Single-stage Management of Distal Tibial Nonunion and Hindfoot Arthritis through Arthrodesis using a Retrograde Intramedullary Nail Combined with External Fixation.

Abstract

This study evaluated the effectiveness of single-stage tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail combined with external fixation for distal tibial nonunion or malunion in patients with concomitant ankle and subtalar/hindfoot arthritis. The purpose of this study is to evaluate the effectiveness of single-stage tibiotalocalcaneal arthrodesis using a retrograde intramedullary nail combined with external fixation for the treatment of distal tibial nonunion or malunion in patients with concomitant hindfoot arthritis. Retrospective observational analysis METHODS: Clinical and radiological data were retrospectively analyzed for 34 consecutive patients treated between 2022 and 2025. All underwent tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail and external fixation. Preoperative and final follow-up assessments included patient satisfaction, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Visual Analog Scale (VAS) pain score. Mean VAS improved from 7.7 ± 1.2 preoperatively to 2.5 ± 1.3 at 1-year follow-up (p < 0.001). Mean AOFAS score improved from 36.1 ± 13.9 to 75.7 ± 9.4 (p < 0.001). Single-stage retrograde intramedullary nailing with external fixation was effective in treating distal tibial nonunion or malunion with concurrent hindfoot arthritis in our patient cohort, demonstrating the feasibility of this combined approach. 4.