Vol. 7, Issue 2, Part B (2025)

Introduction: Post-traumatic arthritis following complex ankle fractures is a well-recognized complication that can result in significant functional impairment and chronic pain. Open trimalleolar fractures with severe soft tissue injury pose unique challenges in management, often requiring staged treatment protocols. This case report describes the successful management of post-traumatic ankle and subtalar arthritis following an open trimalleolar fracture using tibiotalocalcaneal (TTC) arthrodesis with a retrograde intramedullary nail

Case Report: A 59-year-old male sustained a high-energy open trimalleolar ankle fracture that was initially managed with delta frame external fixation and supplementary K-wire fixation. Five months post-injury, the patient developed severe deformity with posterior subluxation of the ankle joint, equinus positioning, and disabling pain due to advanced ankle and subtalar arthritis with major cartilage loss. Following comprehensive evaluation, the patient underwent TTC arthrodesis through a lateral approach using a retrograde tibiotalar nail with bone grafting. At one year follow-up, the patient achieved complete union with a stable, pain-free joint and full weight-bearing capacity.

Discussion: Post-traumatic arthritis represents a significant complication following severe ankle fractures, with reported incidence rates ranging from 20-40%. TTC arthrodesis with retrograde intramedullary nailing provides a reliable salvage option for patients with combined ankle and subtalar arthritis, offering high fusion rates and satisfactory functional outcomes. This case demonstrates the effectiveness of staged management protocols and definitive fusion surgery in restoring function and alleviating pain in severe post-traumatic hindfoot arthritis.

Conclusion: TTC arthrodesis using retrograde intramedullary nail fixation represents an effective surgical option for managing severe post-traumatic ankle and subtalar arthritis following complex fractures. Appropriate patient selection, meticulous surgical technique, and structured rehabilitation can yield excellent clinical outcomes with reliable pain relief and functional restoration.