{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T09:03:50Z","timestamp":1779699830983,"version":"3.53.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Orthop Surg (Hong Kong)"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Tibiotalocalcaneal (TTC) arthrodesis is a well-established treatment for end-stage ankle arthritis. In patients with prior lateral malleolar fixation, the role of the fibula during arthrodesis remains controversial. While some surgeons prefer fibular preservation as an onlay graft, concerns exist regarding its biological viability after previous surgical interventions. This study aimed to compare clinical and radiological outcomes of fibular excision versus fibular onlay grafting in this specific patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective comparative study included patients who underwent TTC arthrodesis using retrograde intramedullary nailing following prior plate-and-screw fixation of the lateral malleolus. Patients were divided into two groups based on surgical technique: fibular excision and fibular preservation as an onlay graft. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale (VAS) for pain. Radiological evaluation included time to union. The primary outcome was postoperative pain assessed using the Visual Analog Scale (VAS), while secondary outcomes included AOFAS score, time to union, operative time, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 37 patients were included in the final analysis. Baseline characteristics were comparable between the groups. Both techniques resulted in significant improvement in AOFAS scores, with no significant difference between groups (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.825). Postoperative VAS scores were significantly lower in the fibular excision group (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.011), and this difference was supported by a moderate effect size (Cohen\u2019s d = 0.45), indicating clinical relevance. Time to union was similar between groups (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.945). Operative time was significantly shorter in the fibular excision group (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with prior lateral malleolar fixation, preserving the fibula as an onlay graft during TTC arthrodesis does not improve union or functional outcomes. Instead, fibular excision is associated with shorter operative time and lower postoperative pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10225536261453550","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T11:11:26Z","timestamp":1779534686000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fibular onlay grafting does not improve clinical or radiological outcomes but increases operative time in tibiotalocalcaneal arthrodesis after prior lateral malleolar fixation: A retrospective comparative study"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4020-9488","authenticated-orcid":false,"given":"Adem","family":"Sahin","sequence":"first","affiliation":[{"name":"Istanbul University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3772-1699","authenticated-orcid":false,"given":"Ali","family":"Ozyalcin","sequence":"additional","affiliation":[{"name":"Izmir Bak\u0131rcay University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2344-7801","authenticated-orcid":false,"given":"Anil","family":"Agar","sequence":"additional","affiliation":[{"name":"Firat University Hospital, Firat University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6646-0163","authenticated-orcid":false,"given":"Fatih","family":"\u015eent\u00fcrk","sequence":"additional","affiliation":[{"name":"Istanbul University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1607-5432","authenticated-orcid":false,"given":"Soner","family":"Kocak","sequence":"additional","affiliation":[{"name":"Istanbul University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9225-917X","authenticated-orcid":false,"given":"Cemil","family":"Erturk","sequence":"additional","affiliation":[{"name":"Istanbul University of Health Sciences Kanuni Sultan Suleyman Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0543-6"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23462"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2010.07.004"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1071100714523270"},{"key":"e_1_3_7_6_2","first-page":"102","article-title":"A method of ankle stabilization","volume":"268","author":"Stone KH","year":"1991","unstructured":"Stone KH, Helal B. A method of ankle stabilization. Clin Orthop Relat Res 1991; 268: 102\u2013106.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.30B3.506"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-07025-1"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-46034-x"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3548-1"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.03.031"},{"key":"e_1_3_7_12_2","first-page":"101100","article-title":"Transfibular ankle arthrodesis with use of sagittally split fibula as a biological plate leads to excellent outcome: a retrospective analysis","volume":"38","author":"Kumar DV","year":"2023","unstructured":"Kumar DV, Kar S, Mittal R, et al. Transfibular ankle arthrodesis with use of sagittally split fibula as a biological plate leads to excellent outcome: a retrospective analysis. J Clin Orthop Trauma 2023; 38: 101100.","journal-title":"J Clin Orthop Trauma"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200312000-00022"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.bot.0000184142.90448.e3"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070002101002"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2015.01.001"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1590\/1413-785220233105e267148"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2007.0431"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070502601004"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-023-05097-1"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fas.2019.08.015"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2018.10.3.368"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2021.02.006"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200203000-00020"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12570-014-0254-2"},{"issue":"5","key":"e_1_3_7_27_2","first-page":"644","article-title":"The success of tibiotalocalcaneal arthrodesis with intramedullary nailing: a systematic review of the literature","volume":"77","author":"Jehan S","year":"2011","unstructured":"Jehan S, Shakeel M, Bing AJ, et al. The success of tibiotalocalcaneal arthrodesis with intramedullary nailing: a systematic review of the literature. 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