1. Dr.Rajiv Shah
‘Foot & ankle orthopaedics’
Foot & ankle surgeon
President, Indian Foot & Ankle Society

2.  Simultaneous
fusion(arthrodesis)
of ankle & subtalar
joint

3. 3
Indications
Post trauma
Post infection
Post degenerative
arthritis -OA
AVN talus
Paralytic/flail foot &
ankle
Charcot neuropathy
Loss of talar body
FailedTAR
Severe instability

4. 4
Indications
Failed ankle arthrodesis
RA, Seronegative arthropathy
Skeletal defects after tumor excision
Nonunions
Severe deformity

5.  Broad, congruous & bleeding articular
surfaces in apposition
 Well stabilized & compressed of articulating
surfaces with utmost care of skin and soft
tissues
 Painless & stable fusion of ankle & subtalar
joints in functional position
 Foot at 90 degree angle to long axis of tibia
with 5-7 degree of hindfoot valgus

6.  Hindfoot nail
 Nail + screws
 Blade plate
 External fixator
 Ring(Ilizarov) fixator
 Taylor spatial frame
 Combinations

7. Valgus deformity – Supine position
Varus position – Lateral position
Severe varus – additional medial approach
Transfibular osteotomy
2.5 cm above lateral malleolus
Fibula is cut in bevelled fashion

8.  Preserve fibula in young patients for later
date possibility ofTAR
 Preparation of ankle & subtalar joints
 Fixation – nail, blade plate, ex-fix or ring
fixator
 Blade plate : Anterior, posterior or lateral
approach

12.  Compression at both joints-15mm
 Two plane locking-40% increase in stability
 Lock all holes
 10mm nail, 150-180 mm length
 Countersink nail up to 5mm
 Grafting if needed
 Use of end cap
• Prevention of medullary bleeding
• Preservation of threads for extraction
• limiting the heterotopic ossification

13. Stress fracture at tip of nail
(Controlled with longer nail)
Non union
(exchange nailing+ bone
grafting)
(ring fixator +bone grafts)

14.  Pre-assembled, embedded distal locking
mechanism in the nail
 7 mm of in-board compression
 Ability to compress the subtalar and ankle
joints separately
 Screws can still be removed without having
to disengage compression and/or
locking mechanisms

15.  Blade plate – adoloscent/ humerus with
blade length of 40mm with plate holes up
to 5-8
 Provisional fixation of joints with guide
wires/k wires/ST pin/ Schanz screws before
blade insertion

16.  Guide wire:5-10mm of
calcaneus bone shall
remain plantar to the
blade plate
 Push flush to lateral
cortex
 Do contour to prevents
valgus malunion
 4.5 screw proximally &
6.5 screws distally

17.  Guide wire in
proximal screw hole
to prevent rotation of
blade plate while
hammering it in
 Cut a notch in lower
end of tibia for sitting
of blsde plate
 Use AO tension device
for giving compression

19.  Prone position
 Midline longitudinal approach -
14-16cms
 Skin+ paratenon in one incision
 Z plasty of achilles
 FHL with NV retracted medially

23. That’s all…
Thank you all..