25 RA patients with their ankles fused with an intramedullary nail were compared to 35 RA patients with their ankles fused with compression screws.

24/25 nailed patients showed radiographic healing at follow-up after 3 (1–8) years, and 26/35 ankles in the compression screw group examined after 6 (1–14) years healed after the first attempt and another 5 after repeat surgery.

In the nailed group 23 patients were satisfied and 2 somewhat satisfied. In the compression screw group 20 were satisfied, 12 somewhat satisfied and 3 dissatisfied.

There were 4 deep infections (3 healed after nail extraction and antibiotics, one unhealed) in the nail group and 1 deep infection (healed after antibiotics) in the compression screw group.

Six patients in the nailed group also had a permanent plantar sensory loss.

Conclusion: Ankle fusion with retrograde intramedullary nailing seems to result in a high rate of healing and satisfied patients, but cares a substantial risk of deep infection compared to fusion with compression screws, which has a lower fusion rate fewer satisfied patients, but less complications.

RA patients with a normal subtalar joint are of course only managed by compression screws.