P4 Ankle arthrodesis with intramedullary nail

Introduction. Ankle arthrodesis is performed in a variety of methods. We propose a new technique for tibiotalar arthrodesis using a newly designed intramedullary nail.Methods. We proposed development of an intramedullary device for ankle arthrodesis which spared the subtalar joint using a sinus tarsi approach. Standard saw bones models and computer assisted modeling and stress analysis were used to develop different nail design geometries and determine the feasibility of insertion. After the final design was constructed, the device was tested on three cadaveric specimens.Results. Four basic nail geometries were developed. The optimal design was composed of two relatively straight segments, each with a different radius of curvature for their respective tibial and talar component. We successfully implemented this design into three cadaveric specimens.Conclusion. Our newly designed tibiotalar nail provides a new technique for isolated tibiotalar fusion. It utilizes the advantages of a tibiotalar calcaneal nail and spares the subtalar joint. This design serves as the foundation for future research to include compression options across the tibiotalar joint and eventual transition to clinical practice.

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New Technique for Tibiotalar Arthrodesis Using a New Intramedullary Nail Device

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00001 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0000

Author(s):

Sherif Dabash ◽

Emmanuel Eisenstein ◽

Amr Abdelgawad

Keyword(s):

Intramedullary Nail ◽

Subtalar Joint ◽

Ankle Arthrodesis ◽

New Technique ◽

Radius Of Curvature ◽

Computer Assisted ◽

Intramedullary Device ◽

Sinus Tarsi Approach ◽

Tibiotalar Arthrodesis ◽

A New Technique

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Ankle arthrodesis is performed in a variety of methods.We propose a new technique for tibiotalar arthrodesis using a newly designed intramedullary nail Methods: We proposed the development of an intramedullary device for ankle arthrodesis which spared the subtalar joint using a sinus tarsi approach. Standard saw bones models and computer-assisted modeling and stress analysis were used to develop different nail design geometries and determine the feasibility of insertion. After the final design was constructed, the device was tested on three cadaveric specimens. Results: Four basic nail geometries were developed. The optimal design was composed of two relatively straight segments, each with a different radius of curvature for their respective tibial and talar component. We successfully implemented this design into three cadaveric specimens Conclusion: Our newly designed tibiotalar nail provides a new technique for isolated tibiotalar fusion. It utilizes the advantages of a tibiotalar calcaneal nail and spares the subtalar joint. This design serves as the foundation for future research to include compression options across the tibiotalar joint and eventual transition to clinical practice.

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Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle

Foot & Ankle International ◽

10.1177/1071100718800836 ◽

2018 ◽

Vol 40 (1) ◽

pp. 48-55 ◽

Cited By ~ 4

Author(s):

Cassandra Tomczak ◽

Douglas Beaman ◽

Serene Perkins

Keyword(s):

Intramedullary Nail ◽

Case Series ◽

Ankle Arthrodesis ◽

Retrospective Case ◽

Level Of Evidence ◽

Combined Use ◽

Acute Correction ◽

Average Body Mass ◽

Ability Measure

Background: The severely deformed, infected, and unstable neuroarthropathic ankle is challenging to treat. We evaluated our preliminary experience and results of combined internal and external ring fixation for a complex neuropathic population. Methods: We retrospectively reviewed medical records and radiographs for 8 patients with unilateral severely deformed ankle neuroarthropathy associated with infection and ulceration. Treatment included single-stage reconstruction arthrodesis with an interlocked intramedullary nail coated with antibiotic-containing cement combined with ring fixation. Taylor Spatial Frame™ technology was used when the deformity was not amenable to acute correction (5 patients). Protected postoperative weightbearing was permitted. Their mean age averaged 55.6 (range, 42-66) years with an average body mass index of 38.4 (range, 28.7-49.6) kg/m2. Results: Seven patients achieved limb preservation. Average time for fusion healing was 15.2 (range, 12.2-22.2) weeks, frame time was 17.7 (range, 12.2-23.0) weeks, and follow-up was 34.1 (range, 24.1-68.8) months. All presenting wounds and infection successfully resolved. Reinker and Carpenter scale was excellent for 2 patients, good for 2 patients, and fair for 3 patients. Foot and Ankle Ability Measure averaged 59.0% (range, 39.3%-87.5%). One patient developed a recalcitrant calcaneal ulcer with osteomyelitis that required a transtibial amputation 17 months after successful ankle arthrodesis. Conclusions: Combined use of interlocked intramedullary nail and ring external fixation for neuroarthropathic ankle arthrodesis achieved a functional and clinically stable salvaged lower limb for most patients. Level of Evidence: Level IV, retrospective case series.

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