title: Union rate of tibiotalocalcaneal nails with internal or external bone stimulation.
abstract: BACKGROUND
  The use of bone growth stimulation has been reported in the application of hindfoot and ankle arthrodesis. Most studies have been retrospective case series with few patients. The authors present a comparative analysis of patients undergoing tibiotalocalcaneal (TTC) arthrodesis via a retrograde intramedullary arthrodesis nail to evaluate the influence of internal versus external bone stimulation in this population.
  
  
  METHODS
  One hundred fifty-four patients were treated with retrograde intramedullary nailing. A comprehensive chart and radiographic review was performed from a database of patients who underwent TTC fusion with or without bone stimulation. Ninety-one patients with retrograde TTC nailing were treated with direct current internal bone stimulation at the time of the index procedure (internal group) and 63 were treated with combined magnetic field external bone stimulation (external group). The primary end point was fusion with potential variables evaluated for influence on fusion rates.
  
  
  RESULTS
  Demographically the cohorts were similar groups in age and comorbidities. Surgical and outcome data were examined, and there were few statistically significant differences between the two groups. There was no statistically significant difference in rate of union (52.7% and 57.1%, p = .63) or rate of complications between the internal and external groups. Overall, the success rate for achieving a stable, functional limb for the groups was 81.3% (74/91 patients) and 82.5% (52/63 patients) in the internal and external groups, respectively (p = .62).
  
  
  CONCLUSIONS
  The authors demonstrated there were no statistically significant differences between the union and complication rate when comparing these types of internal and external bone stimulation in this patient population. Consideration of these results may help guide physicians when considering bone stimulation as an adjunct to TTC fusions with a retrograde intramedullary nail.
authors.affiliation: Orthopedic Foot and Ankle Center, Westerville, OH 43082, USA. ofacresearch@orthofootankle.com
authors.forename: J George
authors.initials: JG
authors.lastname: De Vries
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Berlet
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Hyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001857:Bone Matrix; D001858:Bone Nails; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D055909:Magnetic Field Therapy; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D053657:Platelet-Rich Plasma; D011859:Radiography; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery