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<p>Failed pilon fractures in patients with peripheral neuropathy present a complex reconstructive challenge due to poor bone quality, impaired healing, and high rates of fixation failure. When standard revision fixation is unlikely to succeed, treatment options are limited and amputation is frequently considered. This prospective case series evaluates the role of tibiotalocalcaneal arthrodesis using retrograde hindfoot nailing as a limb-preserving strategy in this difficult subgroup and clarifies patient selection criteria. Between January 2022 and June 2024, fifteen consecutive patients with failed pilon fracture fixation and confirmed neuropathy underwent hindfoot nailing following institutional ethical approval. Acute fractures were excluded; all cases represented chronic fixation failure with deformity, nonunion, or articular collapse. Clinical outcomes were assessed using pain scores and functional status, and radiological outcomes focused on fusion and associated complications. At a mean follow-up of 15&#xa0;months, fusion was achieved in 13 of 15 patients (86.7%) at a mean of 6.1&#xa0;months. Pain scores improved significantly, and all patients achieved a stable, plantigrade limb suitable for ambulation. Two patients demonstrated delayed union and one superficial infection; no implant failures or amputations occurred. This study suggests that hindfoot nailing is a reliable option for selected patients with failed pilon fractures and neuropathy when revision fixation is unlikely to succeed. Rather than serving as a primary fracture treatment, hindfoot nailing should be considered a definitive reconstructive solution aimed at achieving stability, pain relief, and limb preservation in high-risk cases.</p><p><i>Level of evidence</i>: IV (Prospective case series).</p>

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Tibiotalocalcaneal hindfoot nailing for failed pilon fractures in neuropathic patients: a prospective case series and treatment rationale

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Girish Vijaykumar,
  • Vivek Anand,
  • Gautham Patel,
  • Ravishankar Muniramaiah,
  • Shubhkarman Kahlon

摘要

Failed pilon fractures in patients with peripheral neuropathy present a complex reconstructive challenge due to poor bone quality, impaired healing, and high rates of fixation failure. When standard revision fixation is unlikely to succeed, treatment options are limited and amputation is frequently considered. This prospective case series evaluates the role of tibiotalocalcaneal arthrodesis using retrograde hindfoot nailing as a limb-preserving strategy in this difficult subgroup and clarifies patient selection criteria. Between January 2022 and June 2024, fifteen consecutive patients with failed pilon fracture fixation and confirmed neuropathy underwent hindfoot nailing following institutional ethical approval. Acute fractures were excluded; all cases represented chronic fixation failure with deformity, nonunion, or articular collapse. Clinical outcomes were assessed using pain scores and functional status, and radiological outcomes focused on fusion and associated complications. At a mean follow-up of 15 months, fusion was achieved in 13 of 15 patients (86.7%) at a mean of 6.1 months. Pain scores improved significantly, and all patients achieved a stable, plantigrade limb suitable for ambulation. Two patients demonstrated delayed union and one superficial infection; no implant failures or amputations occurred. This study suggests that hindfoot nailing is a reliable option for selected patients with failed pilon fractures and neuropathy when revision fixation is unlikely to succeed. Rather than serving as a primary fracture treatment, hindfoot nailing should be considered a definitive reconstructive solution aimed at achieving stability, pain relief, and limb preservation in high-risk cases.

Level of evidence: IV (Prospective case series).