Skip to main content
SpringerLink
Log in

Use in Arthrodesis

  • Chapter
  • First Online:
Essential Biomechanics for Orthopedic Trauma

  • 1101 Accesses

Abstract

Arthrodesis is typically reserved as a salvage procedure, can be performed utilizing multiple fixation constructs, and leads to successful fusion when biomechanical principles are followed. General principles for bony union such as joint preparation, compression, bony apposition, mechanical alignment, stable fixation, and appropriate strain at the arthrodesis site are observed with intramedullary nailing just like any other fixation construct. However, the use of intramedullary nails for arthrodesis is unique in its ability to limit soft tissue dissection and provide support to the fusion through its load-sharing properties. It is typically limited to knee and hindfoot fusions because the regional anatomy easily accommodates medullary fixation. Obtaining primary bony fusion is the goal of any arthrodesis; however, nails are particularly well suited for fusion through both primary and secondary healing, thus expanding the indications and abilities of a surgeon to achieve fusion. Intramedullary nailing offers its own unique challenges, particularly in obtaining and maintaining joint compression, which is likely contributory to nonunions when they occur, but can be mitigated by maximizing the biomechanical principles observed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Thomas RL, Sathe V, Habib SI. The use of intramedullary nails in tibiotalocalcaneal arthrodesis. J Am Acad Orthop Surg. 2012;20(1):1–7.

    Article  CAS  Google Scholar 

  2. Parker L, Singh D. (i) The principles of foot and ankle arthrodesis (Mini-symposium foot and ankle). Orthop Trauma. 2009;23(6):385–94.

    Article  Google Scholar 

  3. Ray RG, Ching RP, Christensen JC, Hansen ST Jr. Biomechanical analysis of the first metatarsocuneiform arthrodesis. J Foot Ankle Surg. 1998;37(5):376–85.

    Article  CAS  Google Scholar 

  4. Kowalski RJ, Ferrara LA, Benzel EC. Biomechanics of bone fusion. Neurosurg Focus. 2001;10(4):E2.

    Article  CAS  Google Scholar 

  5. Miller SD. Compression forces of internal and external ankle fixation devices with simulated bone resorption. Foot Ankle Int. 2010;31(5):469–70; author reply 70–1.

    Article  Google Scholar 

  6. Fragomen AT, Meyers KN, Davis N, Shu H, Wright T, Rozbruch SR. A biomechanical comparison of micromotion after ankle fusion using 2 fixation techniques: intramedullary arthrodesis nail or Ilizarov external fixator. Foot Ankle Int. 2008;29(3):334–41.

    Article  Google Scholar 

  7. McCormick JJ, Li X, Weiss DR, Billiar KL, Wixted JJ. Biomechanical investigation of a novel ratcheting arthrodesis nail. J Orthop Surg Res. 2010;5:74.

    Article  Google Scholar 

  8. Berson L, McGarvey WC, Clanton TO. Evaluation of compression in intramedullary hindfoot arthrodesis. Foot Ankle Int. 2002;23(11):992–5.

    Article  Google Scholar 

  9. Mückley T, Hoffmeier K, Klos K, Petrovitch A, von Oldenburg G, Hofmann GO. Angle-stable and compressed angle-stable locking for tibiotalocalcaneal arthrodesis with retrograde intramedullary nails. Biomechanical evaluation. J Bone Joint Surg Am. 2008;90(3):620–7.

    Article  Google Scholar 

  10. Kaspar K, Schell H, Seebeck P, Thompson MS, Schutz M, Haas NP, et al. Angle stable locking reduces interfragmentary movements and promotes healing after unreamed nailing. Study of a displaced osteotomy model in sheep tibiae. J Bone Joint Surg Am. 2005;87(9):2028–37.

    Article  CAS  Google Scholar 

  11. Woods JB, Burns PR. Advances in intramedullary nail fixation in foot and ankle surgery. Clin Podiatr Med Surg. 2011;28(4):633–48.

    Article  Google Scholar 

  12. Mückley T, Eichorn S, Hoffmeier K, von Oldenburg G, Speitling A, Hoffmann GO, Bühren V. Biomechanical evaluation of primary stiffness of tibiotalocalcaneal fusion with intramedullary nails. Foot Ankle Int. 2007;28(2):224–31.

    Article  Google Scholar 

  13. Yakacki CM, Khalil HF, Dixon SA, Gall K, Pacaccio DJ. Compression forces of internal and external ankle fixation devices with simulated bone resorption. Foot Ankle Int. 2010;31(1):76–85.

    Article  Google Scholar 

  14. Griffin MJ, Coughlin MJ. Evaluation of midterm results of the Panta nail: an active compression tibiotalocalcaneal arthrodesis device. J Footo Ankle Surg. 2018;57(1):74–80.

    Article  Google Scholar 

  15. Marsell R, Einhorn TA. The biology of fracture healing. Injury. 2011;42(6):551–5.

    Article  Google Scholar 

  16. Berend ME, Glisson RR, Nunley JA. A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis. Foot Ankle Int. 1997;18(10):639–43.

    Article  CAS  Google Scholar 

  17. Alfahd U, Roth SE, Stephen D, Whyne CM. Biomechanical comparison of intramedullary nail and blade plate fixation for tibiotalocalcaneal arthrodesis. J Orthop Trauma. 2005;19(10):703–8.

    Article  Google Scholar 

  18. Froelich J, Idusuyi OB, Clark D, Kogler GF, Paliwal M, Dyrstad B, et al. Torsional stiffness of an intramedullary nail versus blade plate fixation for tibiotalocalcaneal arthrodesis: a biomechanical study. J Surg Orthop Adv. 2010;19(2):109–13.

    PubMed  Google Scholar 

  19. Kim K, Snir N, Schwarzkopf R. Modern techniques in knee arthrodesis. Int J Orthop. 2016;3(1):487–96.

    Article  Google Scholar 

  20. Peterson JM, Chlebek C, Clough AM, Wells AK, Batzinger KE, Houston JM, et al. Stiffness matters: Part II – The effects of plate stiffness on load-sharing and the progression of fusion following ACDF in vivo. Spine (Phila Pa 1976). 2018;43(18):E1069–76. https://doi.org/10.1097/BRS.0000000000002644.

    Article  Google Scholar 

  21. Bong MR, Kummer FJ, Koval KJ, Egol KA. Intramedullary nailing of the lower extremity: biomechanics and biology. J Am Acad Orthop Surg. 2007;15(2):97–106.

    Article  Google Scholar 

  22. Schneider E, Michel MC, Genge M, Zuber K, Ganz R, Perren SM. Loads acting in an intramedullary nail during fracture healing in the human femur. J Biomech. 2001;34(7):849–57.

    Article  CAS  Google Scholar 

  23. Lindsey RW, Gugala Z, Milne E, Sun M, Gannon FH, Latta LL. The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect. J Orthop Res. 2006;24(7):1438–53.

    Article  CAS  Google Scholar 

  24. Lindsey RW, Gugala Z. Cylindrical titanium mesh cage for the reconstruction of long bone defects. Osteo Trauma Care. 2004;12(3):108–15.

    Article  Google Scholar 

  25. Frigg A, Dougall H, Boyd S, Nigg B. Can porous tantalum be used to achieve ankle and subtalar arthrodesis? A pilot study. Clin Orthop Relat Res. 2010;468(1):209–16.

    Article  Google Scholar 

  26. Henricson A, Rydholm U. Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement: a short-term follow-up of 13 patients. Acta Orthop. 2010;81(6):745–7.

    Article  Google Scholar 

  27. Bussewitz B, DeVries JG, Dujela M, McAlister JE, Hyer CF, Berlet GC. Retrograde intramedullary nail with femoral head allograft for large deficit tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2014;35(7):706–11.

    Article  Google Scholar 

  28. Mauffrey C, Zagrocki L, Jordan RW, Seligson D. Retrograde tibiotalocalcaneal nails: an option for complex open pilon fractures. Current Orthop Pract. 2012;23(5):507–11.

    Article  Google Scholar 

  29. Blake Peterson, Sonny Bal, Ajay Aggarwal, Brett Crist, (2016) Novel Technique: Knee Arthrodesis Using Trabecular Metal Cones with Intramedullary Nailing and Intramedullary Autograft. The Journal of Knee Surgery. 29(06):510–15.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Trauma Service, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    Kyle M. Schweser & Brett D. Crist

Authors
  1. Kyle M. Schweser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brett D. Crist
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kyle M. Schweser .

Editor information

Editors and Affiliations

  1. Orthopaedic Trauma Service, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    Brett D. Crist

  2. BayCare Health System, Lutz, FL, USA

    Joseph Borrelli Jr.

  3. Injury Repair and Recovery Program, McGill University Health Center Research Institute, Montreal, QC, Canada

    Edward J. Harvey

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schweser, K.M., Crist, B.D. (2020). Use in Arthrodesis. In: Crist, B., Borrelli Jr., J., Harvey, E. (eds) Essential Biomechanics for Orthopedic Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-36990-3_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-36990-3_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-36989-7

  • Online ISBN: 978-3-030-36990-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation