title: Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus.
abstract: Retrograde intramedullary nailing for tibiotalocalcaneal arthrodesis is a salvage procedure reserved for severe cases of deformity. The aim of the present study was to compare the outcomes of this technique in patients with and without diabetes mellitus (DM). A total of 61 patients with and 56 without DM underwent retrograde intramedullary nailing and had a minimum follow-up period of 12 months. The overall incidence of complication was 45.2%; however, the overall incidence of complications between those with and without DM was not significantly different (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.38 to 1.65, p = .54). Patients with DM had a significantly greater rate of superficial infections (OR 8.3, 95% CI 1.01 to 68.67, p = .03). However, no difference was seen in the rate of deep infection (OR 0.90, 95% CI 0.34 to 2.46, p = .83) or noninfectious complications (OR 0.50, 95% CI 0.23 to 1.13, p = .09). Successful limb salvage was achieved for 96.8% of the patients with DM and 94.7% of those without DM (p = .66). A femoral head allograft was used in 32 (27.4%) of 117 patients to substitute for an osseous void. Of the 32 patients who required a femoral head allograft, 21 (67.7%) experienced a complication compared with 32 (37.6%) of 85 patients who did not require a femoral head allograft (OR 3.16, 95% CI 1.35 to 7.41, p = .008). The incidence of patient satisfaction was 80% for patients with DM and 72% for those without DM (p = .36). Despite a high incidence of complications, limb salvage was accomplished in approximately 95% of patients with complicated deformities. Four patients (6.56%) with DM experienced a tibia fracture; therefore, we now routinely use a 300-mm-long nail for this reconstruction.
authors.affiliation: Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA; Professor of Orthopaedic Surgery, University of Pittsburgh Medical Center Mercy Center for Healing and Amputation Prevention, Pittsburgh, PA. Electronic address: wukichdk@upmc.edu.
authors.forename: Dane K
authors.initials: DK
authors.lastname: Wukich
authors.affiliation: Resident in Podiatry, University of Pittsburgh Medical Center Mercy Center for Healing and Amputation Prevention, Pittsburgh, PA.
authors.forename: Brady R
authors.initials: BR
authors.lastname: Mallory
authors.affiliation: Graduate Student in Biostatistics and Epidemiology, Department of Epidemiology and Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
authors.forename: Natalie C
authors.initials: NC
authors.lastname: Suder
authors.affiliation: Clinical Faculty in Biostatistics and Epidemiology, Department of Epidemiology and Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
authors.forename: Bedda L
authors.initials: BL
authors.lastname: Rosario
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods; D001177:Arthropathy, Neurogenic / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011859:Radiography; D012016:Reference Values; D018570:Risk Assessment; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Charcot foot; complication; fusion; neuropathy; outcomes; surgery