Abstract
BACKGROUND: Tibiotalocalcaneal (TTC) arthrodesis is an established treatment for osteoarthritis (OA), offering stabilization and earlier weightbearing. However, its role in managing traumatic fractures (TFs) remains controversial because of higher risks of complications. This study aimed to compare complication rates, readmissions, and predictors of adverse outcomes in TTC arthrodesis performed for OA vs TF using a national database. METHODS: A retrospective cohort study was conducted using the Nationwide Readmissions Database (2016-2021). Patients undergoing TTC arthrodesis were identified via International Classification of Diseases, Tenth Revision (ICD-10) codes and stratified by indication (OA or TF). Primary outcomes included complication rates, 30- and 90-day readmissions, and revision surgeries. Multivariable logistic regression identified independent predictors of complications. Propensity score matching (PSM) was performed to account for baseline differences. RESULTS: TF cases exhibited significantly higher complication rates (54.5% vs 16.0%, P < .001), including malunion (11% vs 2%, P < .001) and cellulitis (5% vs 1%, P < .001). Readmission rates were also elevated in TF patients at 30 days (17% vs 3%, P < .001) and 31-90 days (14% vs 4.8%, P < .001). Logistic regression identified chronic kidney disease, diabetes, and obesity as independent predictors of complications. PSM confirmed these findings, demonstrating significantly higher rates of complications and readmissions in TF patients. DISCUSSION: Findings indicate that TTC arthrodesis for TF is associated with higher risks of complications and readmissions compared with OA, attributable to acute injury characteristics and surgical complexity. Chronic comorbidities further exacerbate these risks. Optimizing perioperative management and timing of surgery in TF patients may mitigate complications. This study highlights the need for individualized care strategies to improve outcomes in TTC arthrodesis for trauma. LEVEL OF EVIDENCE: Level III, therapeutic: case-control study.