Locking plate versus retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis

Abstract

Background:Tibiotalocalcaneal arthrodesis (TTCA) surgery is indicated for the end-stage disease of the tibiotalar and subtalar joints. Although different fixation technique of TTCA has been proposed to achieve high fusion rate and low complication rate, there is still no consensus upon this point. The purpose of this study is to compare the clinical efficacy of retrograde intramedullary nail fixation (RINF) and locking plate fixation (LPF) for TTCA.Materials and Methods:Fifty four patients who underwent TTCA through the lateral approach with lateral fibular osteotomy using RINF (32 patients, 18 male/14 female, mean age: 48) or LPF (22 patients, 12 male/10 female, mean age: 51) between January 2007 and January 2010 were retrospectively analyzed. Demographic and clinical characteristics, surgery (operation time, blood loss) outcomes (postoperative fusion rates, visual analog scale and foot and ankle surgery score and complications) were compared.Results:The LPF group had a shorter operation time (72.3 ± 9.2 vs. 102.8 ± 11.1 min, P < 0.001), less blood loss (75.9 ± 20.2 vs. 140.0 ± 23.8 ml, P < 0.001) and less intraoperative fluoroscopy sessions (3.6 ± 0.9 vs. 8.4 ± 1.3, P < 0.001) than the RINF group. Patients were followed up for 12–24 months (mean of 16.2 months). Both groups had similar postoperative fusion rates (90.6% and 95.4%) and the LPF group showed a nonsignificant lower complication rate (18.2% vs. 28.1% respectively). Patients at higher risk on nonunion due to rheumatoid diseases may have a lower nonunion rate with LPF than RINF (one out of eight vs. three out of nine, P < 0.001).Conclusions:The LPF for TTCA was simpler to perform compared with RINF, but with similar postoperative outcomes and complication rates.

Tibiotalar and Tibiotalocalcaneal Arthrodesis with Paragon28 SilverbackTM Plating System in Patients with Severe Ankle and Hindfoot Deformity

“…Our bone union rate of 100% is consistent with outcomes reported in a recent systematic review by Van de Heuvel et al (99%) [ 17 ]. The bone union time also does not differ greatly from the literature: 14 weeks on average in our study and other recent studies [ 6 , 16 , 17 , 48 ], slightly shorter than the 18 reported by Zhang et al [ 4 ].…”

“…Currently, similar bone union rates in TT arthrodesis with different fixation devices are reported in the literature; although, some studies report better results with plate fixation than with screw fixation alone [ 21 ] or with a retrograde nail [ 4 ].…”

“…Ankle OA has remained as the main indication for TT arthrodesis or fusion since its first description in 1882 [ 3 ], especially in the end stages which can alter physiological gait leading to the development of subtalar (ST) joint degeneration with OA. When both joints (TT and ST) are severely affected, the surgical indication often shifts to tibio–talo–calcaneal (TTC) arthrodesis [ 4 ]. In addition to primary OA, other causes described in the literature may lead to TT or TTC arthrodesis surgery including post-traumatic OA [ 5 ], failures after total ankle replacement (TAR) [ 6 ], Charcot neuroarthropathy of the ankle [ 7 ], avascular necrosis (AVN) of the talus [ 8 ], inflammatory arthropathy [ 9 ] and bone loss due to bone tumors [ 10 ], or septic arthritis [ 11 , 12 ].…”

“…To prepare the joint surfaces for TT or TTC arthrodesis, both open and arthroscopic approaches can be used. Open approaches have been described as anterior, lateral, or posterior [ 4 , 15 , 16 , 17 ], while the arthroscopic approach is based on two portals (antero-medial and antero-lateral or postero-medial and postero-lateral) [ 18 , 19 ]. A wide variety of fixation devices such as cannulated screws [ 20 , 21 , 22 ], plates and screws [ 4 , 23 , 24 ], retrograde intramedullary nails [ 8 , 19 , 25 ], and external fixators [ 26 , 27 , 28 ] have been used amongst the various approaches.…”

Transfbular ankle arthrodesis: A novel method for ankle fusion — A short term retrospective study

“…may be indicated. 25 We do not have experience with this procedure, and it was not indicated in any of our patients as the fibula was used as a lateral stabilizing biological plate.…”