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Review
. 2018 Sep;11(3):439-444.
doi: 10.1007/s12178-018-9507-y.

Retrograde Hindfoot Nailing for Acute Trauma

Ivan S Tarkin  1 , Mitchell S Fourman  2
Affiliations
Review

Retrograde Hindfoot Nailing for Acute Trauma

Ivan S Tarkin et al. Curr Rev Musculoskelet Med. 2018 Sep.

Abstract

Purpose of review: The role of retrograde hindfoot nailing in the treatment of acute orthopedic trauma is explored.

Recent findings: Tibio-talar calcaneal (TTC) nailing is an acceptable treatment alternative for the low-demand geriatric patient with peri-articular ankle trauma permitting immediate weight-bearing with low rates of complication and return to functionality. Hindfoot nailing can be used for limb salvage in the younger active patient; yet, joint-preserving reconstruction is preferred when feasible. Retrograde TTC nailing is a reliable option for hindfoot/distal tibia stabilization especially in the elderly frail population. Hindfoot nailing is reserved for a select subset of active patients when severity of bone, joint, and soft tissue injury are not amenable to more conventional reconstruction.

Keywords: Geriatric ankle fracture; Hindfoot nail; Limb salvage; Primary ankle fusion; Tibio-talar calcaneal nail.

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Conflict of interest statement

Conflict of Interest

Both authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
a 89-year-old female with open distal quarter tibia fracture. Patient with co-morbid medical conditions and minimally ambulatory. Patient and family decided to pursue limb salvage yet amputation was offered. Conventional ORIF, antegrade nailing, or external fixation strategies deemed unreliable in this patient with diabetes, peripheral vascular disease, and osteoporotic bone. b Nail inserted retrograde after open fracture care resulting in uneventful fracture healing and ankle joint auto-fusion
Fig. 2
Fig. 2
a Active elderly female s/p open ankle fracture/dislocation with significant irreversible cartilage injury as demonstrated in the clinical photo (a) and presentation radiograph. (b) Hindfoot nail placed with percutaneous method (c) after open fracture care and fracture reduction. Joint preparation performed though traumatic wound. Medial malleolus excised to promote primary healing of traumatic wound (d, e). Patient achieved a pain free extremity and returned to pre-injury function
Fig. 3
Fig. 3
Hindfoot nail combined with limited ORIF and distal fibula transfer utilized for obtaining fracture union and ankle arthrodesis for severe open pilon fracture
Fig. 4
Fig. 4
a 55-year-old polytrauma patient with history of smoking with new type C3 pilon fracture. His past history is significant for symptomatic arthrosis of ankle and subtalar joints from previous calcaneous malunion as seen on sagittal CT scan. b Arthrodesis of both tibio-talar and subtalar joints and fracture fixation with TTC nail resulting in best outcomes for this complex hindfoot injury
Fig. 5
Fig. 5
a Supermorbid elderly obese female polytrauma patient with diabetes and peripheral vascular disease with open grossly contaminated talus extrusion. Talus without meaningful vascular attachment. b Talectomy and fusion performed for limb salvage with hindfoot nail. Shortening of the hindfoot allowed for primary wound closure of the transverse wound and uneventful soft tissue healing
See this image and copyright information in PMC

References

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    1. Lemon M, Somayaji HS, Khaleel A, Elliott DS. Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail. J Bone Joint Surg Br. 2005;87(6):809–813. doi: 10.1302/0301-620X.87B6.16146. - DOI - PubMed
    1. Amirfeyz R, Bacon A, Ling J, Blom A, Hepple S, Winson I, et al. Fixation of ankle fragility fractures by tibiotalocalcaneal nail. Arch Orthop Trauma Surg. 2008;128(4):423–8. Thirteen patients were treated with either a long humeral nail or a short TTC fusion nail through the same approach. All patients returned to their baseline function regardless of the hardware used, and radiographic analysis showed fracture union in all cases. Findings reinforced that the benefits of TTC nailing, early weight-bearing, and fewer complications outweighed the stiffness that resulted from the joint immobilization in the geriatric population. - PubMed
    1. Fourman MS, Tarkin IS. Retrograde tibiotalocalcaneal hindfoot nail without joint preparation is a viable salvage technique for geriatrics with extensive comorbidities and minimal ambulatory status following major trauma Proceedings of the American Academy of Orthopaedic Surgery Annual Meeting; Orlando, FL; March 2017. Here, we describe our institutional experience with acute TTC nailing following orthopedic trauma, which included a total of 18 patients treated after high- and low-energy injuries. Joint preparation was only performed in those patients whose traumatic wounds permitted access. Despite a significantly co-morbid population (mean Charlson Index 3.9) and a high percentage (22.2%) of high-energy trauma, limb preservation was possible in 88.9% of patients, and 83.3% were able to return to weight-bearing as tolerated.

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