Primary Triple Arthrodesis for Management of Rigid Flatfoot Deformity.
| Autor: | Seybold JD; Twin Cities Orthopedics, Edina, Minnesota., Coetzee JC; Twin Cities Orthopedics, Edina, Minnesota. |
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| Jazyk: | angličtina |
| Zdroj: | JBJS essential surgical techniques [JBJS Essent Surg Tech] 2016 Aug 10; Vol. 6 (3), pp. e29. Date of Electronic Publication: 2016 Aug 10 (Print Publication: 2016). |
| DOI: | 10.2106/JBJS.ST.16.00009 |
| Abstrakt: | Introduction: Primary triple arthrodesis is a powerful and reliable procedure for stabilizing and correcting painful rigid flatfoot deformities with a low rate of complications. Step 1 Preoperative Planning: Pay careful attention to the history, physical examination, and weight-bearing radiographic studies as they are critical for selecting patients who will benefit from a triple arthrodesis. Step 2 Room Setup and Patient Positioning: Position the patient supine on the operating table with the toes pointing straight up to the ceiling. Step 3 Incisions and Exposure: For a standard triple arthrodesis, use 2 incisions: a lateral sinus tarsi incision, which allows exposure of the subtalar joint, CC joint, and lateral aspect of the TN joint, and a medial incision, which provides exposure of the TN joint. Step 4 Joint Preparation: Ensure that joint preparation is thorough as this is critical for the success of any hindfoot arthrodesis. Step 5 Reduction of Deformity: Reduce the TN joint first, followed by the subtalar joint, restoring a plantigrade foot and approximately 5° of hindfoot valgus alignment. Step 6 Joint Fixation: Perform rigid fixation of the subtalar joint first, followed by fixation of the TN and CC joints. Step 7 Accessory Procedures: Accessory procedures are often required in addition to the triple arthrodesis to ensure that appropriate hindfoot alignment and a plantigrade foot are achieved. Step 8 Wound Closure: Perform a staged wound closure, taking care to maximize soft-tissue coverage over the involved hindfoot joints. Step 9 Postoperative Care: Ensure that the patient follows strict non-weight-bearing precautions in the immediate postoperative period to limit micromotion at the arthrodesis sites and allow for timely fusion. Results: In one of the largest published series of patients managed with triple arthrodesis (111 patients), Pell et al. reported a union rate of 98% at a minimum follow-up of 2 years, with 91% of patients indicating that they would be willing to repeat the procedure under similar circumstances 4 . |
| Databáze: | MEDLINE |
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