Hindfoot Ankle Reconstruction Nail Trial (HARNT) - A National Collaborative Study of Complex Ankle Fractures in the United Kingdom

Description

In a recent presentation on the Hindfoot Ankle Reconstruction Nail Trial study, Chris Bretherton, an orthopaedic registrar from Oxford, discussed the findings of a large-scale analysis focusing on surgical treatments for complex ankle fractures in the UK. The study aimed to profile patient characteristics and surgical outcomes, particularly assessing the use of hindfoot nails in this demographic. Chris revealed that the study, designed to shift focus from implant types to patient populations, included 1,360 fracture cases across 56 collaborating units, with findings indicating a significant proportion of cases involving older patients with multiple comorbidities, including diabetes and dementia.



Despite the expectation that hindfoot nails would facilitate earlier weight-bearing post-operatively—supported by BOAST guidelines—only 35% of patients in the hindfoot nail group were permitted immediate weight-bearing, illustrating a gap in clinical practice versus recommended guidelines. Complications also emerged as a concern, especially among fusion cases, with a reported 20% major complication rate, suggesting the need for cautious interpretation of the technique's efficacy.



The study concluded that while hindfoot nails were used in only 9% of the analyzed cases, the relatively high complication rates challenge the perception of it being a low-risk solution for complex ankle fractures. Chris highlighted selection bias and compliance issues with weight-bearing guidelines as areas for future improvement, and thanked collaborators for their contributions to the extensive data collection process. The presentation invites further discourse on enhancing outcomes for this vulnerable patient group.

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