Abstract: An intermedullary nail for targeted arthrodesis of the tibiotalar joint. The intramedullary nail may be advanced through a bore extending through the calcaneus, talus, and into the tibia. In an example, a distal end portion of the intramedullary nail is disposed proximal to the subtalar joint. It has been recognized that creation of a bore for introduction of the intramedullary nail does not significantly disrupt the articular surface area of the subtalar joint. Furthermore, locking fasteners used to secure the intramedullary nail may introduced laterally and/or anteriorly to facilitate benefits in relation to patient placement and manipulation during an operation. Furthermore, arthrodesis may be extended to adjacent anatomy through use of extension plates at least partially secured by locking fasteners also engaging the intramedullary nail.