142. DOI: 10.1016/j.fcl.2018.11.004
  14. Rabinovich RV, Haleem AM, Rozbruch SR. Complex ankle arthrodesis: review of the literature. World J Orthop 2015;6(8):602–613. DOI: 10.5312/wjo.v6.i8.602
  15. Mendicino RW, Catanzariti AR, Saltrick KR, et al. Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing. J Foot Ankle Surg 2004;43(2):82–86. DOI: 10.1053/j.jfas.2004.01.012
  16. Quill GE. Tibiotalocalcaneal arthrodesis. Tech Orthop 1996;11:269–273. DOI: 10.1097/00013611-199601130-00009
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