Periprosthetic Fracture After Hindfoot Fusion Nail Treated With Spanning Antegrade Tibial Nail

Abstract

Periprosthetic fracture after hindfoot fusion nailing is a complex, uncommon complication. There is no consensus in the literature regarding optimal treatment of these injures, with proposed solutions, including cast immobilization, retrograde femoral and humeral nails, circular external fixation, and amputation. The goal of revision surgery is to adequately bypass and stabilize the fracture, protect the hindfoot fusion site from increased stress, and promote early weight bearing in a load-sharing fashion. In this report, we present the case of an unstable periprosthetic tibia fracture involving the proximal aspect of a hindfoot fusion nail 10 weeks after surgery in the setting of an incompletely fused hindfoot. The patient was successfully treated using a spanning antegrade suprapatellar tibia nail extending from the proximal aspect of the tibia to the plantar aspect of the calcaneus to bypass the tibia fracture as well as protect and maintain fixation across the hindfoot fusion. At final follow-up, the patient had union across her tibia fracture as well as her hindfoot fusion and was able to return to her activities of daily living and ambulate in normal shoe wear. Level of Evidence: Level V