Acute deformity correction with simultaneous ankle fusion and lengthening using a retrograde lengthening nail

C. Robbins, D. Paley, B. Lamm

Introduction: Revision ankle fusion for failed primary surgery or malunion often results in a residual limb length discrepancy (LLD). Restoring ankle and hindfoot alignment with simultaneous lengthening can optimize function and diminish LLD. The purpose of our study was to evaluate whether ankle fusion and limb lengthening can be achieved simultaneously by insertion of a retrograde intramedullary lengthening nail (Precice) combined with ankle fusion.

Methods: This was a retrospective review of 18 limbs in 17 patients who underwent simultaneous ankle fusion and tibial lengthening with an internal lengthening nail. All patients had preoperative leg length discrepancy and ankle deformity. Deformities were corrected acutely with ankle fusion through lateral and/or medial approaches with internal fixation and a retrograde Precice lengthening nail. The osteotomy was performed proximal to the ankle fusion.

Results: Clinical, subjective, objective and radiographic analyses were performed with an average follow-up over 12 months. The mean lengthening was 3.95 cm (1.8-7.2) and the average final LLD was 1 cm (0.7-1.1 cm). The foot was plantigrade with neutral hindfoot alignment and the foot was rotated 5-15 degrees external in all cases. At final follow-up no patient had pain and all claimed to be walking much better than before surgery.

Conclusion: Acute correction of residual deformity from failed ankle fusion or malunion can be successfully combined with ankle fusion and simultaneous retrograde distal tibial lengthening with an intramedullary lengthening nail.