Uploaded November 2025 | Updated September 2026, 2 weeks ago
In this full‑length surgical demonstration, we walk step‑by‑step through the DualCompression Hindfoot Fusion Nail System technique, showing how to safely approach tibiotalocalcaneal (TTC) fusion using static and dynamic compression technology.
Beginning with exposure of the ankle joint through the universal anterior incision, between tibialis anterior and extensor hallucis longus, the surgeon works within a safe zone free of major neurovascular structures. Once the transverse vein is encountered and cauterized, the joint is entered, osteophytes are removed, and soft tissue is cleared to improve visualization.
The ankle joint is then fully prepared. All cartilage from the talar neck through the posterior tibial surface is removed, optionally including medial and lateral gutters to increase ease of reduction. With the lamina spreader in place, the joint opens for better access to subchondral bone, which can be stimulated using a burr, drill holes, or an osteotome. After ankle prep, the surgeon verifies reduction, ensuring a 90° neutral position and proper talar apposition—even if 5–10% posterior cartilage remains, which is acceptable in neutral alignment.
Attention then shifts to thorough subtalar joint preparation, an essential step for tibiotalocalcaneal (TTC) fusion. An incision is made over the sinus tarsi, taking care to identify safe anatomical planes. The posterior facet is exposed, cartilage removed from calcaneal and talar sides, and preparation is extended into the middle and anterior facets. Adequate visualization allows confirmation of complete cartilage removal—often aided by seeing the flexor hallucis longus (FHL) excursion. Deformity correction (varus/valgus) can be performed via lateral or medial wedge removal as required. Once both joints are fully prepared, the ankle and hindfoot are reduced to neutral with ~5° hindfoot valgus.
A large plantar incision is created to support instrumentation. Fluoroscopy is now required. The guidewire is placed aiming toward the lateral process of the talus on the lateral view, and centered within the calcaneus on the axial view—the most critical part of achieving proper alignment. Once satisfied, reaming begins: starting with the initial reamer into calcaneus, followed by sequential reamers sized 9, 10, 11, and 12 mm. Laser depth marks (180, 210, 240 mm) ensure adequate tibial depth for the 210‑mm nail.
Bone grafting is performed before nail insertion using ArthroCell™ delivered into both ankle and subtalar joints to fill voids and stimulate fusion. Radiopaque tips assist in fluoroscopic confirmation. The nail’s nitinol cable assembly is tightened prior to insertion to ensure proper dynamic compression function. The guidewire is removed, and the nail is inserted retrograde under fluoroscopy to a depth just beneath the calcaneal cortex.
Screw fixation follows:
Posterior calcaneal screw (slot #1)
Medial tibial screw (#2 position)
Optional talar screw
Lengths are selected using depth gauges and adjusted for guide clearance. Static compression (≈900 N) is applied through the cable system, visibly opening the calcaneal–talar interface, followed by dynamic compression via the nitinol component. The second calcaneal screw locks into the nitinol system to maintain ongoing compression throughout healing.
After removing the cable, the construct is complete. Post‑op protocol includes splinting for two weeks, heel‑touch weight‑bearing, and full weight‑bearing by six weeks. This video provides a comprehensive, reproducible, and high‑yield approach for mastering the full TTC fusion workflow with the DualCompression Hindfoot Fusion Nail.
👇 Helpful Arthrex Reference Links:
arthrex.info/4o9XaGL
Nitinol Compression Technology Overview: arthrex.com/foot-ankle/fusion
👍 Like, subscribe, and comment if you’d like to see more patient success stories and innovations in minimally invasive orthopedic procedures.
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: / linkedin.com/company/arthrex
Facebook: / facebook.com/Arthrex
Instagram: / instagram.com/arthrexmeded
X: https://x.com/arthrex
In this full‑length surgical demonstration, we walk step‑by‑step through the DualCompression Hindfoot Fusion Nail System technique, showing how to safely approach tibiotalocalcaneal (TTC) fusion using static and dynamic compression technology.
Beginning with exposure of the ankle joint through the universal anterior incision, between tibialis anterior and extensor hallucis longus, the surgeon works within a safe zone free of major neurovascular structures. Once the transverse vein is encountered and cauterized, the joint is entered, osteophytes are removed, and soft tissue is cleared to improve visualization.
The ankle joint is then fully prepared. All cartilage from the talar neck through the posterior tibial surface is removed, optionally including medial and lateral gutters to increase ease of reduction. With the lamina spreader in place, the joint opens for better access to subchondral bone, which can be stimulated using a burr, drill holes, or an osteotome. After ankle prep, the surgeon verifies reduction, ensuring a 90° neutral position and proper talar apposition—even if 5–10% posterior cartilage remains, which is acceptable in neutral alignment.
Attention then shifts to thorough subtalar joint preparation, an essential step for tibiotalocalcaneal (TTC) fusion. An incision is made over the sinus tarsi, taking care to identify safe anatomical planes. The posterior facet is exposed, cartilage removed from calcaneal and talar sides, and preparation is extended into the middle and anterior facets. Adequate visualization allows confirmation of complete cartilage removal—often aided by seeing the flexor hallucis longus (FHL) excursion. Deformity correction (varus/valgus) can be performed via lateral or medial wedge removal as required. Once both joints are fully prepared, the ankle and hindfoot are reduced to neutral with ~5° hindfoot valgus.
A large plantar incision is created to support instrumentation. Fluoroscopy is now required. The guidewire is placed aiming toward the lateral process of the talus on the lateral view, and centered within the calcaneus on the axial view—the most critical part of achieving proper alignment. Once satisfied, reaming begins: starting with the initial reamer into calcaneus, followed by sequential reamers sized 9, 10, 11, and 12 mm. Laser depth marks (180, 210, 240 mm) ensure adequate tibial depth for the 210‑mm nail.
Bone grafting is performed before nail insertion using ArthroCell™ delivered into both ankle and subtalar joints to fill voids and stimulate fusion. Radiopaque tips assist in fluoroscopic confirmation. The nail’s nitinol cable assembly is tightened prior to insertion to ensure proper dynamic compression function. The guidewire is removed, and the nail is inserted retrograde under fluoroscopy to a depth just beneath the calcaneal cortex.
Screw fixation follows:
Posterior calcaneal screw (slot #1)
Medial tibial screw (#2 position)
Optional talar screw
Lengths are selected using depth gauges and adjusted for guide clearance. Static compression (≈900 N) is applied through the cable system, visibly opening the calcaneal–talar interface, followed by dynamic compression via the nitinol component. The second calcaneal screw locks into the nitinol system to maintain ongoing compression throughout healing.
After removing the cable, the construct is complete. Post‑op protocol includes splinting for two weeks, heel‑touch weight‑bearing, and full weight‑bearing by six weeks. This video provides a comprehensive, reproducible, and high‑yield approach for mastering the full TTC fusion workflow with the DualCompression Hindfoot Fusion Nail.
👇 Helpful Arthrex Reference Links:
arthrex.info/4o9XaGL
Nitinol Compression Technology Overview: arthrex.com/foot-ankle/fusion
👍 Like, subscribe, and comment if you’d like to see more patient success stories and innovations in minimally invasive orthopedic procedures.
Arthrex is a global leader in orthopedic surgical innovation, dedicated to advancing minimally invasive techniques and medical education. Our mission is to help surgeons treat their patients better by providing cutting-edge products, expert training, and comprehensive resources for orthopedic procedures, including sports medicine, joint preservation, and trauma care.
Stay Connected: 👍 Subscribe to our channel for the latest in orthopedic surgical techniques and product updates.
📱 Follow Arthrex on:
LinkedIn: / linkedin.com/company/arthrex
Facebook: / facebook.com/Arthrex
Instagram: / instagram.com/arthrexmeded
X: https://x.com/arthrex
