72: Arthrodesis Procedures - Smith Flashcards

1
Q

indications for triple arthrodesis

A
  • PAIN, deformitly, instability, progression
  • valgus foot deformity
    • collapsing pes planovalgus
    • ruptured tibialis post tendon
    • tarsal coalition and arthritic deformities
      • congenital, rheumatoid, degenerative, posttraumatic
  • varus foot deformity
    • cavus
    • cavovarus
    • talipes equinovarus
  • miscellaneous
    • lateral ankle instability and ankle equinus
    • neuromuscular disease
      • hereditary familial sensorimotor neuropathies
      • paralytic deformities
      • charcot jt deformities
      • other dz affecting the spinal cord adn brain
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2
Q

what jts are fused in triple arthrodesis?

A

fusion STJ and CC and TN jt

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3
Q

triple arthrodesis procedure names

A

Ryerson ***

Hoke **

Lambrinudi

Brewster

Dunn

Seiffert or break

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4
Q

complicatiosn of triple arthrodesis

A
  • pseudoarthrosis/non-union
    • 7-23%
    • usually at talonavicular jt
  • develpment of DJD in adjacent jts
  • AVN
  • ankle instability
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5
Q

how is the foot positioned for triple arthrodesis?

A
  • May accommodate deformity in all three body planes by resection of bone at the joints
  • Arthrodesis position of rearfoot should be 0 - 5 degrees of valgus (thou shall not varus - fusion position STJ)
  • Arthrodesis position of forefoot should be parallel to the ground and perpendicular to the heel ***
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6
Q

fixation of triple arthrodesis?

A
  • Three 6.5 mm partially threaded cancellous screws (lag design)
    • threads must cross the fusion site
  • May use smaller screws or staples across midtarsal joint
  • May staple all three arthrodesis sites
  • Steinmann pins
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7
Q

type of incision to be made for triple arthrodesis

A

ollier’s incision

  • lateral approach from tip of lateral malleolus to the base of the metatarsals

also make a medial incision to access the TN jt better

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8
Q

review anatomy near incision

A
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9
Q

order of resection

A

1st: midtarsal joint (CC, TN)

2nd: STJ

FUSE In the reverse order

temp fixate STJ w/ cannulated guide wire

position the forefoot and temp fixate

then fixate STJ, CC, TN

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10
Q

post op care triple arthrodesis

A
  • short leg cast for 12 wks NWB
  • partial WB for additional 4 wk
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11
Q

indications ankle arthrodesis

A
  • Severe pain and/or deformity
    • DJD: S/P ankle fracture
    • RA
    • Talar collapse
    • Infection
    • Drop foot
    • Congenital deformities
    • Ankle implant revision
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12
Q

ankle arthrodesis positioning

A
  • right ankle to leg ( 0 degrees dorsiflexion)
  • body can tolerate 5 degrees of plantarflexion
  • external rotation of 13-15 degrees foot (line up tibial tuberosity with the 2nd toe)
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13
Q

pantalar arthrodesis

A

ankle AND triple arthrodesis

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