Complex Tibial Pilon Fractures May Be Another Good Indication for Hindfoot Nails

The trade-off

Tibiotalocalcaneal (TTC) nailing is increasingly used for comminuted pilon fractures, but it fuses the subtalar joint. That cost has been hard to weigh without knowing how often the joint degenerates anyway.

Inside the study

Researchers reviewed 473 patients treated with open reduction and internal fixation (ORIF). X-rays were graded with the Kellgren-Lawrence and NSS systems, and CT scans, when available, with the CT Ankle Osteoarthritis (CTAO) system. Patients were grouped by the time from injury to their latest X-ray, from under 12 months to more than 48 months.

What the imaging showed

• X-ray arthritis grades were linked to age, smoking, steroid use, comorbidity burden, fracture classification, and time since injury.

• Patients imaged 25 or more months after injury had significantly higher arthritis grades than those imaged within 24 months.

• CT scores also correlated with age.

The takeaway

The subtalar joint often deteriorates after pilon fractures treated with ORIF. Sacrificing it with early hindfoot nailing may therefore matter less clinically than feared.