The TTC Fusion Surgical Procedure Using the VersaNail® System

The decision to proceed with tibiotalocalcaneal (TTC) fusion surgery with the VersaNail^® System should be made jointly by you and your doctor only after you feel that you understand as much about the procedure as possible. If the decision to proceed with surgery is made, there are several things that may need to be done.

Your surgeon will reexamine your foot and ankle and your clinical test results, including X-rays.

Your surgeon may suggest a complete physical examination by your medical or family doctor.
You may also see a physical therapist.

An assessment will be made of any needs you will have at home after you are released from the hospital.

The Day of Your TTC Fusion Surgery

On the day of surgery, you will probably be admitted to the hospital in the morning. For TTC ankle fusion, you will be placed under general anesthesia, or a spinal type anesthetic. The procedure begins by accessing the diseased ankle and preparing it for the implant.

Preparing and Aligning the Joint Surfaces

The surgeon will first access your ankle through two incisions on the front of your ankle, just above the foot. Both incisions are up and down, or vertical. These two incisions allow your surgeon to access the ankle and foot joints.

Debridement follows, which is the cleaning and preparing of the joint surfaces for the implant by surgically removing unwanted or diseased tissue. The surgeon reshapes the fibula bone, which is on the outside (small-toe side) of the ankle. He/she may secure material for possible use in bone grafts later in the procedure. The surgeon also contours the ankle joint for optimum alignment. The ability to achieve optimum alignment using the VersaNail system is an important part of the operation.

After the joints have been prepared, a third incision is made. This one is in the bottom of the foot just in front of the heel. The exact positioning varies based on the unique anatomy of each patient’s foot. This incision becomes the entry point for the VersaNail implant. The doctor surgically creates an opening in the patient’s foot and ankle bones through which the implant will be inserted and affixed with locking screws.

Inserting the VersaNail System Implant

With the ankle prepared and aligned properly and an opening cleared for the implant, the surgeon now selects the optimum size VersaNail implant. Sophisticated equipment is used to help the surgeon select the best size and determine just how the implant should be oriented. This decision will affect the orientation of the screws as well.

The surgeon inserts the implant into the opening in the bottom of the foot. The implant connects and secures the foot, ankle and lower shin. The precise orientation of the implant and the alignment of the screws varies from patient to patient. The ability to adapt to each patient’s anatomy is a key advantage of VersaNail, because the system gives surgeons flexibility in this crucial stage of the operation. At this point, surgeons may add bone grafts to strengthen areas of the bone and joint involved in the procedure.

Locking the Implant

Five specialized surgical screws help affix the implant in place.

Three screws are used in the lower portion of foot and ankle. The versatility of the system allows for flexibility in screw placement, which varies based on exactly where the implant was centered in the previous step.
Two additional screws then are inserted near the top of the implant.  

Because pressure is essential for the bones to fuse, compression is important in any ankle fusion procedure. The VersaNail System offers multiple options for your surgeon to gain compression. In addition, its design and surgical instrumentation let your surgeon make subtle, but important, adjustments in the positioning of the implant within the foot and ankle. The surgeon can also choose different options in the way the screws are oriented within the anatomy. Because every patient and every surgery is unique, the ability to make these subtle adjustments is important.

Final assessment

At this point the surgeon examines the patient for proper implant alignment and screw placement. A special cap is placed on the bottom end of the implant. Incisions are then closed.

After surgery

Your doctor will provide detailed instructions to let you know what to expect after surgery. Typically, a short leg cast will be applied during your first return visit after surgery. You’ll be advised to keep your weight off the ankle for about six weeks. Then, X-rays may be used to examine the success of the fusion process – the degree to which the bones of the ankle joint and the implant begin to fuse together as a result of the surgery. A cast may be applied for an additional four to six weeks or until the fusion is complete. Once healed, the patient is typically instructed to wear a solid-ankle, cushioned-heel shoe with a rocker-sole attachment.

The TTC fusion procedure is not for every patient, and only a surgeon trained in foot and ankle surgery can determine the right method for a given patient. As with any surgery there are risks, and results will vary from patient to patient.

Note

Only surgeons trained in foot and ankle surgery can provide advice about whether TTC Fusion and the VersaNail System are right for you. See your physician to learn more.

Individual results with any medical treatment may vary from the outcomes mentioned in this article. Please consult with your physician about the advisability of any medical treatment that you are considering.

Warnings and Precautions

Device cannot be expected to withstand the unsupported stresses of full weight bearing immediately after surgery. External support and restricted physical activities should be employed until firm bone union is achieved. Proper implant selection should be made for size and shape limitations. Implants should not be bent, notched or scratched during implantation and handling. If other metallic devices are used, they should be manufactured from a similar metal to avoid galvanic corrosion. NO METALLIC IMPLANT SHOULD BE REUSED. Patient should receive detailed instructions on the use and limitations of the device. Since intramedullary nails are not designed as long-term, weight bearing implants they should be removed after fusion occurs whenever possible.

Adverse Effects

The following are the most frequent adverse effects involving the use of intramedullary nails:

Loosening, bending, cracking or fracture of the nail or loss of fixation due to nonunion or osteoporosis; loss of anatomic position with nonunion or malunion with rotation or angulation; infection; allergies and other reaction to the device material.

Last Updated: 09/03/2008