Retrospective Case Study of TTC Fusion Treated with Carbon Fiber Nail

Abstract

Category: Ankle Introduction/Purpose: Tibiotalocalcaneal arthrodesis is a salvage option reserved for severe ankle and hindfoot deformities, arthritis of the ankle and subtalar joints, avascular necrosis of the talus, failed total ankle arthroplasty, and Charcot arthropathy. Implants have long been made from various metals most commonly stainless steel or titanium alloys. Disadvantages of metal implants include limited fatigue life, mismatch of modulus of elasticity, potential for wear debris, corrosion, and radiodensity that can preclude accurate radiographic visualization. Carbon fiber implants have been available for years. The advantageous properties of carbon fiber for use as orthopaedic implants include a similar modulus of elasticity to bone to decrease stress shielding, biocompatilibity, with minimal cellular response when studied invitro and invivo, ability to withstand prolonged fatigue straining and radiolucency on XR. Methods: A Carbofix TM carbon fiber TTC fusion nail was used in 15 patients with for Tibiotalocalcaneal /TC fusion. All patients received preop, intra op xrays, and follow up xrays at weeks 2/6/12. After 12 weeks xrays were taken every 3 months until 1 year. All xrays were read by a radiology attending to assess for consolidation and maintenance of alignment. We also performed CT scan for the nonunion [clinical & Radiological] Results: We were able to find comparable results [patients operated with carbon fiber nail] to the historical data of the patients treated with different metal implants. We were also able to check the safety of using the implant [no tissue reaction or reactivity], easily able to see the fusion across the joints secondary to radioluceny and artifact free CT scan or MRI when required. There were no metal related complications noted. Conclusion: These studies have shown the usefulness of carbon fiber implants but there are no studies which explicitly review Tibiotalocalcaneal/Tibiocalcaneal fusion. We present a retrospective case series of 15 patients who were treated with carbon fiber tibiotalocalcaneal fusion nail.