Tibio-talar-calcaneal (TTC) fusion is a salvage procedure designated for treating various severe hindfoot pathologies. While traditional methods have been effective, the advantage of carbon fiber (CF) retrograde intramedullary nailing (RIMN) presents a potentially superior technique. This study evaluates the efficacy and safety of CF RIMN in TTC fusion, focusing on union rates, complication rates, and patient-reported outcomes.

Conducted as a single-center, retrospective study, this research involved 21 patients who underwent TTC with CF RIMN from 2015 to 2021. Patient selection excluded those with active infections or those needing significant bone allografts. Patient follow-up was conducted at multiple intervals postoperatively, with a minimum follow-up of 24 months, assessing for union complications and using tools like the VAS, SF12, and AOFAS for patient-reported outcomes.

The study observed a 90% union rate among patients. Complication rates included a 14% incidence of iatrogenic fractures to the anterior tibial cortex and 19% postoperative complications. Significant improvement was noted in VAS scores but not in SF12 and AOFAS scores. The use of 200 mm RIMN was identified as requiring careful consideration due to associated complications.

CF RIMN in TTC fusion demonstrates a high union rate with notable complications. The significant improvement in VAS scores indicates patient satisfaction, but the lack of statistical significance in SF12 and AOFAS scores warrants attention. The findings advocate for the cautious use of 200 mm RIMN and highlight the need for further research, suggesting prospective, multicenter studies to validate these findings and explore long-term outcomes.

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