{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:26:52Z","timestamp":1760149612006,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T00:00:00Z","timestamp":1692576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Ankle arthrodesis is a commonly used salvage procedure in the management of post-traumatic ankle fractures, which often result in severe disability and may require the amputation of the distal third of the leg. Successful ankle arthrodesis relies on a thorough assessment of local and systemic risk factors to ensure optimal results. Failure to accurately assess these factors may lead to unsatisfactory results. High-energy trauma causing bone defects and soft tissue necrosis often results in osteomyelitis, a condition that poses a significant threat to the success of the arthrodesis procedure. It is important to apply a standardised surgical protocol to minimise the possibility of superficial and deep infection and limit damage to the neighbouring soft tissues. Therefore, it is critical to undertake surgical lavage and debridement and administer systemic and local antibiotic therapy, along with the use of a spacer, to eradicate infection prior to performing arthrodesis. In this study, we present our experience in the recovery of limbs with post-traumatic complications via tibio-astragalic or tibio-calcaneal arthrodesis using a retrograde intramedullary nail technique. The approach involves a multi-step procedure using a previous antibiotic spacer implant and an autologous bone graft (RIA). This study spanned a period from January 2014 to December 2021 and included 35 patients (12 women and 23 men) with a mean age of 47.8 \u00b1 20.08 years (range: 22\u201385 years). Among the patients, 18 had osteomyelitis following AO 43 C3 fractures, and 9 of them had previous exposure and bone loss at the time of injury. The remaining cases included 10 patients with AO 44 C fracture outcomes and 7 patients with AO 44 B fracture outcomes. Our results emphasise the importance of the meticulous management of local and systemic risk factors in ankle arthrodesis procedures. The successful eradication of infection and subsequent arthrodesis can be achieved via the implementation of surgical lavage, debridement, and systemic and local antibiotic therapy using spacers. This surgical protocol implemented by us has yielded excellent results, saving affected limbs from post-traumatic complications and avoiding the need for amputation. Our study contributes to the existing knowledge supporting the use of retrograde arthrodesis with intramedullary nails in severe cases where limb salvage is the primary goal. However, further research and long-term follow-up studies are needed to validate these results and evaluate the effectiveness of this technique in a larger patient population.<\/jats:p>","DOI":"10.3390\/jfmk8030122","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T08:53:31Z","timestamp":1692608011000},"page":"122","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tibiotarsal Arthrodesis with Retrograde Intramedullary Nail and RIA Graft: A Salvage Technique"],"prefix":"10.3390","volume":"8","author":[{"given":"Giancarlo","family":"Salvo","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Bonfiglio","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3763-693X","authenticated-orcid":false,"given":"Marco","family":"Ganci","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvo","family":"Milazzo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco","family":"Ortuso","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8103-8075","authenticated-orcid":false,"given":"Giacomo","family":"Papotto","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianfranco","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, 95100 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1053\/j.jfas.2018.12.018","article-title":"Single-Stage Tibiotalocalcaneal Arthrodesis With Use of an Antibiotic-Coated Intramedullary Nail for Limb Salvage Following an Open Pilon Fracture Complicated by Osteomyelitis: A Case Report","volume":"58","author":"Wadehra","year":"2019","journal-title":"J. Foot Ankle Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"24472","DOI":"10.1038\/s41598-021-04187-7","article-title":"Analysis of bone transport for ankle arthrodesis as a limb salvage procedure for the treatment of septic pilon fracture nonunion","volume":"11","author":"Rosteius","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1055\/s-0030-1250360","article-title":"Arthrodesis of the infected ankle joint: Results with the Ilizarov external fixator","volume":"149","author":"Gessmann","year":"2011","journal-title":"Z. Orthop. Unfall"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1302\/0301-620X.33B2.180","article-title":"Compression arthrodesis of the ankle and shoulder","volume":"33-B","author":"Charnley","year":"1951","journal-title":"J. Bone Jt. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jor.2019.08.004","article-title":"Ankle arthrodesis: A long term review of the literature","volume":"16","author":"Ferguson","year":"2019","journal-title":"J. Orthop."},{"key":"ref_6","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. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.2106\/00004623-199274070-00012","article-title":"Stability of an ankle arthrodesis fixed by cancellous-bone screws compared with that fixed by an external fixator. A biomechanical study","volume":"74","author":"Thordarson","year":"1992","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1053\/j.jfas.2014.06.002","article-title":"A biomechanical comparison of internal fixation techniques for ankle arthrodesis","volume":"54","author":"Clifford","year":"2015","journal-title":"J. Foot Ankle Surg."},{"key":"ref_9","unstructured":"Trans, R.H.H. (1967). Practice of Intramedullary Nailing, Charles C. Thomas."},{"key":"ref_10","first-page":"1","article-title":"Tibiotalocalcaneal arthrodesis nailing with IM rod","volume":"4","author":"Wichman","year":"1996","journal-title":"J. Orthop. Tech."},{"key":"ref_11","unstructured":"Bartlett, C.S., Hahn, J.C., Hall, J.S., and Duffy, R. (2015). Trauma Scheletrico: Scienza di Base, Gestione e Ricostruzione, Elsevier. (a cura di BD Browner, JB Jupiter, C. Krettek e PA Anderson) cap. 65."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2864","DOI":"10.1007\/s11999-012-2470-9","article-title":"Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion","volume":"470","author":"Fragomen","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/107110079401501102","article-title":"A review of ankle arthrodesis: Predisposing factors to nonunion","volume":"15","author":"Frey","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1007\/s00402-016-2520-y","article-title":"Arthrodesis for septic arthritis of the ankle: Risk factors and complications","volume":"136","author":"Suda","year":"2016","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1097\/00005373-199912000-00013","article-title":"Arthrodesis of the infected ankle and subtalar joint: Technique, indications, and results of 45 consecutive cases","volume":"47","author":"Richter","year":"1999","journal-title":"J. Trauma Inj. Infect. Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1053\/j.jfas.2010.10.011","article-title":"Arthrodesis with internal fixation of the infected ankle","volume":"50","author":"Klouche","year":"2011","journal-title":"J. Foot Ankle Surg."},{"key":"ref_17","first-page":"139","article-title":"Arthrodesis of the ankle joint in septic osteoarthritis: Six years long term outcomes in authors\u2019 personal experience","volume":"23","author":"Simoni","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"602","DOI":"10.5312\/wjo.v6.i8.602","article-title":"Complex ankle arthrodesis: Review of the literature","volume":"6","author":"Rabinovich","year":"2015","journal-title":"World J. Orthop."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1177\/107110079501600905","article-title":"Anatomic structures at risk: Combined subtalar and ankle arthrodesis with a retrograde intramedullary rod","volume":"16","author":"Pochatko","year":"1995","journal-title":"Foot Ankle Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1177\/107110079902000806","article-title":"Stress fractures and tibial cortical hypertrophy after tibiotalocalcaneal arthrodesis with an intramedullary nail","volume":"20","author":"Thordarson","year":"1999","journal-title":"Foot Ankle Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.fas.2007.01.005","article-title":"Suboptimal location of locking screw positioning in tibio-talo-calcaneal arthrodesis with an intramedullary device","volume":"13","author":"Young","year":"2007","journal-title":"Foot Ankle Surg."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/8\/3\/122\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:38:20Z","timestamp":1760128700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/8\/3\/122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,21]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["jfmk8030122"],"URL":"https:\/\/doi.org\/10.3390\/jfmk8030122","relation":{},"ISSN":["2411-5142"],"issn-type":[{"type":"electronic","value":"2411-5142"}],"subject":[],"published":{"date-parts":[[2023,8,21]]}}}