Ankle fusion or arthrodesis is a surgical procedure performed to eliminate pain from ankle arthritis by fusing the ankle bones together. Conventionally, ankle fusion has been performed either with internal fixation using plates and screws or external fixation with frames and pins. However, a new device called Global Ankle Fusion Nail (GAFN) is gaining popularity as it offers certain advantages over traditional methods.

GAFN - An intro to the device

The Global Ankle Fusion Nail (GAFN) is an intramedullary nail designed specifically for ankle fusion. It is made of titanium alloy making it strong and lightweight. The nail has sizing options to fit different ankle sizes. At one end, it has angled teeth that lock into the talus bone above the ankle joint. The other end has teeth that lock into the tibia bone below the ankle. This locked configuration is meant to provide stable fixation during fusion, allowing early weight bearing post-surgery.

Surgical technique with GAFN

Surgery with GAFN is performed under general or regional anesthesia. First, the ankle joint surfaces are prepared by abrading the bone ends to be fused. Measurement is taken to select the appropriate nail size. Guide wires are inserted into the tibia and talus bones under fluoroscopy. Reamers are passed over the wires to shape the canal for the nail. The pre-sized GAFN is inserted by impaction over the guide wires until the distal and proximal teeth lock securely into place. Fluoroscopy is used to confirm proper positioning. Wound is closed routinely.

Post-op care and recovery

Immediate weight bearing as tolerated is allowed with GAFN fixation compared to 6-8 weeks with plates/screws. Patients are discharged with crutches and a removable boot within 2-3 days. Sutures are removed after 10-14 days. Orthopedic follow up visits ensure satisfactory progress of fusion. Touch weight bearing or partial weight bearing may be advised initially depending on bone quality. Full weight bearing occurs by 3 months once fusion is confirmed on x-rays. Return to low impact activities is around 4-6 months with fusion complete by 9-12 months.

Advantages of GAFN over other fixation options

- Early Weight Bearing

One major advantage of using GAFN is that it allows immediate/early weight bearing post-surgery. With plate fixation, patients have to remain non-weight or partial weight bearing for 6-8 weeks to prevent screw/plate breakage before fusion occurs. Early weight bearing aids faster recovery and prevents loss of muscle strength.

- Less Soft Tissue Disruption

GAFN is placed through tiny incisions compared to open exposure needed for plate fixation. This minimally invasive approach disrupts less soft tissue including blood vessels and nerves around the ankle. Less soft tissue trauma means reduced post-op pain, faster healing and recovery.

- Anatomical Nail Placement

Due to its curved and tapered design, GAFN achieves anatomical alignment of the ankle bones intra-operatively. It restores the mechanical axis of ankle better than plates which rely on placement of multiple screws. Proper anatomical fusion position prevents late deformities.

- Lower Risks Of Screw-Related Issues

Placing multiple screws involves risk of screw breakage, loosenss or backing out over time under load. These screw-related problems often lead to non-union, mal-alignment and need for revision surgery. GAFN eliminates such risks by providing fixed angle stable construct without screws.

- Easy Implant Removal If Needed

Should fusion fails or develops complications, removing a intramedullary locked nail is much simpler than taking out a whole plating construct. Preserved soft tissues and minimal dissection allows for any necessary revision with GAFN compared to complex removal of plates/screws.

- Cost Effectiveness

Being a single implant, GAFN reducesinstrumentation costs and shortens surgeryduration compared to plate fixation requiring multiple screws. Early weight bearing gets patients back to work sooner cutting indirect costs like wages/income loss. Overall, GAFN provides better clinical outcomes at lower costs.

Clinical Studies With GAFN

Several studies have validated the clinical efficacy of GAFN for ankle fusion. A multicenter trial of 79 fusions reported 92.4% fusionrate at 1-year with no nail failures. Patients achieved full weight bearing by 12 weeks on average. Complication rate was low at 7.5% including 3% delayedunions addressed non-surgically.

Another review of 29 GAFN ankle fusions found 96.6% fusion rate at 6 months. Average time to full weight bearing and return to work was 10.3 and 14.7 weeks respectively. One patient (3.4%) developed superficial infection while two required bone grafting for delayed unions. No nail failures or revisions were reported.

Overall, Global Ankle Fusion Nail provides a reliable minimally invasive option for ankle arthrodesis with multiple advantages over traditional open plating. High fusion success, fewer complications, early recovery and lower costs establish it as the gold standard technique going forward. With its clear clinical benefits, GAFN is rapidly gaining worldwide acceptance for treating end stage ankle arthritis.

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