Assessing the role of posterior to anterior calcaneal screw fixation in tibiotalocalcaneal nailing after ankle trauma: A retrospective comparative study

Tibiotalocalcaneal (TTC) nailing is commonly used to treat severe ankle trauma, especially in patients with poor bone quality or compromised soft tissue. Although biomechanical studies suggest that posterior-to-anterior (P-A) screws enhance stability, the clinical impact of these screws remains uncertain. This study aims to compare complication rates between patients who underwent TTC nailing with and without P-A screws after ankle trauma. A retrospective analysis was conducted on 33 patients who underwent TTC nailing for ankle trauma between 2016 and 2022. Patients were divided into two groups: those who received P-A screws (n = 13) and those who did not (n = 20). Demographic and surgical variables, including age, comorbidities, and operative factors, were analyzed. Complication rates were compared using nonparametric Wilcoxon rank sum and Fisher's exact tests. Significance was set at p < 0.05. The mean age of patients was 70.5 years, with 63.6 % female and 36.4 % diabetic. The overall major complication rate was 15.1 %, with no statistically significant difference between the P-A screw group and the non-P-A screw group (p = 1.00). Other factors, including age (p = 0.24), time to weightbearing (p = 1.00), and the presence of comorbidities such as diabetes or peripheral arterial disease, did not significantly impact complication rate. Our study found no significant difference in complication rates between patients who received P-A screws during TTC nailing and those who did not. Despite biomechanical studies supporting P-A screws for increased stability, this did not translate to improved clinical outcomes. Further prospective research is warranted to evaluate the clinical relevance of P-A screws in TTC nailing for ankle trauma.