Indications
Rheumatoid arthritis
Combined ankle and subtalar joint osteoarthritis
Talar AVN
Trauma
Severe Deformity
- acquired flat foot
- neurological conditions
Surgical Technique
1. Prepare joint surfaces
Incision
- curved incision
- posterior border fibular
- curved anteriorly along peroneal tendons
- towards 4th MT
Exposure AKJ
- excise distal fibular
Exposure subtalar joint
- elevate peroneals and EDB
- divide TC interosseous ligament
Prepare arthrodesis
- decorticate / remove cartilaginous surfaces
- drill holes
- correct deformity
- ankle joint: 5o valgus, plantigrade, ER 10o
- subtalar joint: 5o valgus
2. Hindfoot nail
Insertion point
- in line with 2nd metatarsal
- junction of posterior 2/3 and anterior 1/3 heel
- should pass through anterior aspect posterior subtalar joint
Insert nail
- distal locking screws calcaneum using jig
- insert bone graft
- compress
- proximal locking
Smith and Nephew Hindfoot Fusion Nail Surgical Technique PDF
Synthes Hindfoot Arthrodesis Nail Surgical Technique PDF