Tibiocalcaneal Marchetti-Vicenzi nailing in revision arthrodesis for posttraumatic pseudarthrosis of the ankle.

The authors conducted a retrospective study of 7 patients treated with tibiotalocalcaneal Marchetti-Vicenzi nailing (one anterograde and six retrograde nails). All these patients had developed pseudarthrosis after previous arthrodesis for posttraumatic ankle fractures. The results were evaluated clinically and radiographically at a median time of four years. Fusion occurred in three patients, in one of them only after removal of the proximal locking screw. Of the remaining four patients, one achieved consolidation after replacement of the Marchetti-Vicenzi nail by another intramedullary nail, two were lost to follow-up after replacement by external or internal fixation, and the last patient developed pseudarthrosis again. At least nine additional interventions were necessary in six patients, including one amputation for intractable pain and severe soft-tissue damage due to the trauma. None of the patients had excellent or good results. The majority was unsatisfied with this type of intramedullary nailing. Therefore our study was terminated prematurely. Revision ankle fusion for nonunion or malunion after external or internal fixation has a high complication rate. Further study is mandatory to prevent or resolve remaining problems.

Closed intramedullary tibial nailing using the Marchetti-Vicenzi nail.

We present the results of using the Marchetti-Vicenzi nail in the management of 41 closed and 16 type I-III open tibial fractures in 56 patients. The treatment goals were to achieve stability and fracture alignment allowing early functional treatment of the knee and ankle by immediate partial or full weight-bearing. Early callus formation and rapid mobilisation were obtained in 84% of the patients. The mean time to clinical union was 9.8 weeks (radiological union 28.4 weeks) for closed fractures and also 9.8 weeks for open fractures (radiological union 28.7 weeks). No late rotational deformities were observed. We argue that intramedullary nailing with a Marchetti-Vicenzi nail is a quick and excellent method of treating selected closed and open tibial fractures.