Comparison of hindfoot arthrodesis nail and humeral intramedullary nail for tibiotalocalcaneal arthrodesis.

Abstract

Tibiotalocalcaneal (TTC) arthrodesis is a standard procedure for severe hindfoot deformities. While both hindfoot arthrodesis nails (HAN) and repurposed humeral intramedullary nails (HIN) are used for fixation, direct comparisons of their outcomes are scarce. This study aimed to directly compare the surgical, clinical, and functional outcomes of HAN and HIN fixation in TTC arthrodesis. Retrospective comparative cohort study. This retrospective cohort study included 55 patients who received TTC arthrodesis from 2019 to 2023. Based on the implant used, patients were divided into a HAN group (n=26) and a HIN group (n=29). We compared the groups for demographic data, intraoperative variables (operative time, blood loss, radiographic alignment), fusion time, and functional outcomes (VAS pain and AOFAS scores). Patient demographics were similar at baseline. Our analysis revealed that the HIN technique resulted in a shorter operation, but the HAN approach allowed for significantly better intraoperative alignment and implant placement (p<0.001). For functional outcomes, the HIN group reported significantly higher AOFAS scores (p=0.028). Fusion times and post-operative pain levels were equivalent between the two groups. Both the HAN and HIN systems proved to be effective and safe for TTC arthrodesis. The choice between them involves a key trade-off: while HAN implants provide greater intraoperative control over alignment, HIN fixation is associated with superior postoperative functional outcomes. The optimal implant should therefore be selected on a case-by-case basis, considering individual patient anatomy and surgeon experience.