Clinical Outcomes Following Tibiotalocalcaneal Arthrodesis with Intramedullary Nailing Combined with Partial Fibulectomy and Onlay Bone Graft

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Although intramedullary nailing is a popular method for tibiotalocalcaneal (TTC) arthrodesis, nonunion is one of the most commonly reported complications. The purpose of this study was to evaluate the fusion rate, improvement in functional outcomes, and occurrence of complications in TTC arthrodesis using retrograde intramedullary nailing with partial fibulectomy and onlay bone graft technique. Methods: We retrospectively reviewed 26 consecutive patients who underwent TTC arthrodesis using the proposed technique. For radiographic outcomes, the union rate, alignment, and any related complications were assessed. Functional outcomes were evaluated using the American Orthopedic Foot and Ankle Society hindfoot scale, Foot and Ankle Outcome Score, and visual analog scale, preoperatively and at the final follow-up. Results: The mean follow-up period was 38.2 months. For the tibiotalar joint, the union rate was 80.8% six months postoperatively, while all the cases achieved complete bony union at twelve months postoperatively and at the final follow-up. However, for the subtalar joint, the union rate was 26.9% at six months postoperatively, which gradually increased to 73.1% at 12 months postoperatively, and 80.8% at the final follow-up without revision surgery. A subgroup analysis showed there was a trend of higher subtalar fusion rate when an additional screw for the subtalar joint fixation was placed (86.7% vs. 54.5%). The functional outcomes significantly improved at the final follow-up. A few minor complications occurred, including surgical site infection, irritational symptoms, and metal failure; however, these eventually resolved. Conclusion: Our technique of TTC arthrodesis with partial fibulectomy and onlay bone grafting demonstrated reliable radiographic and satisfactory functional outcomes including patients with previous failed hindfoot surgery. In addition, it is considered safe, as minimal complications occur postoperatively. We believe that our method of TTC arthrodesis provides a good option where both the tibiotalar and subtalar joints need to be fused.