Surgical restoration of the function of the tibialis anterior muscle can be beneficial regardless of age, sex, medical comorbidity, or delay in diagnosis. Early surgical treatment may be less complicated than delayed treatment, and an intercalated free tendon graft and/or gastrocnemius recession may be necessary to achieve an appropriately tensioned and balanced repair.

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BACKGROUND: Achieving stable fixation when performing tibiotalocalcaneal arthrodesis can be challenging, especially in osteopenic bone. The purpose of the current investigation was to compare the stiffness and fatigue endurance of blade-plate-and-screw fixation with intramedullary rod fixation in a cadaveric model. METHODS: In ten matched pairs of freshfrozen cadaveric legs, a tibiotalocalcaneal arthrodesis was performed with use of a blade-plate and a 6.5-mm sagittal screw in one leg and with use of an intramedullary rod in the contralateral leg. After an initial load-deformation curve was obtained, each specimen was loaded to 270 N through 250,000 cycles at a rate of 3 Hz. RESULTS: Blade-plate-and-screw fixation resulted in significantly higher mean initial and final stiffness and decreased plastic deformation than did intramedullary rod fixation. In addition, there was an inverse correlation between bone-mineral density and the difference in plastic deformation noted between the specimens of each pair. CONCLUSIONS: Blade-plate fixation is biomechanically superior to intramedullary fixation for tibiotalocalcaneal arthrodesis.

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