Understanding Hindfoot Nailing

Introduction:

Hindfoot nailing is a popular surgical procedure in the orthopedic field. These are used to manage hindfoot fractures and deformities affecting its normal anatomy. During this procedure, the intramedullary nails (a metal rod inserted into the affected bone to restore its normal function) are strategically inserted to achieve stable fixation. The hind foot consists of bones, such as calcaneus and talus bones. The main bone plays a role in weight-bearing and movements, such as walking, running, swimming, flying, and climbing stairs. Injury to these structures can cause long-term complications. The surgical procedure offers a versatile solution that provides stability and preservation of the anatomical structures. Advancing surgical intervention may garner attention in the orthopedic community for managing complex hindfoot fractures. The article discusses hindfoot nailing, its procedure, indications, contraindications, risks, and benefits.

What Is Hindfoot Nailing?

Hindfoot nailing is an orthopedic surgical intervention used to manage hindfoot fractures. It is a stabilized approach to reconstructing and stabilizing the hindfoot fracture. During this procedure, the intramedullary nails align with fractured and deformed bones. It is used to restore the structural integrity of the hindfoot.

What Is the Procedure of Hindfoot Nailing?

The hindfoot nailing is an invasive intervention designed to manage hindfoot fractures. The healthcare provider may advise surgical techniques based on the nature of the injury, doctor's preference, and patient needs. The general overview of the procedure of hindfoot nailing is described below:

• Preoperative Assessment: Before the surgical procedure, the healthcare provider may advise the patient to undergo a thorough preoperative assessment by doing imaging studies, such as X-rays and computed tomography (CT) scans, to check for the type, nature, and extent of hindfoot injury. They may also assess associated symptoms, such as pain, difficulty walking, discomfort, and swelling. The surgeon will also assess the quality of skin, amount of deformity, range of motion, and associated bone diseases.

• Anesthesia: The anesthesiologist may inject general and regional anesthesia to provide comfort to the patient and lead to pain control during the procedure.

• Patient Positioning: The patient's position during the procedure can be face lying down or face up.

• Surgical Procedure: The healthcare provider may make a surgical incision to visualize the calcaneus and talus. There are two surgical approaches to managing hindfoot nailing, which are as follows:

  1. Retrograde Approach: During this surgical approach, the healthcare provider may make a surgical incision on the lower aspect of the heel and insert an intramedullary nail through the calcaneus bone. Then the nail is assisted to travel backward toward the talus bone. This type of surgical approach is indicated in the case of calcaneus bone fractures.
  2. Antegrade Approach: During this surgical procedure, the healthcare provider makes a surgical incision on the upper aspect of the foot over the talus bone. The nail is assisted to travel in a forward direction toward the calcaneus bone. This type of surgical approach is indicated in the case of talus bone fracture. This will help in the visualization of the subtalar joint.

• Soft Tissue Dissection: The surgeon dissects the soft tissue and reaches the fractured site of the hindfoot.

• Intramedullary Nail Insertion: The intramedullary nail is carefully placed into the affected bone medullary canal. In addition, the surgeon may use an imaging technique, such as fluoroscopy (same as X-ray, but in this, a thin tube or camera is used to see the affected site and guide the placement of the intramedullary nail).

• Locking Mechanism: The intramedullary nail has a locking mechanism to keep the nail in place. The locking function provides stability to the fractured bone.

• Wound Closure: After the placement of the intramedullary nail, the surgeon may close the incision with the help of sutures.

• Postoperative Care: After the surgical procedure, the healthcare provider monitors the patient in the recovery area to check for signs of infection. The patient is instructed to stay in the hospital for a few days.

• Rehabilitation Plan: The surgeon may initiate a rehabilitation plan during recovery. The physiotherapist may recommend that the patient start weight-bearing activities and exercise to improve mobility.

What Are the Indications and Contraindications of Hindfoot Nailing?

The indications and contraindications of hindfoot nailing are as follows:

Indications:

• Hindfoot nailing is indicated in cases of calcaneus and talus fracture.

• In complex hindfoot fractures.

• Hindfoot deformities.

• Prolonged immobilization.

• In situations where soft tissue disruption is crucial.

• People with high functional demands of hindfoot, such as in athletes.

• Cases in which conservative treatment failed to provide adequate stabilization.

Contraindications:

• In severe soft tissue injuries, the surgical procedure is contraindicated because it may raise the risk of postoperative complications.

• Active infections.

• Severe peripheral vascular disease may raise the risk of postoperative complications.

• Neurological impairment.

• Unstable general health.

• People who cannot follow postoperative instructions, such as rehabilitation exercises, are not advised to undergo this procedure.

What Are the Benefits of Hindfoot Nailing?

The key benefits of hindfoot nailing are as follows:

• Hindfoot nailing provides stable internal fixation and support during the healing process.

• The procedure reduces the blood supply disruption to the surgical area.

• It improves the mobility of the affected area.

• The procedure reduces the risk of complications related to prolonged immobilization.

• It decreases the risk of infection and necrosis (tissue death).

• It improves patient comfort.

• It reduces soft tissue complications.

• The procedure is applicable for complex fractures of the calcaneus and talus.

• The incision associated with the procedure is single, and surgical trauma is less.

• The hospital stays are shorter.

What Are the Risks and Complications of Hindfoot Nailing?

Hindfoot nailing is an effective surgical procedure. In addition, there are several risks and complications associated with the procedure. The common risks and complications are described below:

• In some cases, there is a risk of postoperative wound infection. The bone may also be involved in severe infection cases, leading to osteomyelitis (bone inflammation).

• The surgical procedure carries a risk of nonunion (the bone fails to heal) or delayed union (delayed healing).

• Sometimes, the bone is in an incorrect position during surgery or the healing process.

• The person may feel irritation or discomfort. If an individual experiences persistent irritation, removal of hindfoot nailing is recommended.

• The procedure also risks damage to soft tissues, such as nerves, blood vessels, or tendons.

• The blood flow to the affected site can be reduced and causes increased pressure.

• Permanent nerve damage.

• Risk of blood clot formation.

• Allergic reaction to intramedullary nail.

• Allergic reaction to regional or general anesthesia.

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Conclusion:

In conclusion, hindfoot nailing is a surgical procedure to correct calcaneus or talus fractures. It provides several benefits, such as stable fixation, improved blood supply, and early mobilization. In addition, the associated risks are delayed healing, infections, and permanent nerve injury. The advancement in surgical technique and implant design contributes to improved patient care.