Journal of Foot and Ankle Surgery - 2026-07-11 - Journal Article
Single-stage Management of Distal Tibial Nonunion and Hindfoot Arthritis through Arthrodesis using a Retrograde Intramedullary Nail Combined with External Fixation.
Pavlos M, Christos S, Aristeidis K, Chrysoula A, Antiopi L, Georgios P, Panagiotis P, Tsatas S, Dimitrios P, Vasileios PD
Topics
Key Takeaway
Single-stage tibiotalocalcaneal arthrodesis with retrograde IMN plus external fixation improved AOFAS from 36.1 to 75.7 and VAS from 7.7 to 2.5 at one year in 34 patients with distal tibial nonunion and concurrent hindfoot arthritis.
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Summary
This retrospective series asked whether single-stage tibiotalocalcaneal arthrodesis using a retrograde IMN combined with external fixation could address distal tibial nonunion or malunion and concomitant ankle/subtalar arthritis simultaneously. Thirty-four consecutive patients treated 2022–2025 were assessed with AOFAS and VAS at one year. AOFAS improved from 36.1 to 75.7 and VAS from 7.7 to 2.5 (both p<0.001), with the authors concluding the combined single-stage approach is feasible.
Key Limitation
The paper does not report radiographic union rates, hardware complications, or infection rates, which are the critical outcome metrics for any nonunion surgery and are necessary to evaluate true procedural efficacy.
Original Abstract
BACKGROUND
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.
PURPOSE
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.
STUDY DESIGN
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.
RESULTS
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).
CONCLUSIONS
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.
LEVEL OF CLINICAL EVIDENCE
4.