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Recon > Ankle Arthrodesis > Flashcards

Ankle Arthrodesis Flashcards

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

A

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

20
Q

What is subtotal/incomplete resection aka Dowel fusion

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

A

Minimal - less than 10-15 degrees

22
Q

What is the major benefit of arthroscopic fusion

A

Smaller incisions

23
Q

What are some contraindications for arthroscopic ankle fuson

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

A

12 week

25
Q

What is the union rate for ankle arthrodesis

A

85-97%

26
Q

What is the Ogilvie-Harris Screw technique for ankle arthrodesis

A

2 versus 3 screw technique: medial/lateral malleolus into talus and anterior from tibia to talus

27
Q

What is the Hendrickx et al screw technique for ankle arthrodesis

A
  • 2 incision/3 screw technique
  • additional screw from lateral to medial
28
Q

What is the Holt et al screw technique for ankle arthrodesis

A
  • 3 screw technique
  • additional posterior screw into talar neck
29
Q

What is the Zwipp et al technique for ankle arthrodesis

A
  • 4 screw technique
30
Q

What is the tripod technique in ankle arthrodesis

A
  • home run screw
  • 2nd screw
  • 3rd screw
31
Q

What is the direction of the home run screw in tripod technique

A

Poseriomedial tibia to plantarlateral talar head

32
Q

What is the position of the 2nd screw in the tripod technique

A

Medial tibia into lateral talar process

33
Q

What is the position of the 3rd screw in the tripod technique

A

Anterolateral tibia to posteromedial talus

34
Q

What are the special considerations for IM rod in ankle arthrodesis

A
  • RA
  • failed ankle arthrodesis with STJ involvement
  • Charcot arthropathy
35
Q

Which joint do you must fuse when using an IM rod in ankle arthrodesis

A

STJ

36
Q

What are the different ex-fix you can use in ankle arthodesis

A
  • 2,3,4 pin compression fixators - can create instability/hinge effect
  • Ilizarov frame
  • Taylor Spatial frame
  • Sidekick stealth rearfoot fixators
37
Q

What are some advantages of ex-fix over internal fixation for ankle arthrodesis

A
  • better fixation of osteoporotic bone
  • small bone segment fixation
  • greater strength for weight-bearing
  • allows for fine-tuning of residual deformity post-op
38
Q

What is the goal of ex-fix in ankle arthrodesis

A

Symmetric joint compression
- threaded rods
- russian tensioning technique

39
Q

What is the post-op course for ankle arthrodesis

A
  • 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
Q

What are some complications of ankle arthrodesis

A
  • delayed union/nonunion/malunion
  • wound dehiscence
  • infection
  • adjacent joint arthritis
  • painful/prominent hardware
41
Q

What is the incidence of STJ and TNJ arthritis after ankle arthrodesis

A

STJ - 16%
TNJ - 11%

42
Q

After ankle arthrodesis, patients with HbA1c >7% had a ____ fold increase of post op infection

A

5

43
Q

After ankle arthrodesis, patients with neuropathy had a ____ fold increase risk of post op infection

A

21

44
Q

What preoperative glucose is associated with non infectious complications

A

Less than 100 mg/dL

45
Q

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

A

Transmedial malleolar screw fixation with 3 scews

46
Q

Which approach is associated with excellent union rates, low complication rates and high levels of patient satisfaction in ankle arthrodesis

A

Anteromedial

Recon (10 decks)

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