LAUSR

OBJECTIVES To report the outcomes of staged tibiotalocalcaneal (TTC) arthrodesis for the critical-sized bone defect involving the ankle joint. DESIGN Retrospective review of case series. SETTING Two academic level I trauma centers.Patients/Participants: 20 patients with critical-sized (≥2 cm) segmental bone defect around the ankle joint. INTERVENTION Staged TTC arthrodesis was performed with induced membrane technique (IMT) and retrograde intramedullary nail. MAIN OUTCOME MEASUREMENTS We investigated the radiological evaluation, including modified radiographic union scale for tibia fractures (mRUST) score, time to union, and leg length discrepancy (LLD), as well as functional outcomes using Foot and Ankle Outcome Score (FAOS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS The average bone defect was 6.4 cm (range: 2.4-12.3). Out of the 20 patients, two patients (10%) developed recurrence of infection. Fifteen patients (75%) achieved primary healing. Three patients (15%) were treated with repeated bone grafting and additional plating. The average time to union and LLD were 10 months (range: 5-21) and 9 mm (range: 0-31), respectively. The mean FAOS and AOFAS ankle-hindfoot score were 63 (range: 52-71) and 74 (range: 64-81), respectively. CONCLUSIONS Staged TTC arthrodesis with IMT and intramedullary nail can be an effective treatment method for critical-sized bone defect involving the ankle joint. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.