{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:52:23Z","timestamp":1773103943629,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Nonunion after tibiotalocalcaneal (TTC) arthrodesis remains challenging, especially in revision settings where union rates are substantially lower than in primary procedures. Biological adjuncts are commonly used to enhance healing, yet most described methods employ fibular onlay struts and cancellous autograft. To our knowledge, intramedullary placement of a fibular autograft for ankle fusion has not previously been reported. This study presents a revision of TTC arthrodesis nonunion treated with this technique and summarizes existing evidence on revision ankle arthrodesis, fibular grafting, and bone marrow aspirate concentrate (BMAC). Methods: We report a revision TTC arthrodesis nonunion managed with a decorticated intramedullary fibular autograft spanning the tibiotalar canal, supplemented with cancellous iliac crest autograft and BMAC. A review of PubMed, Scopus, and Google Scholar (search date: 1 September 2025) was performed to identify studies addressing revision ankle fusion, fibular grafting techniques, and BMAC use in foot and ankle arthrodesis. Primary outcomes included union and complications, with CT-based assessment prioritized when available. Results: At 3 months, radiographs and CT demonstrated progressive osseous bridging consistent with fusion; the patient achieved pain-free weight-bearing without complications. Conclusions: Intramedullary fibular autograft in revision TTC arthrodesis is a novel biological-mechanical strategy that leverages endosteal contact and axial stability while augmenting osteogenesis with cancellous autograft and BMAC. The review supports the biological plausibility and safety of this approach and underscores the importance of CT-based assessment.<\/jats:p>","DOI":"10.3390\/jcm15052078","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T13:27:18Z","timestamp":1773062838000},"page":"2078","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Revision of Tibiotalar Arthrodesis Nonunion Using Intramedullary Fibular Autograft Combined with Cancellous Iliac Graft and Bone Marrow Aspirate Concentrate: A Case Report and Literature Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Daniele","family":"Marcolli","sequence":"first","affiliation":[{"name":"Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Unit\u00e0 Operativa Semplice Dipartimentale Centro Patologia del Piede (CPP), ASST Gaetano Pini-CTO, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9096-4219","authenticated-orcid":false,"given":"Alice","family":"Montagna","sequence":"additional","affiliation":[{"name":"Clinica Ortopedica e Traumatologica Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Delmastro","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativa Semplice Dipartimentale Centro Patologia del Piede (CPP), ASST Gaetano Pini-CTO, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Mazzotti","sequence":"additional","affiliation":[{"name":"1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3872-6950","authenticated-orcid":false,"given":"Carlo Francesco","family":"Minoli","sequence":"additional","affiliation":[{"name":"Unit\u00e0 Operativca Complessa Week Surgery, ASST G. Pini-CTO, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Ferrua","sequence":"additional","affiliation":[{"name":"1^ Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milan, Italy"},{"name":"Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9331-820X","authenticated-orcid":false,"given":"Pietro Simone","family":"Randelli","sequence":"additional","affiliation":[{"name":"1^ Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122 Milan, Italy"},{"name":"Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Department of Biomedical, Surgical and Dental Sciences, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"700","DOI":"10.5312\/wjo.v7.i11.700","article-title":"Ankle Arthrodesis: A Systematic Approach and Review of the Literature","volume":"7","author":"Yasui","year":"2016","journal-title":"World J. 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