Arthrodesis Nail Research Articles

Die tibiotalokalkaneare Arthrodese mit einem winkelstabilen Marknagel mit Rückfußvalgus und Kompressionsmöglichkeit

The purpose of this study was to evaluate the first clinical experiences with the newest generation retrograde arthrodesis nail. 28 patients who had tibiotalocalcaneal arthrodesis between 2005 and 2007 using a retrograde compression nail fixation (T2 AAN, Stryker, Duisburg, Germany) were retrospectively reviewed. Complications, functional outcome scores, and patient satisfaction were determined and the radiographs were evaluated for bony healing. The mean time interval until follow-up was 16 months (range: 7-27). All but 1 ankle showed a radiographically healed arthrodesis. 25 patients (89 %) were satisfied with the outcome. The average functional scores at follow-up were 64 (38-86 points) points for the American Orthopedics Foot and Ankle Score (AOFAS) and 65 points for the Mazur Ankle Scoring System (30-83 points). We recorded complications in 7 patients (25 %) including 1 deep infection with breakage of the calcaneus screw, 3 reinfections, 1 deep vein thrombosis, 1 intraoperative fracture of the tibia, 1 delayed union and 1 non-union. Tibiotalocalcaneal arthrodesis is a salvage procedure. Using a specifically designed retrograde intramedullary nail is a reliable method to achieve fusion. Patient satisfaction is high, but the procedure is demanding and complications are frequent. After infections the indication for nail arthrodesis should be evaluated carefully in each case.

Use of a Tibial ACL Guide for Precision Reaming in Ankle Arthrodesis Nailing

The correct placement of hindfoot arthrodesis nails can be difficult, especially when a nail with valgus banding is used. The authors describe a simple and inexpensive technique to facilitate the alignment in tibiotalocalcaneal arthrodesis.

Stabilization of Ankle Fragility Fractures with a Transtibiocalcaneal Fusion Nail

INTRODUCTION: Incidence of ankle fractures in the elderly population increased for the last years. Osteoporosis, compromised soft tissue conditions, vascular supply, and systemic diseases enhance the high demands on fracture management. Here, early results of ankle fracture fixation with transtibiocalcaneal arthrodesis in elderly patients are reported. PATIENT AND METHODS: Five patients with an unstable ankle fracture were included into this prospective study. All of them underwent closed reduction and transtibiocalcaneal arthrodesis by intramedullary nailing (Hindfoot Fusion Nail, Trigen, smith & nephew). Cartilage of tibiotalar and subtalar joint was left intact. Postoperatively early mobilisation with full weight bearing in a Vacoped® boot was allowed. RESULTS: The mean age of patients was 76 ± 11 years (range: 74-87). There were no intraoperative complications. One patient showed postoperatively a heel ulcer with subsequent superficial infection at a screw entry point, which requires screw removal. Postoperative radiographics before and after mobilisation revealed satisfactory reduction results and sufficient arthrodesis without secondary dislocation for all patients. CONCLUSION: Arthrodesis of unstable ankle fractures with transtibiocalcaneal intramedullary nailing allows immediate return to full weight bearing and has a low risk of complications. Therefore Hindfoot nail arthrodesis of ankle fractures might be appropriate particularly for patients with severe comorbidities, poor bone stock, and reduced tissue conditions.

A comparison of two techniques for knee arthrodesis: the custom made intramedullary Mayday nail versus a monoaxial external fixator

The most common indication for knee arthrodesis is pain and instability in an unreconstructable knee following an infected knee arthroplasty. In this study, we compare the use of the Mayday arthrodesis nail (Orthodynamics, Christchurch, UK) versus external fixation, Orthofix (Berkshire UK) and Stryker Hoffman II (County Cork, Ireland). All patients in this study underwent arthrodesis between 1995 and 2006 at Conquest Hospital, Hastings. In group A, 11 patients underwent arthrodesis with a Mayday nail. In all cases, the indications were infected total knee replacements (TKR). Three of these patients previously had failed attempts at arthrodesis with external fixation devices. In group B, seven patients underwent arthrodesis using external fixation. In six patients, the indication was infected TKRs. Results were reviewed retrospectively, with union assessed both clinically and radiologically. The mean inpatient stay for the Mayday nail group was 23 days (range 8–45 days) compared with 76 days (range 34–122) for the external fixation group ( p < 0.01, CI 95). Ten patients in group A went on to confirmed primary arthrodesis. One patient underwent revision arthrodesis with a Mayday nail and subsequently united. In group B only two patients achieved union. The rate of union was significantly greater in the Mayday nail group than the external fixation group (91% vs 29%, p < 0.01). Of those patients that achieved union, there was no difference in the time to fusion between groups. Our study supported the existing literature and found that the Mayday nail appeared more effective than monoaxial external fixators for arthrodesis in the management of infected total knee replacements.

A Biomechanical Comparison of Micromotion after Ankle Fusion Using 2 Fixation Techniques: Intramedullary Arthrodesis Nail or Ilizarov External Fixator

In difficult ankle arthrodesis situations, intramedullary (IM) arthrodesis nails and external fixation are often considered in lieu of standard fusion techniques. The purpose of this study was to compare the amount of micromotion measured across an ankle fusion site stabilized with either an IM nail or with the Ilizarov external fixator. The relative bone mineral density of 8 pairs of human cadaveric lower legs was measured by DEXA scanning. One specimen from each pair was randomly assigned to be stabilized with a new generation IM nail and the other with an Ilizarov external fixator. Specimens were tested in compression, rotation, and dorsiflexion. Optical motion capture was used to measure the direct motion occurring at the fusion site. No significant difference was found between the axial displacements (p = 0.94), torsional displacement (p = 0.07), or the dorsiflexion angular displacement (p = 0.28) for the IM rod group and the external fixation group. A weak correlation was found between BMD and displacement. Both the new generation IM nail and the Ilizarov external fixator imparted excellent stability to the fusion site despite a wide range of bone mineral densities. Medialization of the talus, the ability to compress the nail, and the addition of a posterior-to-anterior locking screw were thought to improve the performance of the nail. Both IM nail and Ilizarov external fixation provided excellent fusion site stability. The decision of which implant to use for complex arthrodesis should be dictated by the clinical needs.

Knee arthrodesis for limb salvage with an intramedullary coupled nail

The demand for revision and salvage procedures after knee arthroplasty is increasing as the number of primary procedures increases. Surgical salvage techniques when revision arthroplasty is contra-indicated include above knee amputation and arthrodesis. The results of arthrodesis are functionally superior to those of amputation but not all techniques of arthrodesis are associated with good results. We present a single surgeon series of 14 consecutive patients who underwent arthrodesis of the knee with a customised intramedullary coupled nail (Mayday arthrodesis nail, Orthodesign Ltd, UK). All patients had a failed knee arthroplasty due to persistent sepsis. Pre-operative scaled radiographs were used to design and manufacture a custom-made implant for each patient. An identical surgical technique and post-operative rehabilitation regime were used in each case. The mean hospital stay was 12 days (range 6-24). Union was achieved in all but one patient at a mean of 4 months (range 3-10). One diabetic patient required subsequent above knee amputation for infected non-union. Two other patients had significant transient complications. We have found that the Mayday nail offers a straightforward, reproducible surgical option for difficult salvage surgery. Good results have been obtained in the majority of cases, avoiding the devastating consequences of above knee amputation.

Traitement palliatif pour métastases proximales du tibia par enclouage centro-médullaire fémoro-tibial

We report the case of an 80-year-old woman treated by palliative knee arthrodesis for metastasis of the proximal left tibia secondary to bladder carcinoma, using percutaneous femoro-tibial intramedullary arthrodesis nailing.

CASE REPORTS: A Subtrochanteric Femur Fracture with Long Intramedullary Femorotibial Nail for Knee Arthrodesis

We present a case report of a patient who had a transverse subtrochanteric femur fracture develop 2 months after uneventful placement of a long femorotibial intramedullary nail for knee arthrodesis. To date, diaphyseal fracture of a femur already stabilized with an intramedullary nail has not been reported. The possible etiology for this unusual complication is discussed.

Retrograde Intramedullary Nailing in Tibiotalocalcaneal Arthrodesis: A Short-Term, Prospective Study

In this prospective study, tibiotalocalcaneal arthrodesis was performed in 29 patients with a retrograde femur nail (Interlocking Compression Nail; Stryker Trauma, Schönkirchen, Germany) inserted through a plantar approach. Patients were evaluated by a standardized follow-up examination using the American Foot and Ankle Society ankle-hindfoot scale and the main criteria of the short-form health survey (36 items). Special emphasis was placed on surgical approach, bony consolidation, and postoperative quality of life. Solid fusion was achieved in 90% of the patients after a mean follow-up of 25 months. Twenty-two patients (76%) showed primary bone healing after an average of 5.2 months; a delayed union was observed in 7 patients. In 79% of the patients, pain was reduced effectively and quality of life substantially improved with the intramedullary nail arthrodesis. The average ankle-hindfoot score improved from 46 (range, 41-53) to 71 (range, 49-83) points. Complications occurred in 6 patients (21%), including 2 deep infections, 3 nonunions, and 1 case of postoperative flexion deformity. The authors found retrograde intramedullary nailing in tibiotalocalcaneal arthrodesis to be an effective technique in obtaining solid fusion, an effective relief from pain, and an improvement of quality of life.

Salvage of osteoporotic ankle fractures after failed primary fixation with an ankle arthrodesis nail: A report on four cases

Salvage of osteoporotic ankle fractures after failed primary fixation with an ankle arthrodesis nail: A report on four cases

Die „Beckenkammspan-Interpositionsarthrodese“ des oberen Sprunggelenks

Bony fusion of the ankle in a functionally favorable position for restitution of a painless weight bearing while avoiding a leg length discrepancy.Disabling, painful osteoarthritis of the ankle with extensive bone defect secondary to trauma, infection, or serious deformities such as congenital malformations or diabetic osteoarthropathies.Acute joint infection. Severe arterial occlusive disease of the involved limb.Lateral approach to the distal fibula. Fibular osteotomy 7 cm proximal to the tip of the lateral malleolus and posterior flipping of the distal fibula. Exposure of the ankle. Removal of all articular cartilage and debridement of the bone defect. Determination of the size of the defect and harvesting of a corresponding tricortical bone graft from the iliac crest. Also harvesting of autogenous cancellous bone either from the iliac crest or from the lateral part of the proximal tibia. Insertion of the tricortical bone graft and filling of the remaining defect with cancellous bone. Fixation with three 6.5-mm titanium lag screws. Depending on the extent of the defect additional stabilization of the bone graft with a titanium plate. Fixation of the lateral fibula on talus and tibia with two 3.5-mm titanium screws for additional support. Wound closure in layers. Split below-knee cast with the ankle in neutral position.Between January 2002 and January 2004 this technique was used in five patients with extensive bone defects (four women, one man, average age 57 years [42-77 years]). No intra- or early postoperative complications. The AOFAS (American Orthopedic Foot and Ankle Society) Score was improved from 23 points preoperatively to 76 points postoperatively (average follow-up time of 25 months). Two patients developed a nonunion and underwent a revision with an ankle arthrodesis nail. A valgus malposition after arthrodesis in one patient was corrected with a supramalleolar osteotomy.

Ankle Arthrodesis with a Retrograde Femoral Nail for Charcot Ankle Arthropathy

Tibiocalcaneal arthrodesis with retrograde intramedullary nailing has gained acceptance as a salvage procedure for a multitude of ankle and hindfoot disorders and is frequently used in Charcot arthropathy of the ankle. Because of the severe osteopenia often associated with Charcot arthropathy of the ankle, an area of stress concentration leading to stress fracture at the proximal aspect of the nail has been identified. To determine if this potential complication can be avoided, nine consecutive diabetic individuals with Charcot arthropathy of the ankle had ankle arthrodesis with a longer retrograde femoral nail. The average age of the patients was 52.3 years. Their average weight was 102.6 kg. Fusion was evident on radiographs in all nine patients at an average of 10.5 weeks. None of the patients developed a stress fracture or evidence of stress concentration at the proximal metaphyseal tip of the nails. One wound infection resolved after debridement and antibiotic therapy, and one postoperative hematoma resolved without surgery. At an average 32-month followup, all patients were ambulatory, using commercially available therapeutic footwear. None had developed a new foot ulcer, infection, or new episode of Charcot arthropathy. The use of a retrograde femoral nail for ankle arthrodesis in patients with Charcot arthropathy appears to decrease the risk of stress fracture compared with shorter nails without increasing the risk of other complications.

Tibiotalocalcaneal Arthrodesis With a Retrograde Intramedullary Nail: A Biomechanical Analysis of the Effect of Nail Length

Fatigue fractures of the tibia have been observed at the level of the proximal end of the nail after successful tibiocalcaneal arthrodesis with a retrograde intramedullary device. To study the effect of nail length, five matched pairs of cadaver tibiae were instrumented with strain gauges and potted in methylmethacrylate from a level 3 cm proximal to the distal medial malleolus to simulate a successful tibiocalcaneal arthrodesis. A standard length (15 cm) ankle arthrodesis nail and an identical longer device terminating in the proximal tibial metaphysis were inserted in each paired tibia using appropriate technique. The strain of the posterior cortex of the tibia was recorded under bending moments of up to 50 Nm for each intact specimen after nail insertion and after proximal locking of the nail. The nails were then exchanged between the specimens of the same pairs and the experiment was repeated to insure uniformity. The standard length locked nail increased the principal strain of the posterior cortex of the tibia at the level of the proximal screw holes 5.3 times more than the locked long nail (353 and 67 microstrains), respectively. This stress concentration was not observed when the proximal extent of the nail terminated within the proximal tibial metaphysis. A successful tibiocalcaneal arthrodesis with a standard length locked intramedullary nail creates stress concentration around the proximal screw holes that may be responsible for the fractures observed clinically. This study supports the use of a "long" retrograde locked intramedullary nail for tibiocalcaneal arthrodesis in patients with systemic or localized osteopenia.

Fractures above and below a modular nail for knee arthrodesis. A case report

Several techniques have been advocated for knee arthrodesis, and there has been an increasing interest in modular intramedullary nails in the recent last years. We report a case of femoral and tibial fractures at each end of a modular nail in a solidly fused knee 8 months after an arthrodesis.

Salvage of failed ankle arthroplasty with an ankle arthrodesis nail

Two patients with failed ankle arthroplasty underwent ankle and subtalar arthrodesis using a retrograde locked ankle arthrodesis nail (Biomet Inc., Warsaw, IN). Both procedures were uncomplicated and resulted in a sound fusion at 3 months postoperatively. Both patients reported satisfaction with the result. We feel that this salvage technique for failed ankle arthroplasty may prove superior to alternative methods described in the literature to date.

髄内釘を用いたＲＡ足関節固定術の検討

We retrospectively reviewed and functionally assessed 13 patients with rheumatoid arthritis (RA) who had undergone ankle arthrodesis with an intramedullary nail. They were all female and followed for an average of 15 months (six to 39 months). The mean duration of RA was 19 years. We used the intramedullary nail with fins for 10 ankles, the ReVision nail (Smith & Nephew) for two ankles, and the Biomet Ankle Arthrodesis Nail for one ankle. Solid fusion was achieved in 11 out of 13 patients. Mean time to union was 4.2 months. The patients were able to bear weight fully in an average of four weeks after surgery. We believe that the intramedullary nail with fins can increase stability, allowing early weight bearing. To treat rheumatoid severe ankle deformities, partial or all resection of the talus was necessary for the correction of ankle alignment. The ReVision nail or the Ankle Arthrodesis Nail was useful for tibiocalcaneal fusion in such cases.

Arthrodesis of the distal interphalangeal joint using a bioabsorbable rod as an intramedullary nail.

There are several fixation techniques for arthrodesis of the distal interphalangeal joint. Since February 1999 we have used a bioabsorbable (poly-L-lactide, PLLA) rod as an intramedullary nail for arthrodesis of 15 distal interphalangeal joints and one interphalangeal joint of the thumb. The advantages include the absence of protruding hardware that would require removal, and technical simplicity. Preoperative diagnoses included degenerative arthritis in five patients, post-traumatic arthritis in 10 patients, and non-union after arthrodesis with crossed Kirschner wires in one patient. All patients were observed until there was clinical and radiographic evidence of fusion with the mean interval to fusion of 8 weeks (range 6-12). There were two cases of minor intermittent local swelling, which resolved. Fixation with a PLLA rod for arthrodesis of the distal interphalangeal joint is a simple and effective technique.

Intramedullary Nailing in Ankle Arthrodesis: Antegrade vs Retrograde

This prospective study compares the clinical results of antegrade and retrograde intramedullary arthrodesis of the upper and lower ankle joint using dynamic interlocking nails with the possibility of axial compression. In 13 patients combined arthrodesis was performed using a retrograde femur nail inserted through the heel, whereas in 18 patients tibiotalocalcaneal arthrodesis was performed using a distal tibia nail through an antegrade approach. Patients were evaluated in a standardized examination using criteria of SF 36 focussing on approach, osseous consolidation and quality of life. Both techniques yielded good results: bony consolidation was achieved in 85-89 % after the mean follow up time. In 74-81 % pain was reduced effectively using the intramedullary nail arthrodesis, quality of life was improved drastically. 3 non-unions occurred, 1 implant failure was reported and there were 2 infections. The advantage of the retrograde technique is the non-invasivity of the proximal tibial. Using antegrade as well as plantar approach, intramedullary nail arthrodesis of the ankle is a suitable technique with very good results for combined arthrodesis of the upper and lower ankle joint.

Tibiotalocalcaneal arthrodesis: a biomechanical analysis of the rotational stability of the Biomet Ankle Arthrodesis Nail.

We hypothesized that the posterior-to-anterior (PA) calcaneal interlocking screw of the Biomet Ankle Arthrodesis Nail would increase rotational stability secondary to increased bone purchase compared with the standard lateral-to-medial (transverse) screw. Each of 10 fresh human cadaver lower limbs (five matched pairs) were stabilized with a nail inserted retrograde through the calcaneus, talus, and tibia according to standard technique. One limb of each pair was fixed with a transverse calcaneal screw; the contralateral limb, with a PA calcaneal screw. Each limb was then subjected to torsional testing on an MTS Mini Bionix load frame. The PA screw construct was significantly stiffer than the transverse screw construct: 1.96 and 1.41 Nm/E, respectively (P < 0.036).

Arthrodesis of the knee: Experience with intramedullary nailing

Knee arthrodesis using an intramedullary nail has gained acceptance as treatment in difficult cases such as infection after total knee arthroplasty (TKA), neuropathic joint, and obesity. A retrospective review of 22 cases treated at our institution using an intramedullary nail for knee arthrodesis was performed. Deep infection after primary (11) or revision (6) TKA was the most common indication for this procedure. A long intramedullary nail was used in 3 cases, a long nail with a proximal interlocking screw was used in 6 cases, and a customized nail with a valgus bend and a proximal interlocking screw was used in 11 cases. A modular knee fusion nail was used in 1 case. Successful fusion occurred in all cases, although 4 patients required additional surgery. Average operative blood loss was 748 mL, and average time to union was 7 months. Shortening of the extremity averaged 3.2 cm. Tibiofemoral alignment was improved by using a customized valgus nail (average, 3.1 valgus; range, 1-5) when compared with a straight nail (average, 0.2 valgus; range, 3 varus to 3 valgus). No patient developed infection in the hip or ankle region as a result of the long intramedullary nail. Intramedullary nailing is an excellent technique for knee arthrodesis in difficult cases. A customized proximal interlocking nail with 5° to 7° of valgus and 5° of anterior angulation improves tibiofemoral alignment and is straightforward to insert or extract should it be necessary. Stability and pain relief are rapid, and the fusion rate is maximized.