arthrodesis
Management
Non-Operative
Education regarding shoe wear
- extra wide / large toe box
Insoles
- longitudinal arch support
- pre MT dome for metatarsalgia
- podiatry to attend to callosities
Toe spacers
Analgesia
Operative
Indications
1. Continued pain and discomfort
2. Difficulties with shoe wear
Ankle Arthrodesis
Results
90% fusion rates
Lose70% sagittal plane ROM
Disadvantages of Arthrodesis
Non union rates up to 12%
Decreased gait speed
Poor mobility over uneven surfaces
Forefoot
Issues
1. Painful Bunion / Hallux valgus
2. Metatarsalgia / MTPJ dislocation
3. Claw toes
Subtalar and Triple Arthodesis
Biomechanics
Able to achieve relatively high level of function after STJ fusion
- previously believed that isolated STJ fusion should not be performed
- believed that triple arthrodesis was operation of choice for hindfoot
- STJ fusion has superior result with less stress on AJ
Average loss of DF 30% / PF 10%
Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints
- imperative that fusion be positioned in ~ 5o valgus
Rheumatoid Thumb
Nalebuff Classification
Type I - Boutonniere
- commonest
- MP flexion / IP hyperextension
- usually EPB rupture with EPL subluxation
Type II
- Boutonniere & Swan Neck
- doesn't exist according to Nalebuff
Rheumatoid Fingers
Conditions
1. PIPJ Synovitis
- synovectomy via dorsomedial approach
2. Flexor tenosynovitis
- may cause trigger finger
- trial HCLA
- remove synovits but don't release A1 pulley
- will worsen ulna drift
3. DIPJ
- rarely affects
Arthrodesis
Indications
Indications have narrowed
- due to success of shoulder arthroplasty
1. Chronic infections of GHJ
2. Stabilization in paralytic disorders
3. Post-traumatic brachial plexus palsy
4. Salvage of failed GHJ Arthroplasty
- may need bone graft procedures
5. Arthritic diseases unsuitable for arthroplasty / young patient
Arthrodesis
Indications
Very few
- young labourer with severe disabling elbow pain
- trial in POP at 90o for 6 weeks
Poor function
- adjacent joints cannot compensate for loss of function
Contraindications
RA
- high failure rate especially flail elbow with poor bone stock
Arthrodesis Conversion
Indications
Severe LBP
- most common indication
Ipsilateral knee pain
- less beneficial
Malposition
- especially abduction
Contraindications
Absent abductor mechanism
Flail
Active infection
Insufficient bone stock
Examination
LLD