Anastasio Albert T, Wu Kevin A, Luo Emily J, Netto Cesar De Cesar, Easley Mark E
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Foot Ankle Orthop. 2025 Mar 18;10(1):24730114251323895. doi: 10.1177/24730114251323895. eCollection 2025 Jan.
Tibiotalocalcaneal (TTC) arthrodesis is used among other methods as a salvage procedure for complex foot/ankle deformity. Fixation is usually achieved through plate/screw constructs or intramedullary (IM) nailing. Although IM nailing uses smaller incisions, fusion rates are variable and complications rates ranging from 25% to 55.7% have been reported. The Phantom ActivCore (AC) nail could serve as a viable alternative to traditional IM nailing by allowing for increased compression capacity and a potentially lower risk of stress fracture. However, no studies have described the early outcomes of TTC arthrodesis using the AC nail. The primary objective of this study was to determine the rates of early-term complications and radiographic union of the AC nail.
Inclusion criteria consisted of patients who had undergone a tibiocalcaneal or TTC arthrodesis using the Phantom Hindfoot TTC Nail System with at least 6 months of follow-up. Radiographic analysis evaluated for successful union and flexibility of the flex coil. Patients were monitored for postoperative complications and additional secondary procedures.
Twenty-one patients were included and had an average follow-up of 9.4 ±4.7 months (range, 4.3-19 months). No intraoperative complications were reported. Seven patients experienced at least 1 adverse event, which included device migration, asymptomatic nonunion, symptomatic nonunion, bone stress reaction, device prominence, and screw breakage. There were no events of perioperative fractures or device breakage. Two patients required secondary surgical interventions. The 5 remaining patients were managed conservatively. An average nail coil flexion angle of 2.6 ± 3.1 degrees and 0.8 ± 1.59 degrees was found on lateral and anteroposterior radiographs, respectively. The overall union rate at a mean follow-up of 9.4 months was 90.4% (95% CI 69.6%, 98.8%).
TTC arthrodesis via the AC nail demonstrated similar union rates and outcomes at short-term follow-up compared with rates generally reported in the literature for other IM nail constructs. The AC nail was able to function as designed and allow for motion at the proximal bone-implant interface.
Level IV, retrospective case series study.
胫距跟（TTC）关节融合术是用于治疗复杂足/踝畸形的挽救性手术方法之一。固定通常通过钢板/螺钉结构或髓内（IM）钉来实现。尽管髓内钉手术切口较小，但融合率不一，且并发症发生率报道在25%至55.7%之间。幻影激活核心（AC）钉通过增加加压能力和潜在降低应力性骨折风险，可能成为传统髓内钉的可行替代方案。然而，尚无研究描述使用AC钉进行TTC关节融合术的早期结果。本研究的主要目的是确定AC钉的早期并发症发生率和影像学骨愈合率。
纳入标准为使用幻影后足TTC钉系统进行胫跟或TTC关节融合术且随访至少6个月的患者。影像学分析评估融合是否成功以及弯曲线圈的灵活性。对患者进行术后并发症及其他二次手术的监测。
纳入21例患者，平均随访9.4±4.7个月（范围4.3 - 19个月）。未报告术中并发症。7例患者经历至少一次不良事件，包括器械移位、无症状骨不连、有症状骨不连、骨应力反应、器械突出和螺钉断裂。无围手术期骨折或器械断裂事件。2例患者需要二次手术干预。其余5例患者接受保守治疗。在侧位和前后位X线片上，平均钉线圈弯曲角度分别为2.6±3.1度和0.8±1.59度。平均随访9.4个月时的总体骨愈合率为90.4%（95%CI 69.6%，98.8%）。
与文献中其他髓内钉结构通常报道的骨愈合率相比，通过AC钉进行TTC关节融合术在短期随访中显示出相似的骨愈合率和结果。AC钉能够按设计发挥功能，并允许近端骨 - 植入物界面处有活动。
IV级，回顾性病例系列研究。
