Summary:Primary as well as revision arthrodesis procedures of the ankle are associated with a high rate of complications including nonunion, malunion, infection, wound healing problems, damage to nerves and blood vessels, and gait disturbance secondary to malposition, all of which have prompted the development of various techniques to avoid or minimize said complications. In addition to those dilemmas are other complex scenarios such as failed total ankle arthroplasty and paralytic or neuropathic deformities which can render a plethora of problems for the treating physician to deal with, including maintenance of length and alignment, and problems with prior incisions or soft tissue damage with a potential for delays in wound healing or complications with bony union