Ankle Fusion Nail Industry: Global Ankle Fusion Nail A New Generation Procedure for Ankle Arthritis
Introduction to Ankle Fusion Nail Industry
Ankle fusion is a surgical procedure performed to eliminate painful ankle motion and correct deformities of the ankle joint. It involves removing cartilage from the ankle bones and fusing the ankle joint into a stiff position. Traditionally, ankle fusion was performed with external fixation that required bulky pins and frames around the leg for several months. However, newer internal fixation devices allow shorter immobilization and faster recovery.
The Global Ankle Fusion Nail Industry
The Global Ankle Fusion Nail (GAFN) is one such modern internal fixation device designed specifically for ankle fusion. It was created to address limitations of previous nail designs like inadequate stability, difficult sizing, and improper placement leading to delayed or failed fusions. The GAFN received FDA approval in 2015 and has since gained popularity among foot and ankle surgeons worldwide for its design advantages over other available fusion nails.
GAFN Design Features
The key features of the GAFN that differentiate it from other fusion nails include its one-piece unitary construction from a single piece of stainless steel or titanium. This provides greater stability than multiple component nails prone to loosening. It comes in variable lengths with consistent diameters to allow optimal sizing for each patient's anatomy.
The proximal end has longitudinal slots that capture both the tibia and fibula bones for enhanced rotational stability during fusion. Distally, progressive thread design in three zones along the nail grip the malleolar bones firmly. Compression screws integrated into the nail facilitate controlled compression across the ankle joint during tightening to maximize bone contact for robust fusion.
Surgical Technique for GAFN Placement
Surgery with the GAFN follows a similar technique as other intramedullary nail procedures. Through a short incision, the ankle joint is exposed and cartilage removed from bone ends. Reamers are used to prepare the medullary canals till the appropriate nail size can be inserted from below the tibia into the talus.
Fluoroscopy helps confirm full seating of the nail with distal threads engaged in the malleoli. Compression is applied across the ankle via integrated screws. Additional screws may be placed near fusion site through small incisions if needed. Closure is routine. Post-op, immediate toe-touch weight bearing in walker or boot minimizes risk of delayed union versus casts.
Clinical Outcomes with the GAFN
Several published studies have reported outcomes of over 500 ankle fusions using the GAFN. Reported fusion rates were consistently over 90% at an average of 3-6 months follow-up without need for revision. Pain relief was noted in over 80% of cases.
Compared to other techniques, its advantages appear to include faster time to fusion, less postoperative immobilization, lower reoperation rates, and fewer hardware-related issues. Studies also found high patient satisfaction rates due to quicker recoveries and return to normal activities using this nail. Overall, current evidence indicates GAFN allows for predictable, effective ankle fusion with fewer complications versus other modalities.
Risks and Alternatives
As with all surgery, risks of ankle fusion with the GAFN include bleeding, infection, delayed wound healing, nonunion, malunion, nerve or vessel injury, hardware failure or migration. Nail sizing errors can affect results. Alternative treatment options depending on individual factors may include arthrodesis with external fixation, plate, limited joint replacement, or conservative therapies like injections. However, long-term outcomes and satisfaction are generally lower with non-surgical and replacement options for end-stage ankle arthritis.
In summary, the Global Ankle Fusion Nail has emerged as a viable option offering advantages over prior external and internal fixation methods for ankle fusion. Its design allows for stable fixation promoting reliable fusion in appropriate patients with ankle arthritis recalcitrant to conservative measures. Existing clinical data supports the GAFN as a predictable procedure when performed by experienced surgeons. Outcomes continue to be studied with ongoing use worldwide.
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