Volume 8, Issue 5, October 2020, Page: 166-170
Tibiotalocalcanean Fusion by Retrograde Sign Nail: An Amazing Solution for Old Ankle Fracture
Jibananda Halder, Department of Orthopaedic Surgery, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh
Md Zulfiqur Ali, Department of Orthopaedic Surgery, Shaheed Mansur Ali Medical College, Sirajganj, Bangladesh
Nahid Sultana, Department of Gynaecology & Obstetrics, Rajshahi Medical College Hospital, Rajshahi, Bangladesh
Received: Jun. 20, 2020;       Accepted: Jul. 13, 2020;       Published: Oct. 26, 2020
DOI: 10.11648/j.js.20200805.15      View  64      Downloads  19
Background: Old ankle fracture is the most challenging problem in whole over the world. Still it is an unsolved problem in many countries like Bangladesh. For ankle fracture so many under-privileged people in our country usually take traditional treatment in the village and suffer from severe pain during walking. Sometimes they want to commit suicide due to pain. Earlier the tibiotalocalcanean fusion was done by only steinman pin, then by conventional interlocki nail. But retrograde SIGN nail is the amazing solution to relief pain in old ankle fracture. Aim of the study: The aim of this study was to assess the outcomes of tibiotalocalcanean fusion (Arthrodesis) by retrograde SIGN nail. Methods: It was a prospective case series of patients with old ankle fractures treated with the SIGN nail conducted during the period from 2017 to 2019 at NITOR, Dhaka of Bangladesh. A total of 35 patients with old ankle fractures were operated using the SIGN nail among which 29 patients came for follow up at 6, 16 and 18, 48 weeks. So finally 29 patients were finalized as the study population. Result: As per AOFAS score in pre-operative stage, condition of all the participants were ‘poor’ but at post-operative stage AOFAS score was found ‘Excellent’ in 10.34% (n=3), ‘Good’ in 34.48% (n=10) ‘Fair’ in 20.69% (n=6) and ‘Poor’ in 23.48% (n=10) participants respectively. Besides this, according to the VAS score in the pre-operative stage 3.45% mild (n=1), 6.90% moderate (n=2), and 89.65% severe (n=26) cases patients. Besides this, in post-operative stage 48.24% mild (n=14), 44.83% moderate (n=13), and 6.90% severe (n=2) cases. Conclusion: This implant may be a good alternative in developing countries. The findings of this study may be helpful in further similar studies and in the treatment procedure.
Old Ankle Fracture, Retrograde SIGN Nailing, Tibiotalocalcanean Fusion, Arthrodesis
To cite this article
Jibananda Halder, Md Zulfiqur Ali, Nahid Sultana, Tibiotalocalcanean Fusion by Retrograde Sign Nail: An Amazing Solution for Old Ankle Fracture, Journal of Surgery. Vol. 8, No. 5, 2020, pp. 166-170. doi: 10.11648/j.js.20200805.15
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Bennett Budnar VM, Hepple S, Harries WG, Livingstone JA, Winson I. Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail. Foot Ankle Int, 2010, 31: 1085-1092.
Boer R, Mader K, Pennig D, Verheyen CC. Tibiotalocalcaneal arthrodesis using a reamed retrograde locking nail. Clin Orthop Relat Res, 2007, 463: 151-156.
Carrier DA, Harris CM. Ankle arthrodesis with vertical Steinmann’s pins in rheumatoid arthritis. Clin Orthop Relat Res, 1991, 268: 10-14.
Haaker R, Kohja EY, Wojciechowski M, Gruber G. Tibio-talo-calcaneal arthrodesis by a retrograde intramedullary nail. Ortop Traumatol Rehabil, 2010, 12: 245-249.
Bennett GL, Cameron B, Njus G, Saunders M, Kay DB (2005) Tibiotalocalcaneal arthrodesis: a biomechanical assessment of stability. Foot Ankle Int 26 (7): 530-536.
Jehan S, Shakeel M, Bing AJ, Hill SO (2011) The success of tibiotalocalcaneal arthrodesis with intramedullary nailing--a systematic review of the literature. Acta Orthop Belg 77 (5): 644-651.
Rockwood CA, Green DP, Bucholz RW. Rockwood and Green’s fractures in adults. 7th ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2010.
Donken CC, Al-Khateeb H, Verhofstad MH, van Laarhoven CJ. Surgical versus conservative interventions for treating ankle fractures in adults. Cochrane Database Syst Rev. 2012; 8: CD008470.
Wei SY, Okereke E, Winiarsky R, Lotke PA. Nonoperatively treated displaced bimalleolar and trimalleolar fractures: a 20- year follow-up. Foot Ankle Int. 1999; 20 (7): 404-407.
Hammett R, Hepple S, Forster B, Winson I. Tibiotalocalcaneal (hindfoot) arthrodesis by retrograde intramedullary nailing using a curved locking nail: the results of 52 procedures. Foot Ankle Int. 2005; 26: 810-815.
Anderson T, Linder L, Rydholm U, Montgomery F, Besjakov J, Carlsson A. Tibio-talocalcaneal arthrodesis as a primary procedure using a retrograde intramedullary nail: a retrospective study of 26 patients with rheumatoid arthritis. Acta Orthop. 2005; 76: 580-587.
Anderson T, Linder L, Rydholm U, Montgomery F, Besjakov J, Carlsson A. Tibio-talocalcaneal arthrodesis as a primary procedure using a retrograde arthritis. Acta Orthop, 2005, 76: 580-587.
Mears DC, Gordon RG, Kann SE, Kann JN. Ankle arthrodesis with an anterior tension plate. Clin Orthop Relat Res, 1991, 268: 70-77.
Thordarson DB, Chang D. Stress fractures and tibial cortical hypertrophy after tibiotalocalcaneal arthrodesis with an intramedullary nail. Foot Ankle Int, 1999, 20: 497-500.
Pickering RM. Campbell’s Operative Orthopedics. 11th ed., Vol. 1, Ch. 3: 163. Mosby Elsevier publishers; 2008.
Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis. Long-term follow-up with gait analysis. J Bone Joint Surg Am 1979; 61: 964-75.
Veselý R, Procházka V, Visna P, Valentová J, Savolt J. Tibiotalocalcaneal arthrodesis using a retrograde nail locked in the sagittal plane. Acta Chir Orthop Traumatol Cech 2008; 75: 129-33.
Moore TJ, Prince R, Pochatko D, Smith JW, Fleming S. Retrograde intramedullary nailing for ankle arthrodesis. Foot Ankle Int 1995; 16: 433-6.
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