Tibiotalocalcaneal Arthrodesis with Intramedullary Nails – Mechanobiological Background and Evolution of Compressive Technology

Tibiotalocalcaneal arthrodesis is a surgical procedure which involves fusion of the tibiotalar and subtalar joints to reduce patient pain, increase stability, and improve function. The success of this procedure largely depends upon the stability and apposition of the bone surfaces being fused. Intramedullary nails have long been used as a method of internal fixation during the tibiotalocalcaneal arthrodesis process to reduce micromotion and provide stability and compression across the joints. This review focuses on the mechanobiological processes and foundations of arthrodesis, along with the evolution of intramedullary nails used during arthrodesis. This evolution includes both material selection and, in particular, the ability of nails to provide compression across the fusing joints. This compressive evolution includes external compression, internal compression, and finally sustained internal compression as provided by the intramedullary nails.

Keywords: Bone Mechanobiology; Internal Fixation; Joint Fusion; NiTiNOL; Sustained Compression; Tibiotalocalcaneal Arthrodesis; Union

Abbreviations: CAD: Computer-Aided Design; CT: Computed Tomography, IM: Intramedullary mm: Millimeter; N: Newton; NiTiNOL: Nickel Titanium Naval Ordnance Laboratory; SCN: Sustained Compression Nail; TTCA: Tibiotalocalcaneal Arthrodesis; μ: Micro