Citations 1
Factors Affecting Outcomes of Hindfoot Fusion Nails for Acute Injury: A Multicenter Study
Kim, Eugene , Tornetta, Paul , Carlson, Jon, Schultz, Alex, Wireman, Garrett , Ollivere, Benjamin J., Zheng, Amy , Patch, David , White, Tim D. , Heinz, Nicholas , Lahurd, Caroline Elizabeth, Ostrum, Robert F. , Baumann, Charles, Kottmeier, Stephen, Doany, Michael E. , Krause, Peter, Redlich, Nathan, Egol, Kenneth, Konda, Sanjit, Mir, Hassan, McCaskey, Meghan , Azer, Emil, Kusler, Jace E. , Beltran, Michael T., Mehta, Samir, Masada, Kendall M. , Hidden, Krystin A., Kuttner, Nicolas P. , Tornetta, Paul , Beltran, Michael J. , Kuttner, Nicolas, Schultz, Alexander , Ollivere, Ben J. , Zheng, Amy, Spitler, Clay A. , White, Tim, Stinner, Daniel J. , Baumann, Charles A. , Krause, Peter C. , Egol, Kenneth A. , Konda, Sanjit R. , Beltran, Michael, Mehta, Samir D. , Hidden, Krystin A.
Journal of Orthopaedic Trauma | February 13, 2026 | Volume: 40 | Issue: 3 | Pages: 148-154
OBJECTIVE: To evaluate the effect of joint preparation and patient factors on outcomes and complications in patients treated acutely with hindfoot fusion nails for ankle and pilon fractures. METHODS: Design: Retrospective chart review. Setting: Thirteen US trauma centers and 2 UK trauma centers. Patient Selection Criteria: Ankle and pilon fractures (AO-OTA types A-C) from 2010 to 2020 acutely treated definitively with hindfoot fusion nail were reviewed. Patients at least 18 years old and with minimum 6 months follow-up or earlier diagnosis of complication were included. Exclusion criteria included nonambulatory at baseline, prior internal fixation that failed and underwent revision, and prior tibiotalar or subtalar arthrodesis. Outcome Measurements and Comparisons: The primary outcome was final postoperative ambulatory status. Secondary outcomes were infectious and fracture-related complications. RESULTS: One hundred forty-nine patients (75 men; 74 women; age 20–99; median 63 years) were treated for ankle (104) or pilon (45; 8A, 13B, 24C) fractures. Eighty-five patients (44%) had open fractures and 55 (37%) had diabetes. Thirty-six patients (24%) had joint preparation at the time of surgery. Forty-five (30%) were made weight bearing as tolerated postoperatively; the median time to mobilize was 1.5 days (0–210) and to full weight bearing was 35 days (0–1462). Fifty-seven patients (85%) returned to their preinjury ambulatory status, which was not affected by joint preparation (50% vs. 59%, P = 0.327). Joint preparation led to higher articular fusion rates (94% vs. 24%; P = 0.001) and fewer hardware removals (19% vs. 42%, P = 0.013), but trended toward a higher fracture nonunion rate (19% vs. 8%, P = 0.053). Forty-five patients (30%) had infectious complications, 60 (40%) had a fracture-related complication, and 67 (45%) had additional procedures. Open fractures did not lead to any differences in superficial or deep infection. Insulin-dependent diabetes was associated with higher rates of infectious complications (31% vs. 15%, P = 0.028) and amputation (17% vs. 4%, P = 0.029). CONCLUSIONS: Hindfoot fusion nails for acute ankle and pilon injuries had high complication rates. More complications occurred in patients with insulin-dependent diabetes. While 95% regained ambulation, only 57% returned to preoperative status. Joint preparation led to higher rates of articular fusion (94% vs. 24%, P < 0.001) but not fracture union (81% vs. 66%, P = 0.106). LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.