65: Arthrodesis Forefoot - Frush Flashcards Preview

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Flashcards in 65: Arthrodesis Forefoot - Frush Deck (26)
1

used for extensor substitution etioloty

digital arthrodesis

2

do you do digital arthrodesis on 5th toe?

no

too rigid

3

advantage of peg in hole or chevron methods over end to end for digital arthrodesis

more stable but more time consuming

beneficial if you have to pull k-wire out early

4

indications for hallux IPJ arthrodesis

  • Neuromuscular Disease
  • Cavus Foot
  • Traumatic Arthritis
  • Iatrogenic Deformities
  • Hallux hammertoes

5

fixation hallux IPJ arthrodesis

k-wire (crossed or intramedullary)

4.0 mm partially threaded cancellous screw (solid or cannualted)

6

what procedure?

hallux IPJ arthrodesis

use a lazy S skin incisioin to expose joint

7

post op care hallux IPJ arthrodesis

WB in post op shoe or boot 6 wks

potential complications = delayed healing of soft tissue or bone, varus or valgus rotation of toe

8

indications 1st MPJ arthrodesis

  • HAV: Neuromuscular
  • Hallux Limitus/ Hallux Rigidus
  • Failed Bunion Procedures
  • Failed Keller or Implant
  • Hallux Varus
  • Arthritis
    • –DJD, OA, or Inflammatory arthidities
  • Combination with a Panmetatarsal resection
  • Loss of extensor or flexor function

9

contraindications 1st MPJ arthrodesis

  • IPJ arthritis or limitation of motion
  • osteoporosis
  • occupational or functional expectations

10

technique for 1st MPJ arthrodesis

  • dorsomedial incision
  • capsular release
  • resection of medial eminence
  • removal of cartilage or fibrous tissue
    • curettage
    • saw (loses length)
    • special cup and cone reamers

11

cup and cone reamers

tyring to remove cartilage to get to bleeding subchondral bone

12

in pt with neuromuscular disease, what might you add to 1st MPJ arthrodesis?

lengthen EHL

13

positioning of 1st MPJ arthrodesis

15 degrees dorsiflexion

15 degrees abduction

0 degrees frontal plane motion

  • tip of hallux should be elevated 10mm from WB surface when foot is loaded, try to keep hallux parallel with lesser digits

14

compression plating for 1st MPJ arthrodesis

2-3 screws should be placed on either side of fusion

could also just use two crossing screws w/o plate

15

post op 1st MPJ arthrodesis

protected WB in cam boot 6-8 wks

if extensive grafting done NWB for 6-8 wks

if external fixation or k-wires used, remoe in clinic 6-8 wks

16

first met cuneiform arthrodesis aka

lapidus

17

indications for lapidus

  • Juvenile HAV with hypermobility
  • Osteoarthritis and Degenerative arthritis
  • Charcot osteoarthropathy
  • Severe adult HAV with IM angle exceeding 15 degrees
  • Medial column instability
  • Ligamentous laxity

18

procedure for lapidus

  • žSkin Incision
    • Dorsal incision extending to the medial cuneiform
  • žArticular cartilage resection
    • Curettage or saw resection to bleeding subchondral bone
    • Transverse and Sagittal plane correction
  • žFixation
    • 3.5 or 4.0 partially threaded cancellous screws
    • Plate and/or Pins

19

post op care lapidus

NWB short leg cast 6-8 wks, then partial WB for 2-4wks

PT at 3 mo

20

(+) and (-) 1st met cuneiform arthrodesis

  • žDisadvantages
    • Extensive sx exposure required
    • May shorten 1st ray
    • Can be technically demanding
    • Prolonged postop period
  • žAdvantages
    • Eliminates 1st met cuneiform hypermobility
    • Stabilizes the medial column
    • Allows for large amount of correction

21

indications for lisfranc's jt arthrodesis

  • post-traumatic arthritis
  • DJD
  • charcot osteoarthropathy
  • pes cavus
  • metatarsus adductus

22

lisfranc's arthrodesis

23

3 distinct components to tarsometatarsal region (lisfranc's arthrodesis)

  • Medial
    • –1st met cuneiform joint
  • Middle
    • –2nd and 3rd met cuneiform joint
  • Lateral
    • –4th and 5th met cuboid joints
  • žAny one of the 3 components may be fused in isolation for focused arthritis
  • If fusing all, fuse the 1st first

24

žDowel Graft Arthrodesis (Inlay Graft)

  • Iliac crest bone graft
  • In situ fusion
  • No correction
  • Crossed k-wire fixation

25

what fixation would you most likely use for lisfranc's jt arthrodesis

staples

- temporarily fixate 1st and 5th mets first to evaluate parabola and foot alignment

26

post op lisfranc's jt arthrodesis

NWB 6-8 wks

may want splint due to edema, then cast

WB in boot for 2-4 wks

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