Tibiotalocalcaneal arthrodesis using retrograde nailing (TTCAN) in post-traumatic conditions with high septic risk. Clinical experience.

PURPOSE: To evaluate the efficacy of tibiotalocalcaneal arthrodesis using retrograde nailing (TTCAN) in post-traumatic conditions with high septic risk. We hypothesized that this minimally invasive technique would achieve bone union and satisfactory functional recovery without increasing septic risk.

METHODS

A prospective single-centre observational study included 20 patients who underwent TTCAN between January 2020 and December 2023. The primary outcome was the complete joint fusion rate at six months. Secondary outcomes included pain assessment, complications, functional evaluation using the modified AOFAS score, and quality of life assessment using the SF-12 questionnaire.

RESULTS

Complete tibiotalocalcaneal fusion was achieved in 55% of patients at six months. Diabetes was significantly associated with fusion failure (p = 0.026). For nonunion cases (n = 14), the consolidation rate reached 78.6% at six months and 92.9% at final follow-up. The mean modified AOFAS score was 48.4 ± 17.5 at six months, improving to 51.2 ± 19.3 at final follow-up (mean 15.6 months). Quality of life assessment showed greater impact on physical (PCS-12: 32.0 ± 6.9) than mental (MCS-12: 47.0 ± 12.7) components. Complications included delayed healing (25%) and one superficial infection.

CONCLUSION

TTCAN proves to be a reliable salvage solution for complex ankle and hindfoot trauma in high-risk septic contexts, enabling limb preservation with acceptable functional outcomes and minimal complications.