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Ankle Arthrodesis Flashcards

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1
Q

What are some indications for ankle arthrodesis (ankle fusion)

A
  • post-traumatic arthritis**
  • RA
  • failed TAR
  • Septic arthritis
  • talar AVN
  • Charcot neuroarthropaty
  • congenital/paralytic deformities
  • drop foot
  • tumor with joint invasion
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2
Q

What are Glissan’s Principles for ankle arthrodesis

A
  • complete removal of all cartilage
  • accurate and close fitting fusion surfaces
  • optimal position of the ankle joint
  • maintenance of the position until fusion is complete
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3
Q

What is one of the main keys to a successful ankle fusion

A

Proper positioning

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4
Q

What is the optimal positioning for ankle fusion

A
  • 0-5 degrees RF valgus
  • 5-10 degrees ER
  • foot 90 degrees DF to leg
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5
Q

Why does the RF need to be in valgus for ankle fusion positioning

A
  • varus can lead to overloading of the forefoot and cause hindfoot symptoms
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6
Q

Why does the foot has to be dorsiflexed to the leg in ankle fusion positioning

A
  • overly plantarflexed can lead to genu recurvatum
  • may need to perform TAL or Gastroc recession too
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7
Q

What are the four surgical approaches for ankle fusion

A
  • anterior
  • lateral/trans fibular
  • medial
  • posterior
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8
Q

What are the 2 types of anterior surgical approaches for ankle fusion

A
  • charnley transverse
  • midline longitudinal
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9
Q

What are the differnet techniques to fusing an ankle

A
  • in situ fusion
  • articulate fusion with bone grafting/wedging
  • fusion with malleolar osteotomy
  • anterior arthrodesis with inlay grafting
  • subtotal or incomplete resection
  • arthroscopic fusion
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10
Q

What is in situ fusion

A
  • fusing in the position its in
  • removal of articular cartilage from talus/tibia
  • used in cases with minimal deformity
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11
Q

What is Goldthwait bone grafting

A

Bone graft used to pack defect through U shaped incision

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12
Q

What is Hallock bone graft

A

Tibial bone graft

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13
Q

What is Chuinard and Peterson bone graft

A
  • iliac bone graft in children
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14
Q

What is wescott bone graft

A

Graft from upper tibia

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15
Q

What is Campbell et al bone graft

A

Autogenous iliac crest graf

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16
Q

What is fusion with malleolar osteotomy

A

Medial or lateral malleolar osteotomy
- better joint exposure
- malleolus can be used as inlay strut graft

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17
Q

What is Horwitz fusion with malleolar osteotomy

A

Lateral approach with fibular osteotomy
Fibular divided longitudinally

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18
Q

What is Glissan fusion with malleolar osteotomy

A

Medial malleolar osteotomy as inlay

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19
Q

What is Wilson fusion with malleolar osteotomy y

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A

Bi-hemi-malleolar approach: tibial graft medially/anterolateral fibular only

20
Q

What is subtotal/incomplete resection aka Dowel fusion

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A
  • medial approach with removal of medial malleolus
  • 1.5 inch bit to ream central joint
  • cavity filled with bone chips
21
Q

What is the angular deformity for arthroscopic fusion

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A

Minimal - less than 10-15 degrees

22
Q

What is the major benefit of arthroscopic fusion

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A

Smaller incisions

23
Q

What are some contraindications for arthroscopic ankle fuson

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A
  • excessive bone loss
  • neuropathic joints
  • active infection
  • poor bone stock
  • talar AVN
24
Q

What is the mean time to union in ankle arthrodesis

25
What is the union rate for ankle arthrodesis
85-97%
26
What is the Ogilvie-Harris Screw technique for ankle arthrodesis
2 versus 3 screw technique: medial/lateral malleolus into talus and anterior from tibia to talus
27
What is the Hendrickx et al screw technique for ankle arthrodesis
- 2 incision/3 screw technique - additional screw from lateral to medial
28
What is the Holt et al screw technique for ankle arthrodesis
- 3 screw technique - additional posterior screw into talar neck
29
What is the Zwipp et al technique for ankle arthrodesis
- 4 screw technique
30
What is the tripod technique in ankle arthrodesis
- home run screw - 2nd screw - 3rd screw
31
What is the direction of the home run screw in tripod technique
Poseriomedial tibia to plantarlateral talar head
32
What is the position of the 2nd screw in the tripod technique
Medial tibia into lateral talar process
33
What is the position of the 3rd screw in the tripod technique
Anterolateral tibia to posteromedial talus
34
What are the special considerations for IM rod in ankle arthrodesis
- RA - failed ankle arthrodesis with STJ involvement - Charcot arthropathy
35
Which joint do you must fuse when using an IM rod in ankle arthrodesis
STJ
36
What are the different ex-fix you can use in ankle arthodesis
- 2,3,4 pin compression fixators - can create instability/hinge effect - Ilizarov frame - Taylor Spatial frame - Sidekick stealth rearfoot fixators
37
What are some advantages of ex-fix over internal fixation for ankle arthrodesis
- better fixation of osteoporotic bone - small bone segment fixation - greater strength for weight-bearing - allows for fine-tuning of residual deformity post-op
38
What is the goal of ex-fix in ankle arthrodesis
Symmetric joint compression - threaded rods - russian tensioning technique
39
What is the post-op course for ankle arthrodesis
- NWB until radiographic consolidation is visualized - 8-12 weeks - transitioned to PWB in CAM walker - When transitioned to regular shoe, patient may require heel lift/heel cushion and full length rocker sole
40
What are some complications of ankle arthrodesis
- delayed union/nonunion/malunion - wound dehiscence - infection - adjacent joint arthritis - painful/prominent hardware
41
What is the incidence of STJ and TNJ arthritis after ankle arthrodesis
STJ - 16% TNJ - 11%
42
After ankle arthrodesis, patients with HbA1c >7% had a ____ fold increase of post op infection
5
43
After ankle arthrodesis, patients with neuropathy had a ____ fold increase risk of post op infection
21
44
What preoperative glucose is associated with non infectious complications
Less than 100 mg/dL
45
The effect of screw position and number on the time to union of arthroscopic ankle arthrodesis article showed which type of screw position and numebr was preferred
Transmedial malleolar screw fixation with 3 scews
46
Which approach is associated with excellent union rates, low complication rates and high levels of patient satisfaction in ankle arthrodesis
Anteromedial

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