Staged Hindfoot Fusion: A 2-Staged Technique Guide for Post-traumatic Nonunion and Osteomyelitis of the Distal Tibia and Talus

This technique guide outlines a 2-staged approach for the management of failed ankle and hindfoot osteosynthesis in the presence of post-traumatic osteomyelitis and structural instability. The method of creating an antibiotic-embedded cement-coated rod is outlined, as is the interval exchange of the rod for a definitive structural interlocking hindfoot nail. This approach aims to promote tibiotalocalcaneal fusion, the eradication of infection, and the restoration of function, which without intervention can lead to significant morbidity, including pain, deformity, and possible amputation. The use of polymethylmethacrylate (PMMA) for the delivery of intramedullary antibiotics has gained popularity in recent decades, and as such, this technique guide describes our method for its use at a metropolitan level 1 trauma center. Level of Evidence: Level IV.