Ankle arthrodesis using retrograde hindfoot nail
An intermedullary nail for targeted arthrodesis of the tibiotalar joint. The intramedullary nail may be advanced through a bore extending through the calcaneus, talus, and into the tibia. In an example, a distal end portion of the intramedullary nail is disposed proximal to the subtalar joint. It has been recognized that creation of a bore for introduction of the intramedullary nail does not significantly disrupt the articular surface area of the subtalar joint. Furthermore, locking fasteners used to secure the intramedullary nail may introduced laterally and/or anteriorly to facilitate benefits in relation to patient placement and manipulation during an operation. Furthermore, arthrodesis may be extended to adjacent anatomy through use of extension plates at least partially secured by locking fasteners also engaging the intramedullary nail.
1. A method for tibiotalar arthrodesis, comprising:
creating a bore extending from a plantar surface of a calcaneus bone through the calcaneus bone, subtalar joint, talus bone, and tibiotalar joint and terminating in intramedullary space of a tibia bone of a patient;
advancing an intramedullary nail into the bore through the calcaneus bone and the subtalar joint;
disposing the intramedullary nail in the tibiotalar joint, with a distal end portion of the intramedullary nail proximal to the subtalar joint;
securing the intramedullary nail to the tibia bone with a tibia locking fastener and to the talus bone with a talus locking fastener, each of which passes though respective apertures of the intramedullary nail;
compressing the tibiotalar joint by applying a compressive force between the tibia locking fastener and the talus locking fastener; and
securing a plate with the talus locking fastener, wherein the plate extends across at least one other joint different than the tibiotalar joint to allow for arthrodesis of the at least one other joint;
wherein the talus bone and the calcaneus bone, forming the subtalar joint, remain free to move relative to each other.
2. The method of claim 1 , wherein the securing the intramedullary nail comprises:
inserting the tibia locking fastener laterally with respect to the tibia bone to extend through a proximal aperture of the intramedullary nail for bicortical fixation at a proximal portion of the intramedullary nail.
3. The method of claim 2 , wherein the securing the intramedullary nail comprises:
inserting the talus locking fastener anteriorly with respect to the talus bone to extend through a distal aperture of the intramedullary nail for unicortical fixation at a distal portion of the intramedullary nail.
4. The method of claim 3 , wherein the distal aperture comprises an elongated distal aperture and compressing comprises:
engaging the talus locking fastener with a set screw disposed in an internal bore of the intramedullary nail;
advancing a set screw proximally within the internal bore of the intramedullary nail; and
applying a compressive force across the tibiotalar joint between the tibia locking fastener and the talus locking fastener in response to the advancing to urge the talus locking fastener proximally within the elongated distal aperture.
5. The method of claim 1 , further comprising:
preparing the tibiotalar joint for arthrodesis via arthroscopic access to the tibiotalar joint.
6. The method of claim 1 , wherein the bore affects not more than 5% of an articular surface area of the subtalar joint.
7. The method of claim 1 , wherein the at least one other joint comprises one or more of a talonavicular joint or a calcaneocuboid joint.
8. A method for tibiotalar arthrodesis, comprising:
creating a bore extending from a plantar surface of a calcaneus bone through the calcaneus bone, through a subtalar joint, through a talus bone, through a tibiotalar joint and terminating in intramedullary space of a tibia bone of a patient;
advancing an intramedullary nail having a proximal end portion and a distal end portion into the bore;
disposing the proximal end portion in the tibia bone and the distal end portion of the intramedullary nail in the talus bone proximal to the subtalar joint;
compressing the tibiotalar joint by applying a compressive force between the tibia bone and the talus bone;
securing the intramedullary nail to the tibia bone with a tibia locking fastener and to the talus bone with a talus locking fastener; and
securing a plate with the talus locking fastener, wherein the plate extends across at least one other joint different than the tibiotalar joint to allow for arthrodesis of the at least one other joint.
9. The method of claim 8 , wherein disposing the distal end portion of the intramedullary nail proximal to the subtalar joint comprises:
disposing the distal end portion of the intramedullary nail in the talus bone.
10. The method of claim 8 , wherein the securing the intramedullary nail comprises:
inserting the tibia locking fastener laterally with respect to the tibia bone for bicortical fixation at a proximal portion of the intramedullary nail.
11. The method of claim 8 , wherein the securing the intramedullary nail comprises:
inserting the talus locking fastener anteriorly with respect to the talus bone for unicortical fixation at a distal portion of the intramedullary nail.
12. The method of claim 8 , wherein each of the tibia locking fastener and the talus locking fastener passes though respective apertures of the intramedullary nail.
13. The method of claim 8 , wherein the securing comprises:
inserting the tibia locking fastener laterally with respect to the tibia bone to extend through a proximal aperture of the intramedullary nail for bicortical fixation at a proximal portion of the intramedullary nail; and
inserting the talus locking fastener anteriorly with respect to the talus bone to extend through a distal aperture of the intramedullary nail for unicortical fixation at a distal portion of the intramedullary nail.
14. The method of claim 8 , further comprising:
preparing the tibiotalar joint for arthrodesis via arthroscopic access to the tibiotalar joint.
15. The method of claim 8 , wherein the bore affects not more than 5% of an articular surface area of the subtalar joint.
16. The method of claim 8 , wherein the at least one other joint comprises one or more of a talonavicular joint or a calcaneocuboid joint.
17. A method for tibiotalar arthrodesis, comprising:
creating a bore extending from a plantar surface of a calcaneus bone through the calcaneus bone, subtalar joint, talus bone, and tibiotalar joint and terminating in intramedullary space of a tibia bone of a patient;
advancing an intramedullary nail into the bore;
disposing a distal end portion of the intramedullary nail proximal to the subtalar joint;
securing the intramedullary nail with a tibia locking fastener and a talus locking fastener, each of which passes though respective apertures of the intramedullary nail;
securing a plate with the talus locking fastener, wherein the plate extends across at least one other joint different than the tibiotalar joint to allow for arthrodesis of the at least one other joint; and
compressing the tibiotalar joint by applying a compressive force between the tibia locking fastener and the talus locking fastener.
18. The method of claim 17 , wherein the at least one other joint comprises one or more of a talonavicular joint or a calcaneocuboid joint.
19. The method of claim 17 , wherein the securing the intramedullary nail comprises:
inserting the tibia locking fastener laterally with respect to the tibia bone.
20. The method of claim 17 , wherein the securing the intramedullary nail comprises:
inserting the talus locking fastener anteriorly with respect to the talus bone.