Publication:

Management of distal tibial nonunion with tibiotalocalcaneal arthrodesis using tarsus nail: a retrospective study

Background Distal tibial nonunion presents a significant challenge due to poor vascularity, limited soft tissue coverage, and mechanical instability. Conventional fixation methods often fail in complex cases, particularly when accompanied by bone loss, deformity, or infection. Tibiotalocalcaneal (TTC) arthrodesis using a tarsus nail has emerged as an effective strategy, providing stable fixation and supporting limb preservation. This study aims to evaluate the clinical and radiological outcomes of managing distal tibial nonunion with TTC arthrodesis using a tarsus nail.

Methods This retrospective study included 40 patients with distal tibial nonunion who underwent TTC arthrodesis using a tarsus nail at a speciality hospital between 2024 and 2025. Functional outcomes were evaluated using standardized scoring systems, including the American Orthopaedic Foot and Ankle Society (AOFAS) score, pain intensity was analyzed by VAS and complications were recorded at one-year follow-up. Radiographic assessments were performed at regular intervals to evaluate bone union and alignment.

Results A total of 40 patients (26 males, 14 females) with a mean age of 52.3±11.6 years were included. At one-year follow-up, radiographic union was achieved in all the patients, with satisfactory alignment in all cases. The mean AOFAS score improved significantly from 38.5±7.2 preoperatively to 78.9±6.8 postoperatively. Pain levels, as measured by the VAS, decreased from a preoperative mean of 7.2±1.1 to 2.1±0.9. No Complications were reported; no cases of implant failure were reported.

Conclusions TTC arthrodesis using a tarsus nail is an effective and reliable procedure for distal tibial nonunion, providing high rates of bone union, significant improvement in functional outcomes, while maintaining limb alignment and stability.