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Tibiotalocalcaneal arthrodesis versus open reduction and internal fixation in treatment of trimalleolar ankle
Ronak J Mahatme1, Meredith Murphy1, Shawn A Moore1
1Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA.
Background:
Trimalleolar ankle fractures are complex injuries associated with high complication rates and poorer outcomes, particularly in elderly and medically comorbid patients. While open reduction and internal fixation (ORIF) remains the standard treatment, alternative strategies such as tibiotalocalcaneal arthrodesis (TTCA) have been increasingly explored for high-risk populations.
Methods:
A retrospective cohort study was performed using the TriNetX Research Network. Adult patients undergoing operative treatment for trimalleolar fractures were identified and stratified by procedure (TTCA versus ORIF). Propensity score matching (1:1) was performed to balance demographics and comorbidities, including age, sex, obesity, tobacco use, osteoporosis, diabetes, dementia, and peripheral vascular disease. Outcomes were assessed at 90 days, 1 year, and 2 years. Primary outcomes included secondary surgery (revision procedures, irrigation and debridement, hardware removal, and below-knee amputation). Secondary outcomes included 90-day infection and wound dehiscence. Risk ratios with 95% confidence intervals were calculated, with p < 0.05 considered significant.
Results:
After matching, 210 patients were included in each group. At 90 days, infection and wound complication rates were similar between TTCA and ORIF cohorts. TTCA was associated with significantly higher rates of secondary surgery at 1 year (28.1% vs 17.1%; RR 1.64, p = 0.007) and 2 years (31.4% vs 21.0%; RR 1.50, p = 0.015). Irrigation and debridement was also more frequent in the TTCA cohort at 1 year (RR 2.25, p = 0.012) and 2 years (RR 2.23, p = 0.009). In sensitivity analysis of closed fractures, findings remained consistent, with higher secondary surgery rates in the TTCA group.
Conclusion:
In this large propensity-matched study, TTCA may be associated with a higher incidence of secondary surgery-particularly irrigation and debridement-compared with ORIF at one and two years postoperatively, while early wound complication rates were similar. These findings may be influenced by residual confounding despite propensity matching.
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Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...