Tarsal Joint Arthrodesis Flashcards
What are the 3 possible locations of plate and screws for tarsal arthrodesis?
Cranial
Medial
Lateral
What can be applied to severe tarsal injuries whilst soft tissue injuries are managed?
ESF
What are indications for a pantarsal arthrodesis?
Shearing injuries
Joint instability
Painful degenerative joint disease that is not responding to medical management
Comminuted fractures of the tarsus
Achilles (common calcanean, (CCT)) tendon rupture.
During a tarsal arthrodesis what can aid intraoperative hemostasis and surgical visibility? (2)
Tourniquet
Esmarch bandage
How to position a patient for a medial plate pantarsal arthrodesis?
Dorsal recumbency with limb abducted
How to remove articular cartilage from in between tarsal joints when prepping for a pantarsal arthrodsesis?
High speed burr
What type plate is used for pantarsal arthrodesis?
Boom plate
What is used on the joint surfaces to secure the plate with a pantarsal arthrodesis?
Cancellous autograft is harvested from either the proximal humerus or ilium
Where to centre a pantarsal arthrodesis plate?
Tallus
Use of a custom arthrodesis plate is recommended for a pantarsal.
What is the appropriate joint angle?
135 degrees
What drill bit for a pantarsal arthrodesis?
2.5mm
What size screw for a pantarsal arthrodesis?
3.5mm of appropriate length
Surgical Technique: Pantarsal Arthrodesis Using a Medial Plate
How is the skin incision made?
The skin incision is made from mid-tibia to first or second metatarsophalangeal joint.
Surgical Technique: Pantarsal Arthrodesis Using a Medial Plate:
What crosses the tibia where extra care is needed to preserve?
medial branch of the saphenous artery and vein as it crosses the distal tibia.
How man metatarsal bones should the distal 2 screws engage?
1 or 2
What ligament is incised to expose calcanean tendon - on medial approach to pantarsal arthrodesis??
SDFT
What is the recommended angle for a Pantarsal arthrodesis in a cat?
115-125
Order these steps with a pantarsal arthrodesis using a medial plate:
- The incision is continued dorsal and plantar to the medial collateral ligament.
-The tendon of the cranial tibialis muscle is located and can be cut if required.
-The talocrural joint is approached after ostectomy of the medial malleolus.
- The incision is continued dorsal and plantar to the medial collateral ligament.
- The talocrural joint is approached after ostectomy of the medial malleolus.
- The tendon of the cranial tibialis muscle is located and can be cut if required.
Surgical Technique: Pantarsal Arthrodesis Using a Medial Plate:
Where is the tendon of the cranial tibialis muscle located?
Crossing the talus and central tarsal bone medially.
What are the first 3 joint apporached and opened medially during aPantarsal Arthrodesis Using a Medial Plate?
- Talocentral a
- Centrodistal
- Medial tarsometatarsal
Pantarsal Arthrodesis Using a Medial Plate:
Hypodermic needles can be used to identify what joints? (2)
- Intertarsal
- Tarsometatarsal
What joint surfaces are cut during Pantarsal Arthrodesis Using a Medial Plate?
How can this be done? (2)
A) Talus and Tibia
B) Burr or power saw
What is the benefit of using an oscillating saw over a burr with joint surfaces during pantarsal arthrodesis?
excellent bone apposition and compression.
Pantarsal Arthrodesis Using a Medial Plate:
Which joints have the cartildage removed? (3)
- Talocentral
- Centrodistal
- Tarsometatarsal
Pantarsal Arthrodesis Using a Medial Plate:
It is necessary to remove A) from the B) aspect of the tarsus and the C) (e.g. with a spinal burr). This allows the plate to lie flush and also aids in skin closure.
A) bone
B) medial
C) proximal metatarsal prominence
Pantarsal Arthrodesis Using a Medial Plate:
The plate can be pre countered and pre placed screws before the debridement of joints.
Where are the 3 screws placed?
1 in talus
2 in metatarsals
True or false:
Pantarsal Arthrodesis Using a Medial Plate:
If the plate is not pre-placed before debriding the joints, then the talar screw is placed first in a neutral position and then the distal tibial and proximal metatarsal screws placed in compression
True
What screw placement is needed when a pantarsal arthrodesis plate is applied? (4 locations) - incldue numbers applied
- Distal tibia (at least 4)
- Talus
- Central or fourth tarsal (depends on plate)
- 3 or 4 in metatarsals (engage more than one metatarsal wherever possible)
What screw can be placed to prevent the plate from bending in the sagittal plane during a pantarsal arthrodesis?
Calcaneotibil position screw
Calcaneotibial position screw:
What is dissected off the calcaneous?
SDFT
Calcaneotibil position screw
Where is the hole drilled? Include direction
From proximal calcaneous in dorsomedial and slight proximal direction through the calcaneus and tibia
What bone removal aids skin closure during a medial pantarsal arthrodesis? (3)
- Medial tibia
- Tarsus
- Proximal metatarsal
How to confirm pantarsal arthrodesis placement?
radiographs
What is needed after dorsal placing and why?
Splinting dressings; due to increased mechanical compromise
True or false
A light dressing is sufficient after medial or lateral application of bone plates to reduce postoperative swelling for 7–10 days.
True
True or false
Lead exercise can be gradually increased over a period of 10–12 weeks. Off-lead exercise can be gradually reintroduced thereafter.
True
Over what period following pantarsal arthrodesis should exercise be increased over?
10-12 weeks
True or false:
Repeat radiography is indicated 2 weeks post OP and potentially repeated after further 4 weeks if inadequate fusion was evident.
False
When is repeat radigrpahy indicated post op with pantarsal arthrodesis?
Repeat radiography is indicated 6–8 weeks post OP and potentially repeated after further 6–8 weeks if inadequate fusion was evident.
Complication rate post op?
30-70%
What necrosis has been reported following medially placed plates - why?
Plantar; not understood why
What artery damage has been linked to plantar necrosis? (2)
- Dorsal pedal a.
- Perforating metatarsal a.
The application of what is a theory behind plantar necrosis?
Rigid cast
Partial arthrodesis is required when what
when the plantar ligaments are damaged producing dorsiflexion of the intertarsal joints
When is Arthrodesis of the calcaneoquartal joint needed?
Plantar ligament damage
Arthrodesis of the tarsometatarsal joint is recommended.. when? (2)
Traumatic luxation or subluxation of tarsometatarsal joint
If the plantar ligaments are damaged; what happens to the intertarsal joints?
Dorsiflexion
Partial arthrodesis is NOT appropriate when which joint is affected?
Tibio tarsal
Define joint/s affected with a partial arthrodesis.
Calcaneoquartel joint +/- tarsometatarsal
Why are hybrid plates useful for tarsal partial arthrodesis?
Allow the insertion of smaller screws into metatarsal bones
What force is on the calcaneoquartel joint with a partial arthrodesis?
Compression
What size drill bit should be used to create a hole for a 3.5 mm cortical bone screw?
2.5mm
Where is the lateral approach to partial arthrodesis made?
A lateral approach is made from the proximal calcaneus to 3–4 cm distal to the tarsometarsal joint.
Order these steps in regards to a partial tarsal arthrodesis:
- The joint capsule and ligaments are removed sharply with a scalpel
- The calcaneoquartal joint is identified
- The fascia is incised parallel and lateral to the SDFT
- The deep fascia is incised lateral to the small branch of the plantar nerve
- The fascia is incised parallel and lateral to the SDFT
- The deep fascia is incised lateral to the small branch of the plantar nerve
- The calcaneoquartal joint is identified
- The joint capsule and ligaments are removed sharply with a scalpel
Incising the deep fascia laterally to the small branch of the plantar nerve will expose what?
DDFT
The articular cartilage is removed with a curette or, preferably, with what during a partial arthrodesis?
High speed burr
What bone plate for a partial arthrodesis?
The bone plate is applied (DCP, LCP, etc.); hybrid plates with smaller screws in the metatarsals are ideal.
What aids plate contouring and skin closure during a partial arthrodesis?
laterally with a high-speed burr to level the lateral aspect;
Lateral pantarsal arthrodesis- Before the joint is debrided, the placement of 2 screws helps improve alignment following debridement of the joint. Where are these?
2 screws above and below the calcaneoquartel joint
Lateral Partial arthrodesis:
Where are screws placed? How many
- Calcaenus (at least 3)
- 4th tarsal bone (1)
- 5th metatarsal (3)
Partial arthrodesis:
It is important to engage more than one metatarsal with the screws, especially which screw?
Proximal
Following arthrodesis; what happens if there is too much tension on closing?
Biological tourniquet
What dressing is placed following partial arthrodesis
Although no cast is required, a light dressing can be applied for 7–10 days to reduce postoperative swelling
Exercise following partial arthrodesis
Lead exercise can be gradually increased over 10–12 weeks and off-lead exercise can be gradually increased thereafter.
When are xrays taken following partial arthrodesis?
Follow-up radiographs should be obtained at 6–8 weeks after the surgery and repeated after 6–8 weeks if inadequate fusion has been identified.
Most complications of partial arthrodesis due to implant failure, what is this secondary to? (3)
- Lack of joint fusion
- Technical errors
- Insufficient post op protection
