The Evolution Of Intramedullary Nailing For Ankle Fusion Nail Industry
Intramedullary nails have been commonly used for decades to treat fractures of long bones like the femur and tibia. Initially developed in the 1950s, these nails are placed inside the hollow medullary canal of bones to align and stabilize fractured bone segments during healing. Over the years, their use has expanded to include procedures beyond fracture treatment. One such application is ankle fusion surgery using intramedullary nailing, also known as global ankle fusion nailing.
Ankle fusion, also called ankle arthrodesis, is a surgical procedure performed to eliminate painful ankle joint motion and improve stability. Traditionally, ankle fusions were done with plates and screws applied to the outside of the leg bones. However, complications with these plate stabilization techniques like hardware irritation and nonunion rates as high as 15-25% led surgeons to explore alternative methods. Intramedullary nailing for ankle fusion was introduced in the early 1990s as a less invasive stabilization option. Since then, global ankle fusion nail designs have steadily advanced through multiple generations.
How global Ankle Fusion Nail Industry works
In a global Ankle Fusion Nail procedure, the surgeon first prepares the ankle joint for fusion by removing cartilage surfaces from the tibia and talus bones. The hollow medullary canals of both bones are then reamed out to accept the intramedullary nail. Specialized global ankle fusion nails feature a curved design that allows them to span the ankle joint internally once inserted. Some nails even have built-in compression capabilities.
The nail is manually inserted or driven into place using an insertion jig and hammer. Proper alignment and leg rotation are crucial to ensure the bones are fused in correct position. Once fitted, the nail links and stabilizes the tibia and talus bones internally. This allows bony surfaces to heal together as one unit (arthrodesis) without relying on external hardware. The nails may be left in place permanently or later removed depending on the surgeon’s preference and individual patient factors.
Benefits Of Global Ankle Fusion Nailing
Less Soft Tissue Disruption: Like all intramedullary devices, global ankle fusion nails provide stabilization from within bone and do not require extensive soft tissue stripping like plates often do. This leads to less post-surgical pain, faster healing, and a lower infection risk.
Improved Fusion Rates: Multiple clinical studies comparing fusion outcomes for plating versus nailing techniques have found significantly higher union rates when using appropriately designed intramedullary nails. Rates as high as 95-100% have been reported versus 75-85% for plates.
Weight-bearing potential: Many nail designs allow full or partial weight-bearing immediately after surgery as the nail handles load transfer internally instead of relying on external fixation. This speeds up postoperative recovery and rehabilitation.
Cosmetic advantage: By avoiding bulky plate and screw constructs on the outside of the leg, nailing techniques provide a less visible, more natural postoperative appearance once incisions have healed.
Long-Term Implant Options: While some surgeons remove nails later, they can also be left permanently without risk of hardware irritation like plates can cause long-term. This eliminates the need for additional removal surgeries.
Drawbacks And Considerations
Technical challenges: Nail insertion and achieving accurate reduction of the ankle joint can require a greater technical skill level for surgeons less experienced with the technique.
Nonunion: Like any fusion procedure, there remains a small risk of nonunion even with intramedullary nails. Risk factors include infection, smoking, diabetes, and bone loss from prior procedures.
Malalignment: If inadequate reduction is achieved during nail placement, the fusion may heal in less than ideal alignment and position. Residual ankle motion is also possible in some cases.
Hardware complications: Issues like nail breakage, loosening inside bone, or proximal tibial fractures around nail tip have been reported, even if at lower rates than plates. Removal procedures may additionally be needed down the line.
Learning curve: As newer techniques, global ankle fusion nailing approaches require dedicated training and experience to achieve consistent results. Outcomes reported by higher volume experienced surgeons will expectedly be better.
Patient Selection
Ideal candidates for global ankle fusion nailing include those with advanced ankle arthritis, injury sequelae like post-traumatic arthritis, and other conditions causing persistent ankle pain that has failed to respond to non-surgical options. General good health, understanding of the procedure’s goals and potential limitations, and ability to appropriately rehabilitate afterwards also factor into surgical candidacy assessments. Younger, more active patients are more likely to prefer nailing to eliminatehardware long-term compared to plates.
Improving Options For End Stage Ankle Arthritis
Over the past 30 years, global intramedullary nailing has significantly advanced ankle fusion surgery. With more anatomically contoured nail designs, compression capabilities, and refined surgical techniques available nowadays, most recent studies report union rates exceeding 90% even in complex cases like revision procedures and those with prior infection or nonunion issues. While plates remain an excellent option in appropriately selected cases, nailing offers distinct benefits for post-surgical recovery, fusion rates, stability, and hardware-related complications long-term.
In Summary, for patients with advanced ankle arthritis unresponsive to conservative treatment, it provides an improved minimally invasive stabilization alternative compared to traditional plates. Outcomes continue advancing as new nail technologies emerge and greater surgeon experience accrues worldwide. Overall, global ankle fusion nailing using modern intramedullary devices has undoubtedly strengthened the armamentarium for successfully managing end-stage ankle arthritis.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
About Author:
Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)