Retrospective Comparison of Complication Rates Following Tibiotalocalcaneal (TTC) Nail Fusion vs ORIF for Neuropathic Ankle Fractures

Background: Ankle fractures occurring in the setting of underlying neuropathy pose a significant risk for complications. Poor clinical outcomes such as primary failure of an operative surgical construct, wound infection, ulceration, and osteomyelitis are increased in neuropathic diabetic patients. Operative management includes open reduction internal fixation (ORIF) vs a fusion of the ankle using a tibiotalocalcaneal (TTC) nail. This study aims to compare clinical outcomes and complication profiles following operative fixation of neuropathic ankle fractures between patients undergoing ORIF and those undergoing TTC fusion. Methods: Institutional review board approval was obtained to create a retrospective database of patients over a 17-year period. Included patients had a diagnosis of neuropathy of the lower extremity and an ankle fracture requiring either ORIF or TTC fusion. Demographic and clinical data were collected for the study sample. Descriptive statistics were conducted, and Kruskal-Wallis and χ² tests were used for analysis. Results: Forty-five patients were included in the study, of which 26 underwent ORIF and 19 had a TTC fusion. There was a significant difference in weightbearing status at 2 weeks postoperatively between the 2 groups (P < 0.01), with 80.8% of ORIF patients and 36.8% of TTC fusion patients being nonweightbearing (NWB). However, there was no significant difference in the weightbearing status between ORIF and TTC fusion patients (P > .05) at later time points. Postoperative complications (P > .99) and use of opioid medications (P > .99) were not statistically significant when comparing ORIF to TTC fusion with no clear difference detected. Conclusion: In patients with neuropathic fractures, TTC fusions were associated with earlier enhanced weightbearing capabilities compared to ORIF. This suggests that electing for a TTC fusion instead of an ORIF may provide the patient with improved function earlier in their recovery process, but we detected no clear difference in long-term postoperative outcomes when comparing TTC fusion and ORIF procedures. Level of Evidence: Level III, retrospective cohort study.