title: Locking plate versus retrograde intramedullary nail fixation for tibiotalocalcaneal arthrodesis: A retrospective analysis.
abstract: BACKGROUND
  Tibiotalocalcaneal arthrodesis (TTCA) surgery is indicated for the end-stage disease of the tibiotalar and subtalar joints. Although different fixation technique of TTCA has been proposed to achieve high fusion rate and low complication rate, there is still no consensus upon this point. The purpose of this study is to compare the clinical efficacy of retrograde intramedullary nail fixation (RINF) and locking plate fixation (LPF) for TTCA.
  
  
  METHODS
  Fifty four patients who underwent TTCA through the lateral approach with lateral fibular osteotomy using RINF (32 patients, 18 male/14 female, mean age: 48) or LPF (22 patients, 12 male/10 female, mean age: 51) between January 2007 and January 2010 were retrospectively analyzed. Demographic and clinical characteristics, surgery (operation time, blood loss) outcomes (postoperative fusion rates, visual analog scale and foot and ankle surgery score and complications) were compared.
  
  
  RESULTS
  The LPF group had a shorter operation time (72.3 ± 9.2 vs. 102.8 ± 11.1 min, P < 0.001), less blood loss (75.9 ± 20.2 vs. 140.0 ± 23.8 ml, P < 0.001) and less intraoperative fluoroscopy sessions (3.6 ± 0.9 vs. 8.4 ± 1.3, P < 0.001) than the RINF group. Patients were followed up for 12-24 months (mean of 16.2 months). Both groups had similar postoperative fusion rates (90.6% and 95.4%) and the LPF group showed a nonsignificant lower complication rate (18.2% vs. 28.1% respectively). Patients at higher risk on nonunion due to rheumatoid diseases may have a lower nonunion rate with LPF than RINF (one out of eight vs. three out of nine, P < 0.001).
  
  
  CONCLUSIONS
  The LPF for TTCA was simpler to perform compared with RINF, but with similar postoperative outcomes and complication rates.
authors.affiliation: Department of Orthopaedic, 6 People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai - 200 233, China.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic, 6 People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai - 200 233, China.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Department of Orthopaedic, 6 People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai - 200 233, China.
authors.forename: Guohua
authors.initials: G
authors.lastname: Mei
keywords: Ankle; Locking plate fixation; arthrodesis; bone plates; intramedullary; nailing; retrograde intramedullary nail; subtalar arthritis; tibiotalar arthrodesis; tibiotalocalcaneal arthrodesis