Tibiotalocalcaneal fusion is generally reserved for complex cases such as severe deformity or bone loss, infection, Charcot and revision procedures. Subsequently published series have been small and there are no studies comparing plate fixation and intramedullary nailing. We present the outcomes in the largest series to date and have also compared the union rate and complication rate between blade plate fixation (36) and intramedullary nailing (46). Both groups were well matched for patient and disease factors.

There was a non-statistically significant trend towards better outcomes with nails. Further analysis was conducted comparing the two fixation methods by the indication for surgery, there were no statistically significant differences, the reasons for these findings are discussed.