Outcomes of Tibiotalocalcaneal (TTC) Nailing in Ankle Fractures in Diabetic Patients with Charcot Neuroarthropathy.

Abstract

Background: Ankle arthrodesis, traditionally used for Charcot arthropathy or failed fracture fixation, has evolved to include techniques such as tibiotalocalcaneal (TTC) nailing and tibiotalar arthrodesis. These methods offer advantages like smaller incisions and minimal disruption of the fracture site's biology. This approach is particularly beneficial for diabetic patients, who are prone to vascular complications, diabetic foot ulcers, and infections. Early weight-bearing with implants like TTC nails is especially advantageous for patients with poor bone stock or soft tissue quality. Objective: This study aimed to evaluate the clinical and radiographic outcomes of TTC nailing in ankle fractures among diabetic patients with Charcot arthropathy. Methods : This prospective study included 84 diabetic patients with unstable, displaced ankle fractures and Charcot neuroarthropathy who underwent TTC nailing from October 2022 to June 2024. Primary outcomes were complication rates and functional outcomes, while secondary outcomes included time to weight-bearing and bone union rates. The Foot and Ankle Outcome Score (FAOS) was used to assess functional improvement. Results: At six months postoperatively, FAOS scores were classified as excellent in 54 patients (64.3%), good in 24 patients (28.6%), and poor in 6 patients (7.1%). The mean preoperative FAOS score improved significantly from 19.9 ± 3.81 to 72.6 ± 11.66 at six months (P < 0.001). Union was achieved in 63 patients (75%), delayed union occurred in 15 patients (17.9%), and non-union occurred in 6 patients (7.1%). No significant correlations were found between final FAOS scores and age, body mass index, diabetes duration, or HbA1c levels. Furthermore, postoperative complications included wound infections, which were categorized into superficial and deep infections. Superficial infections occurred in 6 patients (7.1%), characterized by localized erythema and mild discharge around the surgical site. Deep infections, on the other hand, were observed in 3 patients (3.6%), involving deeper tissues and requiring more aggressive management, including hardware removal after achieving complete bone consolidation. Advanced postoperative deformity was noted in 6 patients (7.1%), likely due to the underlying Charcot arthropathy and its associated instability. Conclusion: TTC nailing is a reliable and effective treatment for ankle fractures in diabetic patients with Charcot neuroarthropathy, offering good clinical and functional outcomes with a low complication rate. Level of Evidence: III.