Reaming-induced joint surface destruction in tibiotalocalcaneal nailing: a cadaveric comparison of straight and valgus-curved nails

Abstract Background Tibiotalocalcaneal (TTC) nailing has become an increasingly preferred option for the treatment of complex ankle pathologies and fragility fractures, particularly in geriatric patients. Despite its growing clinical use, limited data are available regarding how different nail designs impact joint surface integrity during intraoperative preparation. This cadaveric study aimed to compare the articular surface destruction caused by straight and valgus-curved TTC nails. Methods 20 fresh-frozen cadaveric lower limbs (mean age 70.1 ± 4.1 years) were randomized to receive either a straight or a valgus-curved TTC nail (n = 10 per group). All procedures were performed by a single experienced orthopedic surgeon without formal joint debridement. After reaming, four joint surfaces—calcaneal posterior facet (CPF), talar posterior facet (TPF), talar dome (TD), and tibial plafond (TP)—were dissected and digitally analyzed using ImageJ software to measure total and reamed areas. Joint destruction (%) and articular reaming (%) were calculated and compared between groups. Results Valgus-curved nails resulted in significantly greater joint destruction in CPF (12% vs. 6%, p = 0.018) and TPF (15% vs. 8%, p = 0.007) compared to straight nails. Articular reaming was also higher in the valgus-curved nails for both CPF (56% vs. 31%, p = 0.012) and TPF (79% vs. 43%, p = 0.004). No significant differences were found in TD or TP for either parameter (all p > 0.05). Conclusion Reaming for valgus-curved TTC nails yielded greater destruction of subtalar joint surfaces than straight nails, but the amount remained below 15%. These findings emphasize the impact of nail design on reaming-induced articular surface destruction during intraoperative preparation and provide quantitative anatomic data on the extent of joint surface involvement.