Abstract
The use of a tibiotalocalcaneal retrograde hindfoot nail without joint preparation has been utilized in this population with promising results. This procedure, however, does not come without complications. It is often difficult to place the nail in the proper position within the calcaneus, talus, and tibia as medial translation is difficult without preparing the joints for fusion. This may contribute to increased nail failure rates and specifically hindfoot fractures. Three cases of hindfoot nail failure are described in patients treated with this technique.
Highlights
Ankle and pilon fractures are common injuries of the lower extremity that can have a detrimental impact to geriatric and immunocompromised populations [1,2].With an increase in elderly and diabetic patients, more patients are presenting with poor bone quality and multiple comorbidities which complicate their injuries [2,3,4]
We believe there are current design flaws associated with the current hindfoot nails and more thought should be given to the spatial relationships of these bones such that a hindfoot nail with a greater valgus bend or new design concept should be entertained
But are not limited to; diabetes mellitus, peripheral neuropathy, end stage renal disease, as well as peripheral vascular disease. These patients present a challenge with regard to open reduction and internal fixation due to a high rate of complications [5]. Ankle fractures in these patients have been classified as ankle fragility fractures and there has been podiatric and orthopedic literature describing techniques and outcomes when these types of fractures are treated with retrograde tibiotalocalcaneal (TTC) nails without joint preparation
Summary
Ankle and pilon fractures are common injuries of the lower extremity that can have a detrimental impact to geriatric and immunocompromised populations [1,2]. But are not limited to; diabetes mellitus, peripheral neuropathy, end stage renal disease, as well as peripheral vascular disease These patients present a challenge with regard to open reduction and internal fixation due to a high rate of complications [5]. Patient has a past medical history consisting of end stage renal disease (undergoing dialysis), insulin dependent diabetes, peripheral neuropathy, hypertension, peripheral vascular disease, and history of previous cerebrovascular accident She was initially treated with a hindfoot nail and was able to ambulate post operatively. A 64-year-old male who sustained a right closed pilon fracture secondary to a ladder fall He is an insulin dependent diabetic with peripheral neuropathy, chronic kidney disease, and peripheral arterial disease. He developed a painful non-union and experienced hardware failure (Figure 3), which required hindfoot nail removal and revision with a larger diameter nail at 4 months
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