Arthroscopic versus open hindfoot fusion using a retrograde tibiotalocalcaneal nail
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Bibliographic record
Abstract
Purpose: Tibiotalocalcaneal (TTC) fusions are often performed as a salvage procedure in patients with severe hindfoot arthritis or hindfoot deformity. Comorbidities in this patient cohort are frequent, leading to increased risk of postoperative complications. Arthroscopic debridement may afford better wound healing and possible improvement of blood supply. This study compares the outcome of a challenging set of patients undergoing TTC fusion with either arthroscopic or open technique. Methods: For this cohort study, the data for patients undergoing TTC fusion from 2009 to 2018 was prospectively collected and the study design is retrospective. 58 consecutive cases were identified; in 51 cases a TTC fusion was performed while in 7 cases a tibiotalar fusion was performed in the setting of a preexisting talocalcaneal fusion. Arthroscopic technique was used in 22 fusions and open technique in 36 fusions. Results: An overall union rate of 89.7% was achieved. Five tibiotalar non-unions and one non-union of both the tibiotalar and talocalcaneal joints was documented. In the arthroscopic fusion group the non-union rate was 9.1% while in the open group it was 11.1%. The overall reoperation rate was 17%. No patient in the arthroscopic fusion group required a reoperation, whereas in the open group the reoperation rate was 27.8%. In patients with PROs the AOS score improved from 53.1 to 26.2 for the arthroscopic group and from 57.2 to 32.3 for the open group. The satisfaction score improved from 1.4 to 2.7 in the arthroscopic group, and 1.1 to 2.8 in the open group. Conclusions: Arthroscopic TTC fusions are a viable alternative to the open procedure. Nonunion rates are similar, while wound complication rates and reoperation rates are lower. Outcomes measured by PROs are comparable. Level of Evidence: Level IV, case cohort study.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it