About

Sheldon S. Lin, MD, is an Associate Professor in the Department of Orthopaedics at Rutgers New Jersey Medical School. He completed his undergraduate studies at Pennsylvania State University and received his medical doctorate from Jefferson Medical College of Philadelphia. Dr. Lin completed his residency in Orthopaedic Surgery at Thomas Jefferson University Hospital and further specialized with a Foot and Ankle Fellowship at the Medical College of Wisconsin under renowned mentors. Since joining the faculty in 1996, he has lectured extensively on trauma, tendon abnormalities, and disorders of the foot and ankle, particularly in diabetic patients. Dr. Lin has published numerous scientific articles on advanced medical techniques such as subtalar arthrodesis, non-operative treatment of posterior tibial tendon dysfunction, and Tendo-Achilles lengthening for equinus contracture in diabetic patients with ulcers. His research interests include foot and ankle injuries, fracture healing in diabetes mellitus, and innovative approaches to bone repair, including the development of artificial periosteum and bioactive grafts to enhance bone regeneration. He is board-certified in Orthopaedic Surgery with a specialization in Foot and Ankle Surgery and is affiliated with University Hospital, Overlook Hospital, and Morristown Memorial Hospital.

Research topics

• Chemistry
• Endocrinology
• Cell biology
• Biochemistry
• Surgery
• Medicine
• Biology
• Intensive care medicine
• Radiology

Selected publications

• Comparative outcomes of autograft versus rhPDGF-BB in rearfoot and ankle arthrodesis: A propensity-matched TriNetX analysis

  The Journal of Foot & Ankle Surgery · 2026-04-01

  articleOpen accessSenior author

  BACKGROUND: Recent evidence suggests that recombinant human platelet-derived growth factor (rhPDGF-BB) may enhance fusion and reduce donor-site morbidity in foot and ankle arthrodesis. However, direct large-scale comparisons between those receiving autograft and rhPDGF-BB remain limited, particularly for high-risk or revision procedures. PURPOSE: To address this gap, we utilized the TriNetX research database to compare fusion outcomes and complication profiles between rhPDGF-BB and autograft in tibiotalocalcaneal (TTC), pantalar, or triple arthrodesis. METHODS: The TriNetX database for patients who underwent tibiotalocalcaneal, pantalar, or triple arthrodesis from 2003 to 2023, with at least one-year follow-up. A 1:1 propensity score match controlled for age, sex, body mass index, nicotine dependence, and comorbidities. Postoperative complications included implant-related infection, surgical site infection, superficial skin infection, infection-related reoperation, wound disruption, osteolysis, nonunion, and hardware removal. Statistical analyses were conducted on TriNetX using Z-tests for pairwise comparisons, with significance set at p < 0.05. RESULTS: A total of 209 patients in the rhPDGF-BB cohort and 7,109 in the autograft cohort were identified. The rhPDGF-BB cohort was older and had higher rates of diabetes, HIV, and several other comorbidities (all p < 0.05). After propensity matching (n = 208 per cohort), the rhPDGF-BB cohort had a lower nonunion rate (OR 0.36; 95% CI 0.19-0.69; p = 0.001) with no other significant outcome differences. CONCLUSION: Our findings suggest that rhPDGF-BB may be associated with lower nonunion rates compared with autograft without increased complications. Given the observational design, these results should be considered hypothesis-generating and warrant validation in prospective randomized studies.

  PublisherDOI

• Assessing the Impact of SGLT2i on Outcomes Following Hindfoot Arthrodesis: A TriNetX Analysis

  Foot & Ankle Orthopaedics · 2026-01-01

  articleOpen accessSenior author

  Category: Hindfoot, Other Keywords: Hindfoot Fusion, Hindfoot Arthrodesis, Obesity Introduction/Purpose: Sodium–glucose cotransporter-2 inhibitors (SGLT2i) have gained widespread use in patients with type 2 diabetes mellitus (T2DM) due to their cardiometabolic benefits, and their popularity continues to grow. Recent evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may improve orthopaedic outcomes, including postoperative recovery, however, whether SGLT2i exert a similar effect on bone healing and surgical outcomes is unknown. Hindfoot arthrodesis procedures, including ankle, triple, and subtalar arthrodesis carry substantial risks of pseudarthrosis and infection. This study aimed to evaluate the association between SGLT2i use and clinical outcomes following hindfoot arthrodesis in patients with T2DM. Methods: We performed a retrospective analysis using the TriNetX US Collaborative Network, which aggregates electronic health records from 71 health care organizations. Patients with T2DM undergoing ankle, triple, or subtalar arthrodesis between 2005–2025 were identified. Two cohorts were created: patients prescribed SGLT2i within one year prior to surgery (n=561) and those without SGLT2i exposure (n=9,012). Outcomes included pseudarthrosis (ICD-10 M96.0) and postsurgical infection (ICD-10 T81.4) within 12 months postoperatively. Propensity score matching was applied for age, sex, race, comorbidities, hemoglobin A1c, body mass index (BMI), and renal function, resulting in 556 patients per group. Risk ratios, odds ratios, and Kaplan–Meier survival analyses were performed, with significance set at p&lt;0.05. This study design ensured balance across metabolic and demographic factors known to influence bone healing and infection risk. Results: Following matching, baseline demographics, HbA1c levels, BMI, and renal function were comparable between groups. Failure to achieve fusion occurred in 10.0% of SGLT2i users versus 18.7% of non-users (risk ratio 0.53, 95% CI 0.39–0.73, p&lt;0.001). Kaplan–Meier analysis demonstrated significantly improved probability of maintained fusion among SGLT2i users (HR 0.53, 95% CI 0.38–0.75, p&lt;0.001). The mean number of pseudarthrosis instances was also significantly lower among SGLT2i patients (0.40 vs 0.73, p=0.013). Postsurgical infection rates did not differ significantly (10.8% vs 8.3%, p=0.15), and survival analysis confirmed no increased hazard of infection with SGLT2i exposure (HR 1.35, 95% CI 0.92–1.99, p=0.21). Conclusion: In this multicenter analysis, SGLT2i use was associated with a significantly reduced risk of pseudarthrosis following hindfoot arthrodesis in patients with T2DM, without elevating infection risk. Beyond glycemic control, SGLT2i exert systemic effects—reducing insulin resistance, lowering advanced glycation end products, decreasing inflammation, and improving renal and cardiovascular function—that may create a more favorable biological environment for bone healing. The observed benefit is consistent with these mechanisms and highlights the importance of optimizing metabolic status in surgical patients. Future prospective studies should validate these findings and clarify the direct role of SGLT2i in promoting arthrodesis.

  PublisherDOI

• Comparative Outcomes of Autograft vs rhPDGF-BB in Tibiotalocalcaneal, Pantalar, or Triple Arthrodesis: A Propensity-Matched TriNetX Analysis

  Foot & Ankle Orthopaedics · 2025-10-01

  articleOpen accessSenior author

  Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Recent studies have suggested that recombinant human platelet-derived growth factor (rhPDGF-BB) may facilitate fusion and reduce donor-site morbidity in foot and ankle arthrodesis. However, direct large-scale comparisons between those receiving autograft and rhPDGF-BB remain limited – particularly for high-risk or revision procedures. Existing trials indicate promising outcomes in older patient populations, yet questions remain regarding efficacy, safety, and cost-benefit in broader clinical practice. To address this gap, we utilized the TriNetX research database to investigate whether rhPDGF-BB confers comparable or superior fusion outcomes and complication profiles compared to autografts. Methods: The TriNetX database was queried using CPT and ICD codes to identify patients undergoing tibiotalocalcaneal (TTC), pantalar, or triple arthrodesis from 2003 to 2023, with a minimum of one-year follow-up. Patients were divided into autograft and rhPDGF-BB cohorts. Demographics, comorbidities, and Charlson Comorbidity Index (CCI) scores were collected. Total complication rates within one-year post-op, including prosthetic joint infections, surgical site infections, superficial skin infections, infection-related return to operating room, wound disruption, osteolysis, nonunion, and hardware removal, were also collected. A 1:1 propensity score matched analysis was performed based on age, sex, body mass index (BMI), nicotine dependence, and select comorbidities. Statistical analyses were conducted on TriNetX using Z-tests for pairwise comparisons, with significance set at p&lt; 0.05. All results are shown in Table 1. Results: A total of 172 patients in the rhPDGF-BB cohort and 6,741 in the autograft cohort were identified. The rhPDGF-BB cohort was older (59.6 vs. 56.8 years, p = 0.012) and had higher rates of diabetes (34.9% vs. 27.1%, p = 0.023), HIV (16.3% vs. 11.0%, p = 0.030), and several comorbidities, including chronic lower respiratory disease, liver disease, dementia, peptic ulcers, nicotine dependence, malignancy, myocardial infarction, and stroke (all p &lt; 0.05). After propensity matching (n = 172 per cohort), the rhPDGF-BB cohort had a lower nonunion rate (OR 0.354, 95% CI 0.165-0.760, p = 0.006) with no other significant outcome differences (Table 2). Conclusion: Our propensity-matched analysis supports the growing evidence favoring rhPDGF-BB as an effective alternative to autograft, demonstrating a significantly lower nonunion rate without increased complications. These findings underscore the potential for rhPDGF-BB to address high-risk scenarios while mitigating morbidity associated with autograft harvest. Future prospective, randomized studies are warranted to validate these outcomes, elucidate long-term cost-effectiveness, and optimize patient selection. Overall, our results highlight the value of biologic adjuncts in advancing care for complex hindfoot and ankle arthrodeses, offering clinicians additional tools for improving fusion rates and reducing procedural morbidity.

  PublisherDOI

• Cost-Effectiveness Thresholds for Venous Thromboembolism Prophylaxis in Ankle Fracture Surgery: A Break-Even Analysis

  Foot & Ankle Orthopaedics · 2025-07-01

  articleOpen accessSenior author

  Background: The role of venous thromboembolism (VTE) chemoprophylaxis following ankle fracture surgery remains controversial. Although pharmacologic prophylaxis is standard in major orthopaedic procedures, its utility in foot and ankle trauma surgery is unclear because of low reported VTE rates and potential bleeding risks. Furthermore, no consensus exists on the cost-effectiveness of prophylactic agents in this population. Methods: A literature review and the TriNetX Research Network were used to identify postoperative symptomatic VTE rates following ankle open reduction internal fixation (ORIF). The cost of treating a symptomatic VTE was estimated from existing literature and adjusted to 2025 US dollars. Drug pricing data were obtained from an online pharmacy database. A break-even analysis was conducted to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) for each agent to be cost-effective. A subanalysis compared 30-day bleeding and transfusion rates between patients who received prophylaxis and those who did not. Results: The low and high literature-based VTE rates were 0.33% and 1.2%, whereas the TriNetX-derived VTE rate was 0.56%. Among 64 184 patients undergoing ankle ORIF without prophylaxis, 384 developed a symptomatic VTE. Aspirin (81 mg and 325 mg) and warfarin (5 mg) were cost-effective at all 3 VTE rates, with NNTs ranging from 9217 to 10 547. Enoxaparin (40 mg) was only cost-effective at the highest VTE rate (NNT = 131), whereas rivaroxaban (20 mg) was not cost-effective at any rate. Enoxaparin and rivaroxaban became cost-effective only when VTE treatment costs exceeded $50 000 and $1 500 000, respectively. Patients receiving prophylaxis had higher bleeding (0.56% vs 0.26%) and transfusion (0.82% vs 0.25%) rates ( P &lt; .001). Conclusion: In summary, this study found that aspirin 81 mg, aspirin 325 mg, and warfarin are cost-effective for VTE chemoprophylaxis following ankle fracture fixation. Enoxaparin and rivaroxaban are generally not cost-effective, and their use may be appropriate only in high-risk patients. Level of Evidence: Level IV, economic analysis.

  PublisherDOI

• Binding of zinc to processed human bone allograft and potential use of zinc as an anti-microbial agent

  Exploration of BioMat-X · 2025-07-07 · 1 citations

  articleOpen access

  Aim: Zinc is essential for normal bone growth and can promote bone regeneration. Processed human bone allograft treated with zinc shows improved bone formation activity. Various factors were tested for effects on zinc binding to bone allograft with the long-term goal of developing methods to enhance the bone formation activity and safety of bone allograft in orthopaedic applications. Methods: The amount of zinc bound to allograft was measured using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). Fluorescent visualization of zinc bound to allograft was accomplished using Zinpyr-1. The potential anti-microbial property of zinc-treated allograft was measured by exposing allograft to Staphylococcus aureus. After washing, the exposed allograft was cultured in bacterial media to measure residual Staphylococcus aureus. Data were analyzed using standard parametric methods. Results: Rapid binding of zinc to bone allograft (1–15 min) was relatively insensitive to zinc concentration, incubation time, pH, or divalent cation competition. In contrast, zinc salt counter ions had significant effects, with zinc acetate producing more rapid zinc binding than zinc chloride or zinc picolinate. The ability of Staphylococcus aureus to contaminate bone allograft was also significantly reduced by prior zinc treatment. Conclusions: The study results provide guidelines for modifying the processing of bone allograft to enhance bone formation activity while also improving the resistance of the allograft to bacterial contamination.

  PublisherOA PDFDOI

• Impact of Local Vancomycin on Postoperative Outcomes in Ankle Arthrodesis: A Propensity-Matched Cohort Study

  JAAOS Global Research and Reviews · 2025-10-01 · 2 citations

  articleOpen accessCorresponding

  INTRODUCTION: In orthopaedic surgery, intrawound vancomycin has become a widely used strategy to reduce the incidence of surgical site infections, commonly caused by gram-positive microorganisms. This study evaluated the incidence of postoperative orthopaedic complications in patients undergoing ankle arthrodesis with and without the use of intrawound vancomycin. METHODS: This retrospective study used data from the TriNetX Research Network to identify patients who underwent ankle arthrodesis between October 1, 2002, and October 1, 2022. This population was divided into two cohorts: patients who received perioperative cefazolin and local vancomycin (cefazolin-vancomycin) and patients who received perioperative cefazolin but no local vancomycin (cefazolin-only). This study assessed rates of implant-related complications occurring within 2 years of the arthrodesis. RESULTS: A total of 374 patients in the cefazolin-vancomycin cohort and 5,218 in the cefazolin-only cohort were identified, with an average age of 58.0 ± 14.0 years and 56.6 ± 14.6 years, respectively (P = 0.083). Before matching, the cefazolin-vancomycin cohort had higher rates of comorbidities, including diabetes (30% vs. 21%, P < 0.001), obesity (32% vs. 21%, P < 0.001), and liver disease (13% vs. 5%, P < 0.001). After propensity matching, each cohort had 373 patients. The cefazolin-vancomycin group demonstrated a significantly lower risk of nonunion (13% vs. 19%, P = 0.020), whereas other outcomes showed no statistically significant differences. CONCLUSION: This study evaluated the incidence of postoperative complications in patients undergoing ankle arthrodesis with and without intrawound vancomycin. The analysis demonstrated a markedly lower nonunion rate in the cefazolin-vancomycin group (13%) compared with the cefazolin-only group (19%), aligning with previously reported rates but lower than those seen in high-risk populations. These findings suggest that local vancomycin administration may mitigate nonunion risk and optimize fusion outcomes in ankle arthrodesis by reducing infection.

  PublisherDOI

• Antiphospholipid Syndrome in Orthopaedic Foot and Ankle Surgery: A Propensity-Matched Analysis

  Foot & Ankle Orthopaedics · 2025-10-01

  articleOpen accessSenior author

  Background: Antiphospholipid syndrome (APS) is a systemic autoimmune disorder associated with a heightened risk of thromboembolic events. The purpose of this study is to evaluate the impact of APS on medical and surgical postoperative outcomes following foot and ankle surgery. Methods: Using the TriNetX Research Network, we identified patients undergoing foot and ankle surgery between 2004 and 2024. APS patients with and without postoperative venous thromboembolism (VTE) prophylaxis were matched 1:1 with controls based on demographics and comorbidities. Outcomes within 30 and 90 days postoperatively were compared, including thromboembolic events. Preoperative laboratory test values were also assessed in a subset of APS patients not on anticoagulation. Results: At 90 days postoperatively, APS patients receiving VTE prophylaxis (APS+VTE) (n = 524) had significantly higher rates of deep vein thrombosis (13.4% vs 9.0%, P = .024), but similar rates of stroke and pulmonary embolism compared to patients without APS receiving VTE prophylaxis (Control+VTE). Anemia was significantly less common in the APS+VTE group at 30 days (14.7% vs 22.3%, P = .001) and 90 days (16.4% vs 23.9%, P = .003). APS patients without postoperative anticoagulation (APS–VTE) (n = 932) had a higher rate of pulmonary embolism at 90 days (5.8% vs 3.3%, P = .011) compared to patients without APS and VTE prophylaxis (Control–VTE). Anticoagulation-naïve APS patients demonstrated significantly higher preoperative International Normalized Ratio (1.64 vs 1.09, P &lt; .001), prothrombin time (17.7 vs 12.3, P &lt; .001), activated partial thromboplastin time (38.6 vs 29.2, P &lt; .001), serum creatinine (1.08 vs 0.94, P &lt; .001), estimated dry weight (14.3 vs 13.7, P &lt; .001), along with urea nitrogen (17.0 vs 15.9, P &lt; .001), sodium (139.13 vs 139.25, P = .001), potassium (4.14 vs 4.10, P = .012), and bicarbonate (26.2 vs 25.8, P &lt; .001) compared with matched controls. Conclusion: APS patients undergoing foot and ankle surgery had significantly higher thromboembolic event rates than controls, even with anticoagulation, and those who received anticoagulation had lower anemia rates, suggesting differential bleeding risk. Level of Evidence: Level III, retrospective cohort study.

  PublisherDOI

• A Comparative Analysis of Subtalar and Ankle Arthrodesis in Patients With and Without Prior Ipsilateral Fusion

  Foot & Ankle Orthopaedics · 2025-10-01

  articleOpen access

  Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Subtalar arthrodesis is a widely performed procedure for managing arthritis, calcaneal fractures, deformities, and instability of the hindfoot. Some studies suggest that prior ankle arthrodesis may negatively impact subtalar fusion due to altered joint biomechanics and vascular supply, but evidence remains limited. Few direct comparisons exist between patients with and without prior ankle fusion, leaving uncertainty about its true effect on fusion outcomes. This study, one of the largest of its kind, examines subtalar fusion rates in patients with and without previous ipsilateral ankle arthrodesis. A secondary objective of this study is to examine ankle fusion rates in patients with and without previous ipsilateral subtalar arthrodesis. Methods: This retrospective study utilized data from the TriNetX Research Network to identify patients who underwent a subtalar fusion with (primary ankle + subtalar) and without (subtalar-only) previous ipsilateral ankle arthrodesis between February 20, 2004, and February 20, 2024. A secondary analysis examined those who underwent an ankle fusion with (primary subtalar + ankle) and without (ankle-only) previous ipsilateral subtalar arthrodesis. Patients with a previous nonunion diagnosis or less than one year of follow-up were excluded. Propensity score matching (1:1) controlled for age, sex, BMI, and several comorbidities. Primary outcomes included one-year rates of nonunion and hardware removal. Risk differences with 95% confidence intervals were calculated, and significance was determined using Z-tests (p &lt; 0.05). Results: Before matching, there were 162 patients in the primary ankle + subtalar group and 10,144 patients in the subtalar-only group. Additionally, there were 131 patients in the primary subtalar + ankle group and 5,032 patients in the ankle-only group. There were no significant differences in orthopaedic complications between the primary ankle + subtalar group and subtalar-only groups, including rates of nonunion (14.3% vs. 20.5%, p = 0.142) and hardware removal (15.5% vs. 12.4%, p = 0.422). In the secondary analysis between the primary subtalar + ankle and ankle-only groups, there were no significant differences in nonunion rates (10.0% vs. 15.4%, p = 0.192) or rates of hardware removal (16.2% vs. 12.3%, p = 0.375). Conclusion: This study found no significant differences in nonunion or hardware removal rates between patients undergoing subtalar arthrodesis with and without prior ipsilateral ankle fusion. Similarly, in the secondary analysis, prior subtalar fusion did not significantly impact ankle arthrodesis outcomes. These findings suggest that previous arthrodesis at an adjacent joint does not increase the risk of nonunion or hardware-related complications in subtalar or ankle fusion procedures. Given the lack of evidence for a negative impact, surgeons may view prior ankle or subtalar arthrodesis as less of a contraindication when planning fusion procedures, allowing for greater flexibility in surgical decision-making.

  PublisherDOI

• Trimalleolar Ankle Fracture Management in High-Risk Populations: Tibiotalocalcaneal Arthrodesis vs Open Reduction Internal Fixation

  Foot & Ankle Orthopaedics · 2025-10-01

  articleOpen access

  Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Trimalleolar ankle fractures are challenging, especially in older adults with multiple comorbidities, however there are many options for operative management of these fractures. Tibiotalocalcaneal arthrodesis (TTCA) can be performed with smaller incisions, under local anesthesia, and in less operative time compared to open reduction and internal fixation (ORIF), highlighting its utility as a surgical approach to high-risk ankle fractures. Despite its appeal, outcome data comparing TTCA and ORIF remain sparse. This analysis assessed complication rates in high- and low-risk populations, aiming to determine if TTCA confers benefits or results in increased complications within these distinct risk cohorts. Methods: A retrospective analysis using the Nationwide Readmissions Database was performed on patients with trimalleolar ankle fractures who underwent either TTCA or ORIF. High-risk status was defined as age ≥ 60 years and at least one of the following comorbidities: diabetes mellitus, hypertension, chronic kidney disease, osteoporosis, obesity, morbid obesity, and heart failure. Low-risk status applied to patients aged less than 60 with none of the mentioned comorbid conditions. The sole outcome measure was overall complication rate, comprising wound dehiscence, cellulitis, thromboembolism, nonunion, malunion, infection, and hardware failure. Comparisons were made using Chi-Square tests between TTCA and ORIF within each risk group, as well as between high- and low-risk patients within each treatment modality. Statistical significance was set at p &lt; 0.05. All analyses were performed using IBM SPSS, ensuring consistency in data management and reporting. Results: A total of 306 patients undergoing ORIF were compared to 252 patients undergoing TTCA. Of the 252 in the ORIF cohort, 134 were identified as high-risk, while in the TTCA cohort, there were 118 cases deemed high-risk. In high-risk patients, TTCA was associated with a significantly higher overall complication rate (42%) compared to ORIF (18%; p &lt; 0.05). Among low-risk patients, TTCA also had a higher complication rate (32%) than ORIF (8%; p &lt; 0.05). Within the ORIF group, high-risk patients experienced complications more than twice as often as low-risk patients (18% vs 8%; p &lt; 0.05). Although high-risk TTCA patients likewise demonstrated higher complication rates than their low-risk counterparts (42% vs 32%), this difference was not statistically significant (Figure 1). Conclusion: Although TTCA may offer theoretical advantages for high-risk patients—such as a reduced incision size and potential for local anesthesia—this analysis found higher complication rates with TTCA. These findings suggest that TTCA may not be a better option than ORIF for operative repair of trimalleolar ankle fractures, although the results of this study may be influenced by the possibility that TTCA is reserved for cases of greater fracture severity as compared to cases that undergo ORIF. Ultimately, further research is needed to refine patient selection and reduce complication rates in high-risk populations.

  PublisherDOI

• Use of Sustained Compression to Mitigate Nonunion in Tibiotalocalcaneal Arthrodesis: A Propensity Score–Matched Nationwide Readmissions Database Analysis

  Journal of the American Academy of Orthopaedic Surgeons · 2025-04-15 · 4 citations

  articleCorresponding

  INTRODUCTION: Tibiotalocalcaneal (TTC) arthrodesis is a critical surgical intervention for advanced hindfoot and ankle pathologies, offering pain relief, stabilization, and functional alignment restoration. Intramedullary nail fixation, particularly with dynamic compression (DC) nails, has emerged as a promising solution for addressing high nonunion rates associated with standard static compression (SC) nails. This study compares union and complication rates between DC and SC nails in TTC arthrodesis using the Nationwide Readmissions Database. METHODS: This retrospective cohort study used the Nationwide Readmissions Database to identify cases of TTC fusion with DC and SC nails based on ICD-10-PCS codes. Propensity score matching (1:1) controlled for confounders, including age, sex, and comorbidities. Primary outcomes included complications such as thromboembolism, wound dehiscence, cellulitis, implant-related complications, nonunion, malunion, and infections. Secondary outcomes included 30-day and 31-90-day readmission rates. Statistical significance was set at P < 0.05. RESULTS: The study analyzed 311 cases (149 with DC, 162 with SC). Demographic and comorbidity distributions were balanced after matching. Nonunion rates were significantly lower in the DC group (6.0%) compared with the SC group (17.3%; P = 0.002). Overall complication rates were comparable (DC: 30.2% vs. SC: 35.2%, P = 0.350). DISCUSSION: DC devices demonstrated markedly reduced nonunion rates compared with SC nails, likely because of the continuous compression provided by the nitinol-based design. This novel finding validates the biomechanical advantages of devices using DC in TTC fusion and aligns with previous research advocating for such devices. CONCLUSION: DC nails offer an advancement in TTC arthrodesis by markedly reducing nonunion rates. Future studies should focus on cost-effectiveness, long-term outcomes, and patient-specific optimization to further refine treatment protocols.

  PublisherDOI

Frequent coauthors

• Joseph Benevenia

  Rutgers New Jersey Medical School

  56 shared

• J. P. O’Connor

  54 shared

• Eric Breitbart

  52 shared

• David N. Paglia

  40 shared

• Virak Tan

  35 shared

• Enyi Okereke

  University of Pennsylvania

  35 shared

• Jessica Cottrell

  Seton Hall University

  35 shared

• Christopher Bibbo

  33 shared

Education

• B.S.

  Pennsylvania State University

  1989

• M.D.

  Jefferson Medical College of Thomas Jefferson University

  1989