Talar Avascular Necrosis Treatment With Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nailing With Fibular and Tibial Bone Graft: A Case Report

Introduction Avascular necrosis (AVN) of the talus can lead to progressive bone destruction and collapse of ankle and subtalar joints (1). In advanced stages, significant bone defects develop, limiting treatment options and requiring surgical intervention, such as arthrodesis with augmental bone grafting (2). Case Presentation A 59 year old male with no history of trauma, presented with right ankle edema, deformity and pain that worsens with exertion and has been progressively increasing over the past 4 months. X - ray and MRI of the right ankle revealed fragmentation and structural abnormalities of neck and body of the talus, tibiotalar and talocalcaneal joints, consistent with avascular necrosis of the talus. The surgical treatment of choice was tibiotalocalcaneal arthrodesis using retrograde intramedullary nailing with four-part fibular cortical bone graft and additional tibial bone graft to promote bony fusion and maintain adequate limb length with long-term joint stability. Additionally, immobilisation with an orthopaedic splint and non-weight bearing was applied for 12 weeks. Three months post-operation, the patient reports painless movement. Further rehabilitation and follow-up consultations are scheduled. Discussion AVN of the talus can occur without any prior traumatic event, therefore early recognition of potential underlying risk factors, such as alcohol and corticosteroid use, as well as autoimmune, metabolic and vascular diseases, can be helpful (3,4). The first step in diagnosis involves X - ray imaging to detect structural abnormalities. MRI provides a more detailed evaluation, enables earlier interventions and expands the spectrum of potential treatment options (2). Due to the advanced stage of AVN observed in this case, a tibiotalocalcaneal arthrodesis using four piece fibular bone graft was performed as the appropriate surgical intervention to preserve proper and functional limb length. Conclusions Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing and augmental cortical fibular bone grafting as a joint-sacrificing surgical treatment can lead to significant pain relief when bone structures and joints are dysfunctional in AVN of talus.