Comparison of Plating and Intramedullary Nail for Tibiotalocalcaneal Arthrodesis

Wang Lei; Dai Xiangyang; Yue Ding; Wang Feng; Qin Jian; Yuan Tangbo

Abstract：Objective To compare the clinical effects between anterior locking plate fixation and retrograde intramedullary nail fixation in tibiotalocalcaneal arthrodesis.Methods A retrospective analysis was conducted on medical records of 43 patients who underwent tibiotalocalcaneal arthrodesis at the Sir Run Run Shaw Hospital,Nanjing Medical University between June 2018 and December 2022.There were 20 males and 23 females,aged 36 to 74 years,with an average age of(59.0±7.5)years.Twenty cases involved the left limb,and 23 cases involved the right limb.24 patients were treated with locking plate fixation(Anterior Locking Plate Group)and 19 patients were treated with retrograde intramedullary nail fixation(Intramedullary Nail Group).The two fixation methods were compared in terms of operation time,intraoperative blood loss,hospitalization expenses,bony union rate,bony union time,postoperative complications,American orthopaedic foot and ankle society(AOFAS)ankle-hindfoot scale scores,and short form 36(SF-36)scores.Results The Anterior Locking Plate Group had an average intraoperative blood loss of(78.3±23.5)mL,while the Intramedullary Nail Group had(84.2±21.7)mL.All patients were followed up for 12 to 22 months,with an average of(15.8±2.4)months.The bony union rates for the Anterior Locking Plate Group and Intramedullary Nail Group were 95.8％(23/24)and 94.7％(18/19),respectively.Complications arose in both groups:The Anterior Locking Plate Group experienced 1 case of soft tissue infection,1 case of both soft tissue infection and nonunion,and 1 case of soft tissue irritation;the Intramedullary Nail Group had 1 case of nonunion.The incidence of postoperative complications was 12.5％(3/24)for the Anterior Locking Plate Group and 5.3％(1/19)for the Intramedullary Nail Group,with no statistically significant difference(P＞0.05).The operation time for the Anterior Locking Plate Group and Intramedullary Nail Group were(103.3±16.9)minutes and(115.0±15.3)minutes,respectively;hospitalization expenses were(40 286.8±5162.7)and(53 314.7±6031.6),respectively;the bony fusion times were(4.7±0.5)months and(4.4±0.4)months,respectively;the AOFAS ankle-hindfoot scale scores at six months postoperatively were(65.7±4.8)pointsand(69.8±7.3)points,respectively;the SF-36 scores were(68.5±8.8)points and(73.4±5.5)points,respectively,with significant differences(P＜0.05).However,at the final follow-up,there were no significant differences in AOFAS ankle-hindfoot scores or SF-36 scores(P＞0.05).Conclusion In tibiotalocalcaneal arthrodesis,anterior locking plate fixation resulted in shorter operation time compared to intramedullary nail fixation,but the bony union time was longer.While intramedullary nail fixation demonstrated better clinical effects in the early postoperative period,both methods ultimately achieved good clinical effects.