Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 8 , ISSUE 4 ( October-December, 2021 ) > List of Articles

Symposium: Complex Injuries Around The Ankle

Primary Tibiotalocalcaneal Fusion for High-risk Complex Ankle Fractures

Nicholas Genovese, Jay Patel, Sheldon S Lin, Joshua Greendyk

Keywords : Ankle arthrodesis, Ankle fractures, Diabetic ankle fracture, Fusion, Tibiotalocalcaneal arthrodesis

Citation Information : Genovese N, Patel J, Lin SS, Greendyk J. Primary Tibiotalocalcaneal Fusion for High-risk Complex Ankle Fractures. J Foot Ankle Surg Asia-Pacific 2021; 8 (4):188-192.

DOI: 10.5005/jp-journals-10040-1180

License: CC BY-NC 4.0

Published Online: 20-10-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Successful management of high-risk diabetic patients with unstable ankle fractures remains a difficult task given the high incidence of complications and need for reoperation. Ankle arthrodesis has been primarily described as a salvage procedure for Charcot arthropathy or failed fracture fixation. Primary tibiotalocalcaneal (TTC) fusion is a simple and effective treatment option for dealing with the pathophysiologic factors that diabetic patients encounter when they sustain an unstable ankle fracture.

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  1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury 2006;37(8):691–697. DOI: 10.1016/j.injury.2006.04.130.
  2. Schmidt T, Simske NM, Audet MA, et al. Effects of diabetes mellitus on functional outcomes and complications after torsional ankle fracture. J Am Acad Orthop Surg 2020;28(16):661–670. DOI: 10.5435/JAAOS-D-19-00545.
  3. Shibuya N, Davis ML, Jupiter DC. Epidemiology of foot and ankle fractures in the United States: an analysis of the National Trauma Data Bank (2007 to 2011). J Foot Ankle Surg 2014;53(5):606–608. DOI: 10.1053/j.jfas.2014.03.011.
  4. Regan DK, Manoli 3rd A, Hutzler L, et al. Impact of diabetes mellitus on surgical quality measures after Ankle fracture surgery: implications for “Value-Based” compensation and “Pay for Performance”. J Orthop Trauma 2015;29(12):e483–e486. DOI: 10.1097/BOT.0000000000000394.
  5. Bullard KM, Cowie CC, Lessem SE, et al. Prevalence of diagnosed diabetes in adults by diabetes type - United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67(12):359–361. DOI: 10.15585/mmwr.mm6712a2.
  6. Wukich DK, Joseph A, Ryan M, et al. Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int 2011;32(2):120–130. DOI: 10.3113/FAI.2011.0120.
  7. Pincus D, Veljkovic A, Zochowski T, et al. Rate of and risk factors for intermediate-term reoperation after ankle fracture fixation: a population-based cohort study. J Orthop Trauma 2017;31(10):e315–e320. DOI: 10.1097/BOT.0000000000000920.
  8. Manway JM, Blazek CD, Burns PR. Special considerations in the management of diabetic ankle fractures. Curr Rev Musculoskelet Med 2018;11(3):445–455. DOI: 10.1007/s12178-018-9508-x.
  9. Jones KB, Maiers-Yelden KA, Marsh JL, et al. Ankle fractures in patients with diabetes mellitus. J Bone Joint Surg Br 2005;87(4):489–495. DOI: 10.1302/0301-620X.87B4.15724.
  10. Schon LC, Marks RM. The management of neuroarthropathic fracture-dislocations in the diabetic patient. Orthop Clin North Am 1995;26(2):375–392. DOI: 10.1016/S0030-5898(20)31999-4.
  11. Perry MD, Taranow WS, Manoli 2nd A, et al. Salvage of failed neuropathic ankle fractures: use of large-fragment fibular plating and multiple syndesmotic screws. J Surg Orthop Adv 2005;14(2):85–91.
  12. Chaudhary SB, Liporace FA, Gandhi A, et al. Complications of ankle fracture in patients with diabetes. J Am Acad Orthop Surg 2008;16(3):159–170. DOI: 10.5435/00124635-200803000-00007.
  13. Ayoub MA. Ankle fractures in diabetic neuropathic arthropathy: can tibiotalar arthrodesis salvage the limb? J Bone Joint Surg Br 2008;90(7):906–914. DOI: 10.1302/0301-620X.90B7.20090.
  14. Ebaugh MP, Umbel B, Goss D, et al. Outcomes of primary tibiotalocalcaneal nailing for complicated diabetic Ankle fractures. Foot Ankle Int 2019;40(12):1382–1387. DOI: 10.1177/1071100719869639.
  15. Gougoulias N, Oshba H, Dimitroulias A, et al. Ankle fractures in diabetic patients. EFORT Open Rev 2020;5(8):457–463. DOI: 10.1302/2058-5241.5.200025.
  16. Taylor BC, Hansen DC, Harrison R, et al. Primary retrograde tibiotalocalcaneal nailing for fragility ankle fractures. Iowa Orthop J 2016;36:75–78.
  17. Vaudreuil NJ, Fourman MS, Wukich DK. Limb salvage after failed initial operative management of bimalleolar ankle fractures in diabetic neuropathy. Foot Ankle Int 2017;38(3):248–254. DOI: 10.1177/1071100716676063.
  18. O'Neill PJ, Logel KJ, Parks BG, et al. Rigidity comparison of locking plate and intramedullary fixation for tibiotalocalcaneal arthrodesis. Foot Ankle Int 2008;29(6):581–586. DOI: 10.3113/FAI.2008.0581.
  19. Abebe E, Farrell DJ, Zelle B, et al. Primary posterior blade plate tibiotalar arthrodesis: a salvage procedure for complex nonreconstructable pilon fractures. J Orthop Trauma 2017;31(Suppl 3):S30–S33. DOI: 10.1097/BOT.0000000000000911.
  20. Pellegrini MJ, Schiff AP, Adams Jr SB, et al. Outcomes of tibiotalocalcaneal arthrodesis through a posterior Achilles tendon-splitting approach. Foot Ankle Int 2016;37(3):312–319. DOI: 10.1177/1071100715615398.
  21. Nickisch F, Avilucea FR, Beals T, et al. Open posterior approach for tibiotalar arthrodesis. Foot Ankle Clin 2011;16(1):103–114. DOI: 10.1016/j.fcl.2010.11.001.
  22. Mulligan RP, Adams Jr SB, Easley ME, et al. Comparison of posterior approach with intramedullary nailing versus lateral transfibular approach with fixed-angle plating for tibiotalocalcaneal arthrodesis. Foot Ankle Int 2017;38(12):1343–1351. DOI: 10.1177/1071100717731728.
  23. Ahmad J, Pour AE, Raikin SM. The modified use of a proximal humeral locking plate for tibiotalocalcaneal arthrodesis. Foot Ankle Int 2007;28(9):977–983. DOI: 10.3113/FAI.2007.0977.
  24. Hernigou P, Guissou I, Homma Y, et al. Percutaneous injection of bone marrow mesenchymal stem cells for ankle non-unions decreases complications in patients with diabetes. Int Orthop 2015;39(8):1639–1643. DOI: 10.1007/s00264-015-2738-2.
  25. Dekker TJ, White P, Adams SB. Efficacy of a cellular allogeneic bone graft in foot and ankle arthrodesis procedures. Foot Ankle Clin 2016;21(4):855–861. DOI: 10.1016/j.fcl.2016.07.008.
  26. Pitts C, Alexander B, Washington J, et al. Factors affecting the outcomes of tibiotalocalcaneal fusion. Bone Joint J 2020;102-B(3):345–351. DOI: 10.1302/0301-620X.102B3.BJJ-2019-1325.R1.
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