Management of distal tibial nonunion with tibiotalocalcaneal arthrodesis using tarsus nail: a retrospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261080Keywords:
Distal tibial nonunion, Tibiotalocalcaneal arthrodesis, Tarsus nailAbstract
Background: Distal tibial nonunion presents a significant challenge due to poor vascularity, limited soft tissue coverage, and mechanical instability. Conventional fixation methods often fail in complex cases, particularly when accompanied by bone loss, deformity, or infection. Tibiotalocalcaneal (TTC) arthrodesis using a tarsus nail has emerged as an effective strategy, providing stable fixation and supporting limb preservation. This study aims to evaluate the clinical and radiological outcomes of managing distal tibial nonunion with TTC arthrodesis using a tarsus nail.
Methods: This retrospective study included 40 patients with distal tibial nonunion who underwent TTC arthrodesis using a tarsus nail at a speciality hospital between 2024 and 2025. Functional outcomes were evaluated using standardized scoring systems, including the American Orthopaedic Foot and Ankle Society (AOFAS) score, pain intensity was analyzed by VAS and complications were recorded at one-year follow-up. Radiographic assessments were performed at regular intervals to evaluate bone union and alignment.
Results: A total of 40 patients (26 males, 14 females) with a mean age of 52.3±11.6 years were included. At one-year follow-up, radiographic union was achieved in all the patients, with satisfactory alignment in all cases. The mean AOFAS score improved significantly from 38.5±7.2 preoperatively to 78.9±6.8 postoperatively. Pain levels, as measured by the VAS, decreased from a preoperative mean of 7.2±1.1 to 2.1±0.9. No Complications were reported; no cases of implant failure were reported.
Conclusions: TTC arthrodesis using a tarsus nail is an effective and reliable procedure for distal tibial nonunion, providing high rates of bone union, significant improvement in functional outcomes, while maintaining limb alignment and stability.
References
Buhr AJ, Cooke AM. Fracture patterns. Lancet. 1959;1(7072):531-6.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691-7.
Sahlin Y. Occurrence of fractures in a defined population; a 1-year study. Injury. 1990;21:158-60.
Massimiliano M, Silvio C. Tibiotalocalcaneal arthrodesis through retrograde nailing for the treatment of juxtaarticular distal tibia aseptic non-unions: A retrospective study at a minimum follow-up of 4 years. Injury. 2020;51:1377-81.
Richmond J, Colleran K, Borens O, Kloen P, Helfet DL. Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma. 2004;18(9):603-10.
Meani E, Romanò C, Crosby L, Hofmann G. Infection and local treatment in orthopedic surgery. Springer. 2007
Tan YY, Mithun N, James RO, Benjamin AH, Sina B, Wei HT, et al. Tibio-talar-calcaneal nail fixation for ankle fractures: a systematic review and meta-analysis. J Foot Ankle Surg. 2022;61(6):1325-33.
Thomas RL, Sathe V, Habib SI. The use of intramedullary nails in tibiotalocalcaneal arthrodesis. J Am Acad Orthop Surg. 2012;20(1):1-7.
Noonan T, Michael P, Odysseas P, Robert H, Avinash P. Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a biomechanical analysis of the effect of nail length. Foot Ankle Int. 2005;26(4):304-8.
Fenton P, Bali N, Matheshwari R, Youssef B, Meda K. Complications of tibio-talar-calcaneal fusion using intramedullary nails. Foot Ankle Surg. 2014;20(4):268-71.
Jonas SC, Young AF, Curwen CH, McCann PA. Functional outcome following tibio-talarcalcaneal nailing for unstable osteoporotic ankle fractures. Injury. 2013;44(7):994-7.
Downloads
Published
How to Cite
Issue
Section
