This article is more than 5 years old. Information may no longer be current.
Single-stage procedure can address tibial malunion, nonunion with concomitant hindfoot arthritis
A single-stage procedure consisting of tibial osteotomy and retrograde intramedullary nailing for correction of the angular deformity and hindfoot fusion can address tibial malunion or nonunion with concomitant hindfoot arthritis, according to study results.
Twenty-five patients underwent retrograde tibiotalocalcaneal nailing with concomitant realignment tibial osteotomy with takedown of the nonunion or malunion in a single procedure. Researchers recorded baseline patient characteristics and prospectively collected Visual Analog Scale (VAS) pain scores and American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS-AH) scores at the preoperative evaluation and the time of final follow-up. Patients were also asked about their final satisfaction.
Overall, all nonunions, osteotomy sites and fusion sites healed clinically and radiographically at an average of 19.5 weeks, with radiographs revealing continued stable healing of the fusion and osteotomy sites without loss of alignment. Results showed an average preoperative VAS score of 8.3 of 10, which improved to an average of 2.8 at the time of final follow up, and an average preoperative AOFAS-AH score of 43 of 100, which improved to an average of 76 at the time of final follow-up. Researchers found all deformities were corrected to neutral alignment and all patients had a plantigrade foot and the ability to wear off-the-shelf shoes without bracing. At final follow-up, 84% of patients stated they were extremely satisfied with the surgery, 12% were satisfied and 4% were unsatisfied.
“In conclusion, tibial malunion or nonunion with concomitant hindfoot arthritis can be addressed with a single-stage procedure consisting of a tibial osteotomy and retrograde intramedullary nailing for correction of the angular deformity and fusion of the arthritic hindfoot,” the researchers wrote. “This procedure provides a viable alternative to multiplanar external fixation or a staged procedure addressing the nonunion/angular deformity and the hindfoot arthritis separately. Accurate correction with meticulous joint preparation is required to achieve good results.”
Disclosure: Raikin is a consultant for and received payment from Biomet.