Tibiotalocalcaneal fusion over retrograde SIGN Nail

Transcription

1 Tibiotalocalcaneal fusion over retrograde SIGN Nail PROF (DR.) SYED ANWARUZZAMAN Professor and Head Department of Orthopedic &trauma Comilla Medical college & Hospital Comilla, Bangladesh

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7 Introduction Several treatment options are available for pain and disability due to post traumatic condition, arthritis and deformities of ankle. We have studied retrograde SIGN locking nail technique through a 2.5 cm incision in the non weight bearing part of the sole of foot and locking into os-calcis and tibia to achieve fusion and pain free stable foot.

8 Objective Diversified use of SIGN Nail in Tibio-talocalcaneal fusion for stabilization and clinicoradiological wellbeing of the patients having unstable and painful ankle.

9 Historical Background & lit. review Adams, JC(1948) J bone joint surg Br 30 : Stone k, Helal B (1991) Clin orthop Realt Res 268: Carier D, Harries C (1991) Clin orthop Realt Res 268: Kile TA, Donnely RE, Gehrke JC et al (1994) foot & ankle Int 15: Pinzar MS, Kelikian A (1997) Foot & ankle Int 18:

10 Indications Avascular necrosis of talus following untreated and/or maltreated fracture. Severe deformity of ankle following maltreated ankle fracture painful Rheumatoid arthritic foot deformity Failed ankle arthrodesis Severe pilon fracture and trauma to subtalar joint. Failed total ankle replacement

11 Contraindications Contraindications to ankle arthrodesis include, but are not limited to: -Insufficient quantity or quality of bone for fusion -Neurologic or vascular illness that decreases healing or recovery -Medical conditions that increase the risk of anesthesia -Severe deformity of the limb

12 Advantage of SIGN Nail SIGN nail systems brings the simplified instrumentation to the hind foot fusion. The nail configuration and locking holes allows the surgeon to maximize thread Purchage by locking into better bone It allow the surgeon to target the screw through the calcaneous to attain the most stable constract while gaining fusion Rotational stability is achieved by static locking hole and two dynamic distal holes

13 Other appliances TRIGEN hind foot fusion nail Smith and Nephew Ilizarov ring fixator Plate and screw Blair fusion Only Screw and sliding bone graft

14 TRIGEN hind foot fusion nail Smith and Nephew Ilizarov ring fixator

15 Plate and screw Only Screw and sliding bone graft

16 Blair fusion

17 Methods Place of study Comilla medical college and Hospital, Bangladesh Study period July 2015 to June 2016 Number of cases 06 All the cases were selected randomly All are male patient Neglected talar neck fracture 4, distal tibia fracture nonunion with badly scared skin 2

18 Patient selection criteria Avascular necrosis of talus. Severe deformity Painful Rheumatoid arthritic ankle Distal tibia fracture nonunion with badly scared skin.

19 Patient Evaluation History of injury and treatment Medical history and co-morbidity Physical exam- including deformity Imaging Patient needs,goals, expectation.

20 Goal and expectation What are the patients goal and need Household ambulation VS community ambulation Pain relief expectation Walking expectation Risk to neurovascular structure.

21 Technique Site Identify proper site for nail introduction (non weight bearing area of heel) Incision Opening of the port Reaming Introduction of the SIGN nail and locking

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24 Follow up Clinically Radiographically

25 Result Infection none Nail Breakage or failure-- none Clinical out come- pain free, full range of saggital motion, no ankle or hind foot instability, good alignment, ability to walk, ability to ambulate on any walking surface, no discernible limp, no limitation of daily activities.

26 Clinical cases

27 Mr. Anis

28 Mr. Anis

29 Mr. Anis

30 Mr Anis

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32 Mr. kaium

33 Mr. Ershad

34 Mr Ershad

35 Mr Ershad

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37 Conclusion SIGN nail systems brings the simplified instrumentation to the hind foot fusion that has made a standout among other systems. A larger series with multicentric study is recommended for further evaluation of this technique.

38 ACADEMIC Clinical and lecture classes for under graduates Journal club and discussion of difficult and complicated cases on every Thursday Record keeping 1) SIGN data base 2)Departmental records