Pantalar and Hindfoot Arthrodesis

 

 

Pantalar Fusion APPantalar Fusion Lateral

 

Indications

 

Rheumatoid arthritis

Combined ankle and subtalar joint osteoarthritis

Talar AVN

Trauma

Severe Deformity - acquired flat foot / neurological conditions / Charcot /

Ankle fracture in elderly patient with poor skin and co-morbities

 

RA

Rheumatoid arthritis 

 

PlanovalgusSevere Valgus AP

Severe acquired planovaglus

 

Talar AVNPantalar fusionPantalar fusion

Talar AVN

 

HFNHFNHFNHFN

Fragility fractures

 

Technique

 

Lateral approach

- incision fibular to 4th metatarsal

- fibular osteotomy to expose ankle joint

- lift peroneal tendons anteriorly / elevate EDB / divide interosseous ligament to expose subtalar joint

- with severe deformity may need to expose and reduce TNJ and CCJ

- debride joint surfaces / reduce / K wire

- ankle joint: neutral varus/valgus, neutral dorsiflexion, ER 10o

- subtalar joint:  5o valgus (5 deg combined hindfoot valgus)

 

www.boneschool.com/triple-arthodesis

 

www.boneschool.com/ankle-arthrodesis

 

Tibiotalocalcaneal (TTC) / hindfoot nail

 

Smith & Nephew Hindfoot nailSynthes HIndfoot Nail

 

Smith&Nephew Trigen Hindfoot Nail PDF

 

Smith&Nephew Panta2 TTC Arthrodesis nail PDF

 

Synthes Expert Hindfoot Arthrodesis nail PDF

 

Insertion point

- in line with 2nd metatarsal / center of heel pad

- junction of posterior 2/3 and anterior 1/3 heel

- should pass through anterior aspect posterior subtalar joint

- posterior to lateral plantar artery and nerve

 

Screw fixation

- distal screw fixation in calcaneum +/- talus with jig

- compression

- proximal screws medial to lateral