Chundi Gnaneswar, Dawar Abhiram, Ahn David B, Chopra Avani A, Joshi Tej, Lin Sheldon S, Jones Tuckerman
From the Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ (Chundi, Dawar, Ahn, Joshi, Lin, and Jones), and the Penn State College of Medicine, Hershey, PA (Chopra).
J Am Acad Orthop Surg. 2025 Apr 15;33(16):e956-e962. doi: 10.5435/JAAOS-D-25-00011.
Tibiotalocalcaneal (TTC) arthrodesis is a critical surgical intervention for advanced hindfoot and ankle pathologies, offering pain relief, stabilization, and functional alignment restoration. Intramedullary nail fixation, particularly with dynamic compression (DC) nails, has emerged as a promising solution for addressing high nonunion rates associated with standard static compression (SC) nails. This study compares union and complication rates between DC and SC nails in TTC arthrodesis using the Nationwide Readmissions Database.
This retrospective cohort study used the Nationwide Readmissions Database to identify cases of TTC fusion with DC and SC nails based on ICD-10-PCS codes. Propensity score matching (1:1) controlled for confounders, including age, sex, and comorbidities. Primary outcomes included complications such as thromboembolism, wound dehiscence, cellulitis, implant-related complications, nonunion, malunion, and infections. Secondary outcomes included 30-day and 31-90-day readmission rates. Statistical significance was set at P < 0.05.
The study analyzed 311 cases (149 with DC, 162 with SC). Demographic and comorbidity distributions were balanced after matching. Nonunion rates were significantly lower in the DC group (6.0%) compared with the SC group (17.3%; P = 0.002). Overall complication rates were comparable (DC: 30.2% vs. SC: 35.2%, P = 0.350).
DC devices demonstrated markedly reduced nonunion rates compared with SC nails, likely because of the continuous compression provided by the nitinol-based design. This novel finding validates the biomechanical advantages of devices using DC in TTC fusion and aligns with previous research advocating for such devices.
DC nails offer an advancement in TTC arthrodesis by markedly reducing nonunion rates. Future studies should focus on cost-effectiveness, long-term outcomes, and patient-specific optimization to further refine treatment protocols.
胫距跟（TTC）关节融合术是针对晚期后足和踝关节病变的关键外科手术，可缓解疼痛、实现稳定并恢复功能对线。髓内钉固定，尤其是动力加压（DC）钉，已成为解决与标准静力加压（SC）钉相关的高不愈合率问题的一种有前景的解决方案。本研究使用全国再入院数据库比较了TTC关节融合术中DC钉和SC钉的愈合率及并发症发生率。
这项回顾性队列研究利用全国再入院数据库，根据ICD-10-PCS编码识别采用DC钉和SC钉进行TTC融合的病例。倾向评分匹配（1:1）用于控制混杂因素，包括年龄、性别和合并症。主要结局包括血栓栓塞、伤口裂开、蜂窝织炎、植入物相关并发症、不愈合、畸形愈合和感染等并发症。次要结局包括30天和31 - 90天再入院率。统计学显著性设定为P < 0.05。
该研究分析了311例病例（149例使用DC钉，162例使用SC钉）。匹配后人口统计学和合并症分布均衡。DC组的不愈合率（6.0%）显著低于SC组（17.3%；P = 0.002）。总体并发症发生率相当（DC组：30.2% vs. SC组：35.2%，P = 0.350）。
与SC钉相比，DC装置的不愈合率显著降低，这可能是由于基于镍钛诺设计提供的持续加压。这一新发现证实了DC装置在TTC融合中的生物力学优势，并与先前倡导此类装置的研究结果一致。
DC钉通过显著降低不愈合率，为TTC关节融合术带来了进展。未来的研究应关注成本效益、长期结局以及针对患者的优化，以进一步完善治疗方案。
