Off-label use of a PHILOS plate in tibiotalocalcaneal arthrodesis with variable medial cannulated screw support: a retrospective evaluation of 32 ankles

Objective: To evaluate the clinical and radiographic outcomes of tibiotalocalcaneal (TTC) arthrodesis performed using a lateral transfibular approach with the off-label application of a Proximal Humerus Internal Locking System (PHILOS) plate and to exploratorily assess outcomes according to the use of supplemental medial cannulated screw fixation.

Methods: Thirty patients (32 ankles) who underwent TTC arthrodesis between January 2019 and June 2024 and had ≥12 months of followup were retrospectively reviewed. Demographics, comorbidities, surgical indications, implant configuration, fusion rates, complications, reoperations, and patient satisfaction were analyzed. Subgroup findings regarding medial screw support were evaluated descriptively.

Results: The mean follow-up duration was 37.3 ± 19.2 months, and fusion was achieved in 90.6% (29/32) of ankles. Complications occurred in 18.8% (6/32), including 3 nonunions, 2 peri-implant tibial fractures, and 1 superficial infection. Reoperation was required in 3 ankles (9.4%). Patient-reported satisfaction was “excellent” in 71.9%, “good” in 12.5%, “fair” in 6.3%, and “poor” in 9.4%.

Conclusion: Tibiotalocalcaneal arthrodesis performed using the PHILOS plate with a lateral approach demonstrated acceptable fusion and complication rates in this cohort. Subgroup observations regarding supplemental medial screw fixation should be interpreted as exploratory and hypothesis generating.

Cite this article as: Yurteri A, Mercan N, Kekeç AF, Tahak F, Yıldırım A. Off-label use of a PHILOS plate in tibiotalocalcaneal arthrodesis with variable medial cannulated screw support: a retrospective evaluation of 32 ankles. Acta Orthop Traumatol Turc.2026; 60(4), 0553, doi: 10.5152/j.aott.2026.25553.