65: Arthrodesis Forefoot - Frush Flashcards
used for extensor substitution etioloty
digital arthrodesis
do you do digital arthrodesis on 5th toe?
no
too rigid
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
indications for hallux IPJ arthrodesis
- Neuromuscular Disease
- Cavus Foot
- Traumatic Arthritis
- Iatrogenic Deformities
- Hallux hammertoes
fixation hallux IPJ arthrodesis
k-wire (crossed or intramedullary)
4.0 mm partially threaded cancellous screw (solid or cannualted)
what procedure?
hallux IPJ arthrodesis
use a lazy S skin incisioin to expose joint
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
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
contraindications 1st MPJ arthrodesis
- IPJ arthritis or limitation of motion
- osteoporosis
- occupational or functional expectations
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
cup and cone reamers
tyring to remove cartilage to get to bleeding subchondral bone
in pt with neuromuscular disease, what might you add to 1st MPJ arthrodesis?
lengthen EHL
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
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
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
first met cuneiform arthrodesis aka
lapidus
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
procedure for lapidus
- Skin Incision
- Dorsal incision extending to the medial cuneiform
- Articular cartilage resection
- Curettage or saw resection to bleeding subchondral bone
- Transverse and Sagittal plane correction
- Fixation
- 3.5 or 4.0 partially threaded cancellous screws
- Plate and/or Pins
post op care lapidus
NWB short leg cast 6-8 wks, then partial WB for 2-4wks
PT at 3 mo
(+) and (-) 1st met cuneiform arthrodesis
- Disadvantages
- Extensive sx exposure required
- May shorten 1st ray
- Can be technically demanding
- Prolonged postop period
- Advantages
- Eliminates 1st met cuneiform hypermobility
- Stabilizes the medial column
- Allows for large amount of correction
indications for lisfranc’s jt arthrodesis
- post-traumatic arthritis
- DJD
- charcot osteoarthropathy
- pes cavus
- metatarsus adductus
lisfranc’s arthrodesis
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
- Any one of the 3 components may be fused in isolation for focused arthritis
- If fusing all, fuse the 1st first
Dowel Graft Arthrodesis (Inlay Graft)
- Iliac crest bone graft
- In situ fusion
- No correction
- Crossed k-wire fixation
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
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
