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Surg+BioMech [all exams] COPY > 65: Arthrodesis Forefoot - Frush > Flashcards

65: Arthrodesis Forefoot - Frush Flashcards

1
Q

used for extensor substitution etioloty

A

digital arthrodesis

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2
Q

do you do digital arthrodesis on 5th toe?

A

no

too rigid

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3
Q

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

A

more stable but more time consuming

beneficial if you have to pull k-wire out early

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4
Q

indications for hallux IPJ arthrodesis

A
  • Neuromuscular Disease
  • Cavus Foot
  • Traumatic Arthritis
  • Iatrogenic Deformities
  • Hallux hammertoes
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5
Q

fixation hallux IPJ arthrodesis

A

k-wire (crossed or intramedullary)

4.0 mm partially threaded cancellous screw (solid or cannualted)

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6
Q

what procedure?

A

hallux IPJ arthrodesis

use a lazy S skin incisioin to expose joint

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7
Q

post op care hallux IPJ arthrodesis

A

WB in post op shoe or boot 6 wks

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

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8
Q

indications 1st MPJ arthrodesis

A
  • 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
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9
Q

contraindications 1st MPJ arthrodesis

A
  • IPJ arthritis or limitation of motion
  • osteoporosis
  • occupational or functional expectations
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10
Q

technique for 1st MPJ arthrodesis

A
  • dorsomedial incision
  • capsular release
  • resection of medial eminence
  • removal of cartilage or fibrous tissue
    • curettage
    • saw (loses length)
    • special cup and cone reamers
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11
Q
A

cup and cone reamers

tyring to remove cartilage to get to bleeding subchondral bone

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12
Q

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

A

lengthen EHL

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13
Q

positioning of 1st MPJ arthrodesis

A

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
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14
Q

compression plating for 1st MPJ arthrodesis

A

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

could also just use two crossing screws w/o plate

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15
Q

post op 1st MPJ arthrodesis

A

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

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16
Q

first met cuneiform arthrodesis aka

A

lapidus

17
Q

indications for lapidus

A
  • 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
Q

procedure for lapidus

A
  • 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
Q

post op care lapidus

A

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

PT at 3 mo

20
Q

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

A
  • 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
Q

indications for lisfranc’s jt arthrodesis

A
  • post-traumatic arthritis
  • DJD
  • charcot osteoarthropathy
  • pes cavus
  • metatarsus adductus
22
Q
A

lisfranc’s arthrodesis

23
Q

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

A
  • 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
Q
A

žDowel Graft Arthrodesis (Inlay Graft)

  • Iliac crest bone graft
  • In situ fusion
  • No correction
  • Crossed k-wire fixation
25
Q

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

A

staples

  • temporarily fixate 1st and 5th mets first to evaluate parabola and foot alignment
26
Q

post op lisfranc’s jt arthrodesis

A

NWB 6-8 wks

may want splint due to edema, then cast

WB in boot for 2-4 wks

Surg+BioMech [all exams] COPY (74 decks)

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