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 nail for ankle arthrodesis on a patient, comprising:
 a shaft having a proximal portion configured for receipt within a tibial canal of the patient's tibia, a distal portion configured to engage the patient's calcaneus, and a central longitudinal axis extending therebetween, the proximal portion of the shaft being straight,   the shaft defining three, non-intersecting holes in the distal portion, each of the holes configured to receive a fastener extending through the shaft from a first outer side to an opposing second outer side of the shaft such that the fastener can have bone purchase on both sides of the shaft, at least two of the holes having through axes offset and non-perpendicular to the central longitudinal axis, the through axes of the at least two of the holes being offset from perpendicular to the central longitudinal axis in the same proximal/distal direction, and the third hole being positioned between the at least two of the holes relative to the longitudinal axis.   
     
     
       9. The nail of claim 8, wherein the shaft further defines a hole and a slot in the proximal portion of the shaft. 
     
     
       10. The nail of claim 8 wherein the shaft is straight. 
     
     
       11. The nail of claim 8 wherein the axes of the at least two of the holes are non-parallel. 
     
     
       12. The nail of claim 11 wherein the axes of the at least two of the holes are constrained to non-parallel planes. 
     
     
       13. The nail of claim 8 wherein the axis of one of the at least two holes is orientated to direct a fastener toward the talus, and the axis of the other of the at least two holes is orientated to direct a fastener toward the cuboid. 
     
     
       14. The nail of claim 8 wherein the distal portion has a greater outer diameter relative to the proximal portion. 
     
     
       15. The nail of claim 14 further including a frusto-conical transition segment between the distal portion and the proximal portion. 
     
     
       16. The nail of claim 8 wherein the shaft defines a through lumen along the central longitudinal axis. 
     
     
       17. The nail of claim 8 wherein the at least two of the holes are threaded. 
     
     
       18. The nail of claim 8 further comprising fasteners received by the at least two of the holes, wherein the fasteners are threaded. 
     
     
       19. The nail of claim 8 further comprising fasteners received by the at least two of the holes, wherein one of the fasteners is provided in a length that allows the fastener to extend through the nail and cross the calcaneus/talus articulating surface. 
     
     
       20. The nail of claim 19 wherein the one of the fasteners length is 50 to 100 mm. 
     
     
       21. The nail of claim 8 further comprising fasteners received by the at least two of the holes, wherein one of the fasteners is provided in a length that allows the fastener to extend through the nail and cross the calcaneus/cuboid articulating surface. 
     
     
       22. The nail of claim 21 wherein the one of the fasteners length is 50 to 100 mm. 
     
     
       23. The nail of claim 8 wherein the hole axes are oriented about 10-30 degrees circumferentially offset about the nail. 
     
     
       24. The nail of claim 23 wherein the hole axes are oriented about 20 degrees circumferentially offset about the nail. 
     
     
       25. The nail of claim 8 wherein a more proximal hole of the at least two of the holes comprises an offset to the central longitudinal axis of an angle, alpha, between 50 and 75 degrees. 
     
     
       26. The nail of claim 25 wherein the angle, alpha, comprises 55 degrees. 
     
     
       27. The nail of claim 8 wherein a more distal hole of the at least two of the holes comprises an offset to the central longitudinal axis of an angle, theta, between 80 and 90 degrees. 
     
     
       28. The nail of claim 27 wherein the angle, theta, comprises 85 degrees. 
     
     
       29. A nail for ankle arthrodesis on a patient, comprising:
 a shaft having a proximal portion configured for receipt within a tibial canal of the patient's tibia, a distal portion configured to engage the patient's calcaneus, and a central longitudinal axis extending therebetween,   the shaft defining three, non-intersecting holes in the distal portion, each of the holes configured to receive a fastener extending through the shaft from a first outer side to an opposing second outer side of the shaft such that the fastener can have bone purchase on both sides of the shaft, at least two of the holes having through axes offset and non-perpendicular to the central longitudinal axis, the through axes of the at least two of the holes being offset from perpendicular to the central longitudinal axis in the same proximal/distal direction, and the third hole being positioned between the at least two of the holes relative to the longitudinal axis,   the shaft defining a hole and an elongated slot in the proximal portion of the shaft.   
     
     
       30. A nail for ankle arthrodesis on a patient, comprising:
 a shaft having a proximal portion configured for receipt within a tibial canal of the patient's tibia, a distal portion configured to engage the patient's calcaneus, and a central longitudinal axis extending therebetween,   the shaft defining a through lumen extending along the direction of the central longitudinal axis,   the shaft defining three, non-intersecting holes in the distal portion, each of the holes configured to receive a fastener extending through the shaft from a first outer side to an opposing second outer side of the shaft such that the fastener can have bone purchase on both sides of the shaft, at least two of the holes having through axes offset and non-perpendicular to the central longitudinal axis, the through axes of the at least two of the holes being offset from perpendicular to the central longitudinal axis in the same proximal/distal direction, and the third hole being positioned between the at least two of the holes relative to the longitudinal axis.