Factors Affecting Outcomes of Hindfoot Fusion Nails for Acute Injury: A Multicenter Study
Document Type
Article
Publication Date
3-1-2026
Publication Title
Journal of Orthopaedic Trauma
Abstract
OBJECTIVE: To evaluate the effect of joint preparation and patient factors on outcomes and complications in patients treated acutely with hindfoot fusion nails for ankle and pilon fractures. DESIGN: Retrospective chart review. SETTING: Thirteen US trauma centers and 2 UK trauma centers. PATIENT SELECTION CRITERIA: Ankle and pilon fractures (AO-OTA types A-C) from 2010 to 2020 acutely treated definitively with hindfoot fusion nail were reviewed. Patients at least 18 years old and with minimum 6 months follow-up or earlier diagnosis of complication were included. Exclusion criteria included nonambulatory at baseline, prior internal fixation that failed and underwent revision, and prior tibiotalar or subtalar arthrodesis. OUTCOME MEASUREMENTS AND COMPARISONS: The primary outcome was final postoperative ambulatory status. Secondary outcomes were infectious and fracture-related complications. RESULTS: One hundred forty-nine patients (75 men; 74 women; age 20-99; median 63 years) were treated for ankle (104) or pilon (45; 8A, 13B, 24C) fractures. Eighty-five patients (44%) had open fractures and 55 (37%) had diabetes. Thirty-six patients (24%) had joint preparation at the time of surgery. Forty-five (30%) were made weight bearing as tolerated postoperatively; the median time to mobilize was 1.5 days (0-210) and to full weight bearing was 35 days (0-1462). Fifty-seven patients (85%) returned to their preinjury ambulatory status, which was not affected by joint preparation (50% vs. 59%, P = 0.327). Joint preparation led to higher articular fusion rates (94% vs. 24%; P = 0.001) and fewer hardware removals (19% vs. 42%, P = 0.013), but trended toward a higher fracture nonunion rate (19% vs. 8%, P = 0.053). Forty-five patients (30%) had infectious complications, 60 (40%) had a fracture-related complication, and 67 (45%) had additional procedures. Open fractures did not lead to any differences in superficial or deep infection. Insulin-dependent diabetes was associated with higher rates of infectious complications (31% vs. 15%, P = 0.028) and amputation (17% vs. 4%, P = 0.029). CONCLUSIONS: Hindfoot fusion nails for acute ankle and pilon injuries had high complication rates. More complications occurred in patients with insulin-dependent diabetes. While 95% regained ambulation, only 57% returned to preoperative status. Joint preparation led to higher rates of articular fusion (94% vs. 24%, P < 0.001) but not fracture union (81% vs. 66%, P = 0.106). LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
First Page
148
Last Page
154
PubMed ID
41685944
Volume
40
Issue
3
Rights
Copyright © 2025 Wolters Kluwer Health, Inc.
Recommended Citation
Kim, Eugene; Tornetta, Paul; Carlson, Jon B.; Schultz, Alex; Wireman, Garrett; Ollivere, Benjamin; Zheng, Amy; Spitler, Clay; Patch, David; White, Tim; Heinz, Nicholas; Stinner, Daniel; Lahurd, Caroline Elizabeth; Ostrum, Robert; Baumann, Charles; Kottmeier, Stephen; Doany, Michael; Krause, Peter; Redlich, Nathan; Egol, Kenneth; Konda, Sanjit; Mir, Hassan; McCaskey, Meghan; Azer, Emil; Kusler, Jace; Beltran, Michael; Mehta, Samir; Masada, Kendall; Hidden, Krystin A.; and Kuttner, Nicolas, "Factors Affecting Outcomes of Hindfoot Fusion Nails for Acute Injury: A Multicenter Study" (2026). School of Medicine Faculty Publications. 4459.
https://digitalscholar.lsuhsc.edu/som_facpubs/4459
10.1097/BOT.0000000000003104