72: Arthrodesis Procedures - Smith Flashcards Preview

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Flashcards in 72: Arthrodesis Procedures - Smith Deck (13)
1

indications for triple arthrodesis

  • 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

2

what jts are fused in triple arthrodesis?

fusion STJ and CC and TN jt

3

triple arthrodesis procedure names

Ryerson ***

Hoke **

Lambrinudi

Brewster

Dunn

Seiffert or break

4

complicatiosn of triple arthrodesis

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

5

how is the foot positioned for triple arthrodesis?

  • 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 ***

6

fixation of triple arthrodesis?

  • 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

7

type of incision to be made for triple arthrodesis

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

8

review anatomy near incision

9

order of resection

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

10

post op care triple arthrodesis

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

11

indications ankle arthrodesis

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

12

ankle arthrodesis positioning

  • 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)

13

pantalar arthrodesis

ankle AND triple arthrodesis

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