Comparative Functional Outcomes of Ankle Arthrodesis Using Tibiotalocalcaneal Intramedullary Nail versus ProximalHumeral Internal Locking System Plate Fixation

Abstract

Background and Aim: End stage ankle arthritis and complex hindfoot pathology frequently require arthrodesis to restore stability and relieve pain. Evidence comparing tibiotalocalcaneal intramedullary nail fixation with Proximal Humeral Internal Locking System plate fixation using the Foot and Ankle Outcome Score (FAOS) remains limited. This study compared early functional outcome, pain reduction, fusion success, and complications between these fixation strategies. Materials and Methods: A prospective comparative study was conducted in the Department of Orthopaedics, Gurki Teaching Hospital, from September 2024 to March 2025. Eighty participants were enrolled (40 per group). FAOS and visual analogue scale (VAS) pain were recorded preoperatively and at 3 months. Radiographic fusion was assessed at 3 months. Secondary outcomes included time to clinical union and complications. Independent samples t test, paired t test, chi square test, and Mann–Whitney U test were applied, with p < 0.05 considered significant. Results: Mean age was 56.3 ± 12.4 years in the nail group and 57.8 ± 13.1 years in the plate group (p = 0.472). Baseline FAOS was 23.4 ± 8.7 versus 24.1 ± 9.2 (p = 0.689). At 3 months, postoperative FAOS was 68.7 ± 13.4 (n = 46) versus 71.2 ± 12.1 (n = 49) (p = 0.325), with mean FAOS change 45.3 ± 14.6 versus 47.1 ± 13.9 (p = 0.484). VAS decreased from 8.1 ± 1.3 to 2.4 ± 1.8 versus 8.3 ± 1.4 to 2.6 ± 1.9 (p = 0.917). Fusion at 3 months was 95.7% versus 97.9% (p = 0.521). Median time to clinical union was 18 (16–22) versus 17 (15–20) weeks (p = 0.364). Total complications were 20% versus 12% (p = 0.200). Conclusion: Both techniques achieved comparable early functional recovery, pain relief, and fusion success, with low serious adverse outcomes.