Nailing versus plating in tibiotalocalcaneal arthrodesis - A biomechanical human cadaveric study

Severe arthrosis involving ankle and subtalar joints or hindfoot deformities refractory to other forms of treatment is currently managed by tibiotalocalcaneal arthrodesis (TTCA). Relief of pain and acceptable gait pattern along with appropriate alignment are primary goals of treatment. The spectrum of techniques includes using screws, plates, external fixators and various types of intramedullary nails. The aim of this study was to compare the biomechanical stability of a plate specifically developed for hindfoot arthrodesis to an well-established nailing system.

Sixteen paired human cadaveric specimens were assigned to two groups for TTCA treatment via nailing or plating and tested under quasi-static and progressively increasing cyclic loading.

Range of motion during quasi-static testing in dorsiflexion and varus bending was significantly higher for plated specimens (P ≤ 0.048), with no further significant differences between the groups detected among all other loading directions (P ≥ 0.106). Cycles to failure and failure load were not significantly different between the groups (P = 0.600).

Although the intramedullary nail performed superiorly to the plate under quasi-static testing in terms of range of motion in dorsiflexion and varus bending, from a biomechanical point of view the hindfoot arthordesis plate demonstrated comparable promising outcomes under dynamic loading and could be considered as an alternative option to the nailing system for TTCA.