Arthrodesis - Nelson Flashcards
Why Arthrodesis?
Surgical immobilization of a joint by fusion of the adjacent bone
Indications
- Traumatic or degenerative arthritic changes to a joint
- Malalignment of the foot or ankle -> varus/valgus
- Gross instability of joints
- Congenital/deforming conditions -> CMT/Tarsal coalitions/CP
Prep work
- thorough clinical evaluations
- > ROM assessments
- > soft tissue concerns
- > smoking history
- Radiographic Eval
- > position of bones/joints
- > bone stock
- Patient expectation
- Hardware based on procedure
What are the 3 goals for anatomical dissection for arthrodesis?
Exposure
Hemostasis
Atraumatic technique
Who described the triple arthrodesis?
Edwin Ryerson MD
What joints are involved in a triple arthrodesis?
STJ
TN
CC
Indications for a triple arthrodesis
valgus foot deformities PTTD tarsal coalition arhtritic conditions varus foot deformities neuromuscular deformities
Triple arthrodesis concerns
position approach (lateral, medial, dorsal) hardware (internal vs external)
What are the indications for an STJ athrodesis?
- End stage articular disease - trauma: calcfractures
- acquired valgus deformities of the foot
- symptomatic talcalcaneal coalitions
What are the indications for a talo-navicular arthrodesis?
First advocated for children with severe pronation. Indications: 1. Isolated in adults for RA usually 2. flexible deformities - PTTD 3. Kohler's disease 4. Adjuctive to other procedures
Calcaneal-cuboid arthrodesis
Very limited for isolated use
Used to address instability and deformity of the rearfoot-midfoot complex
Indications for a calcaneal-cuboid arthrodesis
- arthritis secondary to certain calcfractures
- isolated cuboid fractures/ “nutcracker injuiries”
- transverse planar deformities - “bone block”
When would you do an ankle arthrodesis?
Degenerative deterioration of the joint Instability of the ankle RA Charcot Failed ankle prosthesis Drop foot Congenital deformities
Ankle arthrodesis techniques
- Simplest technique - removal of articular cartilage from talus and tibia
- Anterior bone graft techniques - rarely used
- Joint resection combined with malleolar osteotomy
- Bimalleolar approach
- Compression arthrodesis - external fixator and IM nails
Arthroscopic ankle arthrodesis: indication and benefits
Indicated for minimal angular deformities Benefits: shorter operative time less blood loss far less morbity
What is a PanTalar arthrodesis?
Fusion of Ankle, STJ, and Midtarsal joints (can also include the CC joint) First described by Lorthioir 1911 Option of single vs staged procedures Indications: DJD Gross joint instability (Polio) Congenital equinovarus deformity
What are some adjunctive procedures to keep in mind?
Calcaneal slide Gatroc-recession Tenotomies: TAL Flexor/extensor lengthenings
Post Op Care (*)
Splint application with modified Jones compression
NWB 4-6 weeks
F/U 1 week, 3 weeks, 6 weeks (remove sutrues 3 weeks)
Serial x-rays
Complications (*)
Wound dehiscence
Entrapment neuropathy
Pseudoarthrosis/non-union
Chronic pain/RSD
Take Homes?
Thorough Work up for patient: surgical planning, hardware
Position, Postion, Position
Patient marriage: complications, post op recovery and pitfalls
