SLR - February 2024 - Sandstrom
Title: Comparison of different fibula procedures in tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a mid-term retrospective studyReference: He W, Zhou H, Li Z, Zhao Y, Xia J, Li Y, Chen C, Huang H, Zhang Y, Li B, Yang Y. Comparison of different fibula procedures in tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a mid-term retrospective study. BMC Musculoskelet Disord. 2023 Nov 13; 24(1): 882.
Level of Evidence: Level 3
Scientific Literature Review
Reviewed by: Olivia Sandstrom, DPM, PGY-2
Residency Program: Creighton University School of Medicine – Phoenix; Phoenix, AZ
Podiatric Relevance: Tibiotalocalcaneal (TTC) arthrodesis is a treatment option for deformities or arthritis of the hindfoot, and can be performed with either fibular sparing or fibular resection approaches. Few studies have assessed what impact, if any, the type of fibular approach has on the overall outcome of the procedure. The aim of this study was to evaluate the effects of various fibular procedures during TTC arthrodesis.
Methods: Adults patients who underwent TTC arthrodesis with a retrograde intramedullary nail over a 5 year period at a single institution were retrospectively reviewed. Patients were divided into 3 groups according to fibular procedure, including fibular osteotomy (FO), fibular strut (FS), and fibular preservation (FP). Operation time, fusion time, radiographic evaluation, and complications were recorded. Additionally, preoperative and postoperative functions were evaluated using the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores.
Results: A total of 58 patients were included in the final results, with 21 in the FO group, 19 in the FS group, and 18 in the FP group. The mean postoperative follow up time was 66 months. All groups showed a high fusion rate (FO: 90.5%, FS: 94.7%, FP: 94.4%). VAS and AOFAS ankle and hindfoot scores at preoperative and final follow-up showed significant statistical differences in all 3 groups, but no statistical difference comparatively between the groups. Mean operation time of the FS group was longer (FS: 131.3 ± 17.1 min, FO: 119.3 ± 11.7 min, FP: 112.2 ± 12.6 min).
However fusion time of the FS group was shorter (FS: 15.1 ± 2.8 weeks, FO: 17.2 ± 1.9 weeks, FP: 16.8 ± 1.9 weeks) – these results were noted to be statistcially significantly different. No severe postoperative complications were recorded.
Conclusions: TTC arthrodesis using a retrograde intramedullary nail is an effective procedure with an overall high fusion rate and no statistically significant difference comparatively between the various fibular procedure groups. While the FS group was noted to have a longer operation time, it was also noted to have a statistically significant shorter time to fusion in comparison with the FO and FP groups, possibly making it a more preferred option. There were some limitations to this study including, but not limited to, its retrospective nature and small sample size. Future larger scale and prospective randomized studies are needed to further verify these results.