Outcomes of Tibiotalocalcaneal Nailing in Ankle Arthrodesis: A Prospective Clinical Study

Abstract

Background: The ankle and hindfoot arthritis, complex deformities, and failed ankle surgeries require arthrodesis for pain relief and to regain a good functional outcome. Tibiotalocalcaneal (TTC) arthrodesis using intramedullary nailing gives a stable, load-sharing construct that allows early mobilization and fusion, particularly in cases with poor bone stock or compromised soft tissue. Methods: This prospective study was conducted between January 2022 and April 2024 on five patients (three males, two females; mean age 52.4 years) with advanced ankle or hindfoot pathology. All patients undergo TTC arthrodesis using retrograde intramedullary nailing. Clinical and radiological assessments were performed using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and fusion grading on sequential radiographs at 6, 12, and 18 months. Results: All five patients achieved good radiological fusion with significant postoperative improvement in AOFAS scores from 38.2 preoperatively to postoperative 81 at 6 and 12 months ( P < 0.05). Mean time of union was 15.4 weeks. Complications included one superficial wound infection and one case of screw back-out, but both were managed conservatively. Conclusion: TTC nailing is an effective and reliable method for ankle and hindfoot arthrodesis, providing high fusion rates, stable fixation, and functional improvement, especially in cases with poor bone quality or failed previous surgeries.

Key Points