Is bone allograft the right choice for tibio-talo-calcaneal fusions using the hindfoot nailing system? Nottingham Hospitals' Experience

B. Choudhry, N. Duncan, S. Dhar

Introduction: This study presents a series of 64 patients undergoing tibio-talo-calcaneal (TTC) fusions with a hindfoot nail to compare the times to union and complications comparing use of allograft with no allograft.

Methods: We conducted a retrospective review of patients undergoing a TTC fusion with a hindfoot nail from a period from 2010 to 2013. A total of 64 patients were collated which were performed by 3 surgeons across two centres. We reviewed the medical notes to determine the complications associated with the procedures and the radiographs to assess the time to clinical/radiological union. A comparison between the patients who had undergone a TTC fusion with allograft versus patients who had not received any allograft was made.

Results: Within our group, n = 15 (23%) patients had allograft utilised and n= 49 (77%) patients underwent TTC fusion without allograft. Within the allograft group, the mean time to union was longer and the complications included deep infection n= 2 (13%), prominent metalwork n=2(13%). The mean number of operations per patient was 1.33. Within the group not receiving allograft, the mean time to union was shorter than that of allograft group and the complications noted were fracture n=1 (2%), prominent metal work n= 1 (2%) & non-union n= 5 (10%), with the mean number of operations per patient being 1.18.

Conclusions: In our study we have found that patients undergoing TTC fusion with bulk allograft had longer times to union with a higher rate of complication p =0.22 and increased number of surgeries. When managing patients with bone loss, the benefits of utilising allograft to maintain limb length versus the longer time to union and increased rate of secondary surgeries needs to be balanced, but appears justified in our series.