Arthrodesis with retrograde compression nail in Charcot neuroarthropathy of the hindfoot

Background: Charcot neuroarthropathy of the hindfoot frequently progresses to severe deformity and instability, often necessitating amputation when conservative measures fail. While various fixation methods exist, achieving stable arthrodesis remains challenging due to poor bone quality and the high metabolic demands of prosthetic ambulation compared to successful limb salvage.

Objective: This article describes a standardized surgical technique for retrograde tibiotalocalcaneal (TTC) intramedullary compression nailing as a salvage procedure for advanced Charcot neuroarthropathy.

Key Points: The procedure utilizes a lateral transfibular approach, where the distal fibula is longitudinally split to serve as both an autologous bone graft and a lateral stabilization plate. Essential technical steps include meticulous articular surface debridement, subchondral drilling, and precise guidewire placement to dictate nail trajectory. The system employs internal compression mechanisms and interlocking screws to stabilize the ankle and subtalar joints. Clinical data from a 19-patient series demonstrated a 84% limb salvage rate, although complications such as infection, non-union, and stress reactions occurred. Success requires preoperative optimization of glycemic control (HbA1c < 7.5%) and vascular status.

Conclusion: Retrograde TTC compression nailing is an effective salvage intervention for reconstructable Charcot hindfoot deformities. By providing rigid internal fixation and facilitating compression, this technique supports bony union and functional weightbearing, offering a viable alternative to below-knee amputation in complex neuropathic cases.