Hindfoot nail

Abstract

The present invention relates to a nail and fastener assembly for use in providing a stable construct for optimal fixation of the hindfoot and to methods for implanting the nail and fastener assembly. One embodiment of the nail and fastener assembly provides additional fixation, for example, in the form of one or more threaded bores, to hold the fasteners in a fixed position. Another embodiment provides angled bores to allow multi-planar and multi-axial implantation of the fasteners. In some instances, the fasteners may cross one or more articulating surfaces of the foot. For example, the fastener may traverse one or more of the calcaneo-cuboid and the talo-calcaneal articulating surfaces to aid in more secure stabilization of the hindfoot.

What is claimed is: 
     
       1. A method for at least partially fusing a patient's calcaneo-cuboid articulating surface and talo-calcaneal articulating surface in a hindfoot fusion process, the method comprising:
 (a) providing a nail having a proximal portion and a distal portion, the distal portion having a first angled fastener-receiving hole and a second angled fastener-receiving hole; 
 (b) providing a first fastener adapted to be received in the first angled fastener-receiving hole and a second fastener adapted to be received in the second angled fastener-receiving hole; 
 (c) implanting the nail into a patient's tibial canal; 
 (d) inserting the first fastener through the first angled fastener-receiving hole in the nail, such that the first fastener at least partially crosses the patient's calcaneo-cuboid articulating surface; and 
 (e) inserting the second fastener through the second angled fastener-receiving hole in the nail, such that the second fastener at least partially crosses the talo-calcaneal articulating surface. 
 
     
     
       2. The method of  claim 1 , wherein at least one of the first fastener-receiving hole and the second fastener-receiving hole is at least partially threaded. 
     
     
       3. A method of ankle arthrodesis on a patient, the patient having a tibia, a cuboid, a talus, and a calcaneus, the tibia having a tibial canal, the method comprising the steps of:
 a. selecting a properly sized nail; 
 b. reaming the tibial canal; 
 c. inserting the nail into the tibial canal; 
 d. inserting a first fastener into the calcaneus, through the nail, and into the cuboid; and 
 e. inserting a second fastener into the calcaneus, through the nail, and into the talus, wherein a tip portion of the second fastener achieves purchase within the talus. 
 
     
     
       4. The method of  claim 3 , further comprising the step of removing cartilage from one or more bones. 
     
     
       5. The method of  claim 3 , further comprising the step of incising a non-weight bearing part of a sole of the patient's foot. 
     
     
       6. The method of  claim 3 , further comprising the step of inserting a guide wire into the tibial canal. 
     
     
       7. The method of  claim 3 , further comprising the step of inserting a transverse fastener into the calcaneus and the nail. 
     
     
       8. A method for fusing bones in a hindfoot fusion process, comprising:
 providing a nail having a proximal portion and a distal portion and a central longitudinal axis extending therebetween, the distal portion defining at least two fastener-receiving holes, each of the holes defining a through axis offset and non-perpendicular to the nail axis, the through axes being non-parallel;   providing at least two fasteners;   implanting the nail into a patient's tibial canal; and   inserting one of the fastener through one of the holes in the nail and inserting the other fastener through the other of the holes in the nail, wherein inserting one of the fasteners comprises inserting the one of the fasteners into the talus.   
     
     
       9. The method of claim 8 wherein inserting the other fastener comprises inserting the other fastener into the cuboid. 
     
     
       10. A method for fusing bones in a hindfoot fusion process, comprising:
 providing a nail having a proximal portion and a distal portion and a central longitudinal axis extending therebetween, the distal portion defining at least two fastener-receiving holes, each of the holes defining a through axis offset and non-perpendicular to the nail axis, the through axes being non-parallel and constrained to non-parallel planes;   providing at least two fasteners;   implanting the nail into a patient's tibial canal; and   inserting one of the fasteners through one of the holes in the nail and inserting the other fastener through the other of the holes in the nail.   
     
     
       11. A method of ankle arthrodesis on a patient, the patient having a tibia, a cuboid, a talus, and a calcaneus, the tibia having a tibial canal, the method comprising:
 reaming the tibial canal;   inserting a nail into the tibial canal;   inserting a first fastener into the calcaneus, through the nail, and directed toward the cuboid; and   inserting a second fastener into the calcaneus, through the nail, and into the talus, wherein the first and second fasteners are non-parallel and a tip portion of the second fastener terminates within the talus.   
     
     
       12. The method of claim 11 further comprising providing the first fastener with sufficient length to engage the cuboid. 
     
     
       13. The method of claim 12 wherein inserting the second fastener comprises inserting the second fastener into the cuboid. 
     
     
       14. The method of claim 11 further comprising providing the nail with two holes, each for receiving one of the fasteners, the holes having non-parallel through axes. 
     
     
       15. The method of claim 14 wherein providing the nail comprises the through axes being constrained to non-parallel planes. 
     
     
       16. The method of claim 14 wherein providing the nail comprises the distal portion defining a third hole between the two fastener-receiving holes relative to a central longitudinal axis of the nail. 
     
     
       17. The method of claim 16 further comprising providing a third fastener and inserting the third fastener through the third hole in the nail. 
     
     
       18. A method for fusing bones in a hindfoot fusion process, comprising:
 providing a nail having a proximal portion and a distal portion and a central longitudinal axis extending therebetween, the distal portion defining three fastener-receiving holes, at least two of the holes defining through axes offset and non-perpendicular to the nail axis, the third hole being positioned between the at least two of the holes relative to the longitudinal axis;   providing three fasteners;   implanting the nail into a patient's tibial canal; and   inserting the fasteners each through one of the holes in the nail, wherein one of the fasteners is inserted into the talus.   
     
     
       19. The method of claim 18 wherein another of the fasteners is inserted into the cuboid. 
     
     
       20. A method of ankle arthrodesis on a patient, the patient having a tibia, a cuboid, a talus, and a calcaneus, the tibia having a tibial canal, the method comprising:
 reaming the tibial canal;   inserting a nail into the tibial canal;   inserting a first fastener into the calcaneus, through the nail, and directed toward the cuboid;   inserting a second fastener into the calcaneus, through the nail, and into the talus, wherein a tip portion of the second fastener terminates within the talus; and   inserting a third fastener between the first and second fastener relative to a longitudinal axis of the nail.   
     
     
       21. The method of claim 20 further comprising providing the nail with three holes, each hole for receiving one of the fasteners, the holes for receiving the first and second fasteners having non-parallel through axes constrained to non-parallel planes. 
     
     
       22. The method of claim 21 wherein providing the nail comprises the third hole being about perpendicular to the nail axis.