Comparison of different fibula procedures in tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a mid-term retrospective study

Abstract

Abstract Background: Tibiotalocalcaneal (TTC) arthrodesis with a retrograde intramedullary nail for severe tibiotalar and talocalcaneal arthritis shows a high fusion rate, but no studies focused on how to handle the fibula intraoperatively could achieve better results. The study aims to compare the effects of different fibular procedures. Methods: We performed a retrospective review of severe tibiotalar and talocalcaneal arthritis in adults treated with TTC arthrodesis by retrograde intramedullary nail between January 2012 and July 2017, totally 58 patients were enrolled in the final analysis with an average age of 53.2 (range 32 to 69) years old, and they were divided into 3 groups according to different fibular procedures: fibular osteotomy (FO, n=21), fibular strut (FS, n=19) and fibular preserving (FP, n=18). Functional outcome and pain were assessed using the American Orthopedic Foot and Ankle Society ankle and hindfoot score (AOFAS) and visual analogue scales (VAS). Operation time, fusion time, radiographic evaluation and complications were also recorded. Results: The mean postoperative follow-up was 66.0 (range 60 to 78) months. All groups showed a high fusion rate (90.5% for FO, 94.7% for FS, and 94.4% for FP), significant improvement in AOFAS ankle and hindfoot score and VAS score at the latest follow-up. There were no significant differences among the 3 groups for these parameters. The mean operation time of FS (131.3±17.1min) was longer than that of FO (119.3±11.7min) and FS (112.2±12.6min) but the fusion time was shorter (15.1±2.8 weeks for FS, 17.2±1.9 weeks for FO and 16.8±1.9 weeks for FP ). These parameters showed great statistical differences. Conclusion: Tibiotalocalcaneal arthrodesis by retrograde intramedullary nail is an effective procedure to treat severe tibiotalar and talocalcaneal arthritis in adults, fibular strut can shorten fusion time when compared with fibular osteotomy and fibular preserving.