midfoot fusion: indications and techniques
TRANSCRIPT
• Introduction
• Indications/Goals of Midfoot Arthrodesis
• Types of Midfoot fusions
• Technique for fusions
• Fixation • Conclusion
• Arteries
• Nerves
• Tendons
• Ligaments
Initial injury is often missed acutely:
• Conservative/Non surgical • Surgical
Sangeorzan et al, Foot & Ankle, Vol 10, 4:193, 1990
Preoperative Considerations:
Determining Extent of Arthrodesis:
Surgical Goals:
Pain relief
Preservation of function
“Although tarsometatarsal arthrodesis may be necessary to manage persistent pain, complete relief of symptoms, even after fusion, may not occur.”
Myerson, et al, Orthop Clin North Am, 20(4):655, 1989
• Nemec et al, FAI, 2011
• Gougoulias, Foot and Ankle Surgery, 2016
Complications:
Special situations:
Diabetic Neuroarthropathy-Indications
• Extent of Arthritis
• Medical conditions
• Deformity
Lamm, Stasko, JFAS, 2016
Lamm, Stasko, JFAS, 2016
Thermal necrosis
• Avoid thermal necrosis
• USE ON COMPROMISED PATIENTS, REVISIONS, DEFECTS
• Johnson et al, JFAS, 2009
• Withey et al, JFAS, 2014
• Ray et al, JFAS, 1998
• Yu, 1993/ Coetzee, 2004/ Patel, 2004
• Eriksson, Acta Orthop Scan, 1984
• Cottom et al. JFAS 2013 • Fixation of Lapidus Arthrodesis with a Plantar
Interfragmentary Screw and Medial Locking Plate: A Report of 88 Cases
• Adavistic joint
• Drummond et al, Foot Ankle Surg, 2018 • Stability of Locking plate and compression
screws for Lapidus arthrodesis: A Biomechanical comparison of plate position
• Eccentric compression • Locking
• Sangeorzan et al, Foot & Ankle, 1990
• Bevilacqua, Clin Pod Med Surg, 2017
• Gait analysis and functional outcome in patients after lisfanc injury treatment
• Van Hoeve et al, Foot Ankle Surg, 2017
• Ajis et al. FAI 2014
Caused by Hypermobility of the medial column, applying increased pressure to the 2nd TMT
• DO NOT WANT TO MAKE THE MIDFOOT TOO RIGID