Expert Hindfoot Arthrodesis Nail (HAN)

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Expert Hindfoot Arthrodesis Nail (HAN)

Fig 1 Hindfoot arthrodesis nail.

Fig 2ad Nail views.

The Expert hindfoot arthrodesis nail (HAN) is indicated to facilitate tibiotalocalcaneal arthrodesis to treat severe foot/ankle deformity, arthritis, instability, and skeletal defects; these include, but are not limited to neuro-osteoarthropathy (Charcot foot), avascular necrosis of the talus, failed joint replacement or failed ankle fusion, distal tibial fracture nonunions, and osteoarthritis, rheumatoid arthritis and pseudoarthrosis, and tumor resection and reconstruction.

The cannulated hindfoot arthrodesis nail has a lateral bend of 12 which allows an entry point in the center of the lateral column of the calcaneus. The nail enables proper hindfoot alignment and restores 35 hindfoot valgus positioning.

The nail design, a rotating insertion handle and the aiming arm enable targeted medial-to-lateral or lateral-to-medial proximal locking. Distal locking options are with spiral blade in the calcaneus for more stability in osteopenic bone, with a 6.0?mm Stardrive locking head screw from the calcaneus into the cuboid, or with a 5.0?mm Stardrive locking head screw from the talus into the navicular or further distal in the medial column. An end cap for screws and for spiral blades is available.

As part of the Expert nail family, the HAN uses most of the instrumentation of the humeral, femoral and tibial nails, except for an extended length 5.0?mm calibrated drill for extra long 6.0?mm locking head screws.

The nails are available in 10, 12 and 13?mm diameters, in 150, 180, and 240?mm lengths, right and left designs.

Details
Clinical Cases
Disclaimer

The objectives of this retrospective study were to document the current clinical experience gained from the use of the HAN in the treatment of patients with various ankle and foot pathologies.

In addition, information was collected relating to surgical details, functional and quality of life outcomes after HAN procedures (SF-36, AAOS-FAOQ and numeric rating scale of pain). Seven participating clinics (four from Europe and three from the USA) recruited 38 patients who underwent ankle arthrodesis using the HAN. A large socioeconomic benefit appears to stem from hindfoot fusion with the HAN in properly selected patients because a high proportion of patients who were on sick leave prior to surgery were able to return to work. Early findings appear to indicate that HAN offers a safe and reliable salvage option for patients undergoing tibiotalocalcaneal arthrodesis. More detailed information on the results will be released in a full manuscript to be submitted for peer review in late 2011.

42-year-old, female with severe insulin-dependent diabetes mellitus (IDDM); Charcot foot, wheel chair since 1 year.

Case provided by Hermann Bail, Berlin, DE

Fig 1ac Preoperative x-rays

Fig 2ac Preoperative soft-tissue condition.

Fig 3ac Image intensifier check postoperative.

Fig 4ac Follow-up 3 months after surgery; Patient can walk for about 15 minutes, and stand on the foot without pain.

A 64-year-old man presented with severe ankle and subtalar arthritis accompanied by large cysts in the talus and calcaneus. Eighteen months after hindfoot fusion with the HAN he walked without pain.

Case provided by Stefan Rammelt, Dresden, Germany

Fig 1ac Preoperative x-rays (ab) and CT scan (c).

Fig 1df The ankle and subtalar joints are solidly fused in an orthograde position. Note the position of the nail within the calcaneus along its physiological axis.

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