by Introduction
Ankle fusion or ankle arthrodesis is a surgical procedure that fuses the ankle joint into a straight position to eliminate pain caused by arthritis or joint damage. Traditionally, ankle fusion procedures involved placing screws and plates externally on the outside of the ankle. However, this external hardware can sometimes cause pain, irritation and difficulty with shoe wear post-surgery. The global ankle fusion nail (GAFN) is an innovative internal implant designed to achieve ankle fusion from the inside out, removing the need for external hardware.
History of ankle fusion techniques
Ankle fusion has been performed for over a century to treat end-stage ankle arthritis and other ankle injuries. Originally, surgeons relied on casting or bracing the ankle post-surgery to achieve fusion. Then in the 1970s, surgeons began using compression screws placed across the ankle joint from the outside. In the 1980s, technology advanced to using compression plates attached to the outside of the ankle bone with screws. While screws and plates provided superior compression compared to casting, they had to be removed in a second surgery once fusion was achieved. Additionally, protruding hardware sometimes caused pain, wound problems and interfering with shoe wear.
Development of Intramedullary techniques
In the early 2000s, orthopedic surgeons began exploring new intramedullary or internal approaches to ankle fusion that did not require external fixation. The first intramedullary ankle fusion nail was introduced in 2003 in Europe and has continued to evolve. Dr. Thomas Pinder at the Sandwell Hospital in the UK is credited with performing and popularizing the intramedullary GAFN technique which has yielded successful fusion rates between 95-98% with minimal complications.
How the GAFN procedure works
In a GAFN procedure, the surgeon starts by making small incisions on the front and back of the ankle. Through these incisions, the surgeon cleans out the ankle joint surface and prepares the ends of the tibia and talus bones for fusion. Next, a titanium nail is inserted down the center of the tibia bone using a guide wire and mallet. Specialized drill bits and sizers are used to ream the intramedullary canals of the tibia and talar bones. The hollow nail locks into place across the prepared ankle joint, applying compression from the inside out to promote bone healing and fusion. No external fixation is required as the nail provides full weight-bearing stability immediately after surgery.
Advantages of the GAFN technique
Compared to external fixation methods, the GAFN approach offers several advantages for patients:
– Less soft tissue disruption as there are no plate/screws overlying skin and tendons. This translates to less pain, quicker healing and less risk of wound issues.
– Earlier weight-bearing and mobilization since nail provides immediate stability. Patients report faster recovery times.
– No hardware irritation from protruding screws/plates underneath the skin. Better tolerability of shoe gear post-surgery.
– Hardware can be left in place permanently in most cases rather than requiring removal surgery.
– Straightforward minimally invasive surgery with minimal blood loss, scarring and infection risk compared to traditional open approaches.
– Superior fusion rates with mechanical strength and stability provided by nail placement down the centers of weight-bearing tibia and talus bones.
Surgical technique considerations
While the GAFN technique delivers many benefits, it does require higher surgical skill levels compared to plating methods. Proper patient selection, pre-operative planning and precise intraoperative technique are crucial for success. Surgeons must carefully prepare the ankle joint, size and insert the nail, and assess stability under fluoroscopy. Malpositioning the hardware can potentially compromise fusion results or cause other problems. Close post-op monitoring is also important to ensure bony union proceeds as expected. The learning curve to competently perform the Global Ankle Fusion Nail procedure is estimated at 20-30 cases according to surgeon experience reports.
In summary, the global ankle fusion nail offers an innovative method for achieving ankle arthrodesis which provides all of the advantages of internal fixation without external hardware complications. When performed by experienced surgeons using meticulous technique, this minimally invasive intramedullary approach yields high fusion rates and superior patient outcomes compared to traditional methods relying on outside plating or screws. As a result, the GAFN is rapidly becoming the new gold standard for surgical management of end-stage ankle arthritis and injuries requiring ankle arthrodesis. Continued follow-up studies will help further refine surgical best practices and evaluate long-term outcomes with this emerging technique. Overall, the GAFN procedure holds great promise for improving recovery and quality of life for patients receiving ankle fusion surgery.
*Note:
- Source: CoherentMI, Public sources, Desk research
- We have leveraged AI tools to mine information and compile it
