Neglected fracture talus, talar avascular necrosis after fixation and severe inflammation ankle arthritis, may progresses to end-stage ankle arthrosis, often in tibiotalar joint and subtalar joint osteoarthritis accompanied by varus or valgus plantar flexion deformity. Patients presented with persistent foot pain, dysfunction, affected normal work and daily life activity. The goal of surgical intervention is stable fixation, pain-free fusion, correction of deformity and improve the function. Kim et al. reported that total ankle replacement combined with subtalar arthrodesis preserve hindfoot function, good clinical outcome in short tearm follow-up [
1], however, there was limitation due to strict surgical indications and high demanding of surgical skills, especially patients associated with hindfoot deformity and need to observe long-term result. Tibiotalocalcaneal arthrodesis was most common surgical treatment for hindfoot pathology, its curative effect and reliable method with good result [
2]. Until now method of fixation still controversia [
3‐
6], the most widely used internal fixation for ankle arthrodesis is crossed lag screw, retrograde intramedullary nail and the blade plate [
7‐
9]. Crossed lag screw fixation, biomechanic axial compression force and less soft tissue demage, but in patients with osteoporotic bone, lack of stability, risk of implant loosening, low fusion rate, difficulty correct varus and valgus deformity. Retrograde intramedullary nailing has biomechanical advantage, but the higher technical demanding, the insertion point must be accurate, even in the operation to calcaneal shift, or sometime cortical bone blocking can occur and tibiotalar joint displacement cause malalignment [
10]. Literature reported that ankle arthrodesis with Blade plate satisfactory curative effect, even in osteoporosis patients also have a high fusion rate [
11]. Complications seen with blade plate fixation include breakage of the plate and deep infection, which may require IV antibiotics and removal of the hardware. Disadvantages of the technique are related to prominence of the plate when it is placed anteriorly or laterally, which can lead to local irritation and need for subsequent removal of the plate.
Ahmad et al. are first reported applied locking plate for tibiotalocalcaneal arthrodesis, biomechanical stability, rigidity and good fusion rate with excellent result [
12,
13], some patients non-union, due to eccentric force of the plate may be hidden [
14]. We performed reverse PHILOS locking plate with medial cannulated screw for TTC arthrodesis, for medial lag screw can compress medial column gap and able to achieve compression lateral column at the same time, to increase the fusion rate together with lateral locking plate especially for some cases with high risk of non-union including osteoporosis and obvious deformity.