Title : Outcomes of hindfoot fusion using hindfoot nailing with supplemental lateral plate via trans-fibular approach for complex deformities with poor bone stock
Abstract:
Background: Complex hindfoot deformities with poor bone quality, including Charcot neuroarthropathy, present increasing challenges. Although circular external fixators can achieve correction, they are associated with prolonged frame time and high rates of reoperation from non-union, broken wires, and pin-site infection. These patients are often frail, especially those with diabetes, who face elevated risks of amputation and mortality. This study evaluates internal fixation technique with hindfoot nailing and a supplemental lateral plate via trans-fibular approach in terms of allowing early weightbearing and maintaining hindfoot alignment.
Methods: All patients undergoing tibiotalocalcaneal (TTC) arthrodesis with deformity correction using internal fixation between October 2022 and June 2026 in Liverpool University Teaching Hospital were included. Data collected included demographics, BMI, Clinical Frailty Score (CFS), diabetes status, HbA1c, smoking history, surgical indication, and arthrodesis type. Outcomes assessed were time to weightbearing, length of hospital stay (LOS), and postoperative wound complications which further subdivided into delayed wound healing, superficial ulcer and deep infection which warrant further debridement or amputation. In addition, bone union status and mortality were also studied.
Results: Eighteen patients were included with total of nineteen limbs operated on ( one patient had bilateral hindfoot fixation) (mean age 58.5 years). The mean CFS was 3.8 and mean BMI 32.3 Eight patients have diabetes, and 2 were active smokers while 6 are ex-smoker. In terms of outcome measures, mean LOS is 7.5 days, and weightbearing began at a mean of 2.9 weeks. For wound complications, 4 had delayed wound healing (2 required antibiotic treatment and 2 managed conservatively with wound care), one patient had superficial ulcer and one patient had deep infection which require debridement then below knee amputation. 17 operated hindfoot fixation had bone union achieved during studied period with one limb pending follow up in future and one lost to follow up. There is no mortality recorded in our cohort of patients.
Conclusion: Internal fixation for TTC arthrodesis appears to be a viable alternative to circular fixation for complex hindfoot deformities. Early weightbearing was achievable, and LOS was acceptable despite significant comorbidity. Wound complications were relatively common, but few patients required major revision surgery. Further studies with longer follow-up are needed to assess fusion rates and long-term limb outcomes.
