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Recon > Triple Arthrodesis > Flashcards

Triple Arthrodesis Flashcards

1
Q

What is a triple arthrodesis

A

Fusion of the talocalcaneal joint aka STJ, Talonavicular joint and calcaneocuboid joint (ie rearfoot joints)

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2
Q

Which of the 3 joints originally fused in a triple arthrodesis isn’t fused anymore

A

Calcaneocuboid joint

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3
Q

How does triple arthrodesis improve foot function

A

By providing:
- stability
- correction of deformity
- elimination of pain

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4
Q

How many degrees is the normal ROM of the STJ

A

30 degrees

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5
Q

How much inversion is normally in the STJ

A

20 degrees

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6
Q

How many eversion is usually in the STJ

A

10 degrees

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7
Q

Which two joints in the rearfoot act as a unit biomechanically

A

CC and TN

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8
Q

How many pronation and supination does the CC and TN produce

A

CC - 17 degrees
TN - 7.3 degrees

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9
Q

How much dorsiflexion and plantar flexion foes the CC and TN produce

A

CC - 2.3 degrees
TN - 7 degrees

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10
Q

How much range does the CC and TN provide in the oblique axis

A

22 degrees

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11
Q

How much range does the CC and TN provide in the longitudinal axis

A

8 degrees

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12
Q

After a TN arthrodesis, how how much motion is lost in the STJ

A

92%

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13
Q

After a TN arthrodesis, how much motion is loss in the CCJ

A

97%

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14
Q

After a TN arthrodesis, how much PT excursion is retained

A

25%

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15
Q

After an STJ arthrodesis, how much motion is loss in the TNJ

A

74%

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16
Q

After a STJ Arthrodesis, how much motion is loss in CCJ

A

44%

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17
Q

After STJ arthrodesis, how much PT excursion is retained

A

46%

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18
Q

After CCJ Arthrodesis, how much motion is loss in the STJ

A

8%

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19
Q

After CCJ arthrodesis, how much motion is loss in the TNJ?

A

33%

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20
Q

After CCJ arthrodesis, how much PT excursion is retained

A

73%

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21
Q

After a double arthrodesis (TN/CC) how much motion is loss in the STJ

A

91%

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22
Q

After double arthrodesis (TN/CC), how much PT excursion is retained

A

25%

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23
Q

What is the famous article by Donna Astion in JBJS?

A

Motion of the Hindfoot after Stimulated Arthrodesis

24
Q

What are the indications for triple arthrodesis

A
  • valgus foot deformities
  • arthritic conditions
  • varus foot deformities
  • neuromuscular disease
  • joint instability
25
Q

What are the valgus foot deformities requiring triple arthrodesis

A
  • collapsing pets planovalgus - end stage
  • tibialis posterior tendon dysfunction - end stage
  • tarsal coalition
26
Q

What are the arthritic conditions that are indications for triple arthrodesis

A
  • RA
  • Degenerative arthritis
  • post-traumatic arthritis
  • chronic pain
27
Q

What varus foot deformities are indications for triple arthrodesis

A
  • cavus and cavovarus - fixed or end stage
  • talipes equinovarus
28
Q

What neuromuscular disease are indications for triple arthrodesis

A
  • Paralytic
  • CP
  • Charcot’s arthropathy
  • Diseases affecting the spinal cord and brain
29
Q

What are the contraindications for triple arthrodesis

A
  • conditions that can’t be adequately correlated and maintained via eternal brain, soft-tissue procedures, tendon balancing, lesser fusions/osteotomy Ess.
  • chronic smoking
  • infection
  • vascular compromise
30
Q

Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis?

A

Smokers have twice the risk of experiencing a non-union after fracture etc

31
Q

What are the goals of triple arthrodesis

A
  • correction of deformity
  • relief of pain **
  • stabilization
  • improved function **
32
Q

What is the clinical test for flexible/rigid cavus foot

A

Coleman block test
- if hindfoot rotates out of varus = flexible
- if hindfoot remains in varus = rigid

33
Q

What is the saltzman view on imaging used for

A
  • check for deltoid insufficiency
  • possible stage IV PTTD
34
Q

What is diagnostic local intra-articulate anesthetic blocks

A

One of the most reliable office procedures for isolating joint pain from other pain generators

35
Q

Which joints are more difficult to inject die diagnostic local anesthesia blocks

36
Q

What are STJ injections performed through

A

sinus tarsi

37
Q

During the surgical treatment for triple arthrodesis, what 2 incisions are made

A

Medial and lateral

38
Q

What is the importance of the lateral incision in triple arthrodesis

A

Provides direct access to subtalar and calcaneocuboid joint

39
Q

What is importance of the medial incision in the surgical treatment for arthrodesis

A

Provides exposure of the Talonavicular joint as well as access for fixation of the STJ

40
Q

Where is the lateral incision made in triple arthrodesis

A

Distal tip of lateral malleolus to the base of the 4th MT

41
Q

Where is the medial incision made in triple arthrodesis?

A

Anterior to the distal tip of the medial malleolus extending dorsomedially toward the naviculocuneiform

42
Q

During internal fixation in triple arthrodesis, which joint is fixed first

43
Q

Which joint is fixed 2nd then 3rd in internal fixation triple arthrodesis

A

TN, then CC

44
Q

In internal fixation triple arthrodesis, what position can the heel be placed in

A

Neutral or slight valgus

45
Q

In internal fixation triple arthrodesis, what position should you never leave the heel in and why?

A

Varus - cannot be accolade by shoe or orthosis

46
Q

What is STJ screw positioning for triple arthrodesis internal fixation?

A
  • 2 screws vs 1 screw
  • talus to calcaneus, calcaneus to talus
  • parallel or divergent
47
Q

TN screw positioning for triple arthrodesis internal fixation

A

2 screws vs 3 screws
Addition of staple or plate

48
Q

What is CC screw positioning for triple arthrodesis internal fixation

A
  • plate
  • staple
  • 1 vs 2 screws
49
Q

What is phase 1 of post operative management in triple arthrodesis

A
  • initial management
  • 0-5 days
  • incision protection - IVAC vs drain vs special dressing
  • dressing change several days later to evaluate the wound
50
Q

What is phase II of post op management of triple arthrodesis

A
  • consolidation
  • 5 days to 4 weeks
  • observe wound healing and resolution of the inflammatory response
  • NWB in CAM or cast/splint
51
Q

What is phase III of post op management of triple arthrodesis

A
  • radiographs are observed to assess osseous healing
  • 4 - 8 weeks
  • AROM exercises of foot, ankle, toes
  • Patient is maintained NWB
52
Q

What is phase IV of post op management of triple arthrodesis

A
  • 10 - 12 weeks
  • radiographs taken again
  • if good consolidation then may begin partial WB with crutches or walker
53
Q

What is phase V of post op management of triple arthrodesis

A
  • 3-6 months
  • at the 3 months the patient is ready to fully WB with high top basketball shoe
54
Q

What are the complications of triple arthrodesis

A
  • pseudoarthrosis
  • recurrence of deformity
  • degenerative arthrosis in adjacent joint
  • AVN of talus
  • lateral instability
  • deltoid instability
55
Q

The complication, pseudoarthrosis, in triple arthrodesis is most common in which joint

56
Q

What is the recurrence of deformity in triple arthrodesis

57
Q

The complication, degenerative arthrosis, in triple arthrodesis affects with adjacent joint

A

Ankle joint

Recon (10 decks)

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