The best ankle and pantalar fusion flashcards are available.
An effective limb salvage option is Pantalar arthrodesis.The authors shared essential pearls for the challenging procedure, explored fixation options and reviewed the outcomes in the literature.
The tibiotalar, subtalar, talonavicular and calcaneocuboid joints are fused.Many consider the procedure to be a salvage procedure prior to major amputation to provide brace-free gait.
The lifetime healthcare costs for amputations have been three times as much as for salvage, according to a study by MacKenzie and colleagues.
Severe pain, instability, and evidence of abnormal plantar pressures are some of the indications for pantalar arthrodesis.
Charcot arthropathy, post-traumatic arthritis, clubfoot, failed total ankle replacement, rheumatoid arthritis and a paralytic foot are some of the diseases that can be seen in a patient with pantalar sclerosing cholangitis.
A pantalar arthrodesis is used to fix a foot.It may allow for painless gait in patients with post-traumatic arthritis.Pantalar arthrodesis can help realign the hindfoot in patients with diabetes.This would allow the patient with diabetes to wear shoes that help decrease the formation of ulcers and reduce the risk of amputation.
There are a number of contraceptives to pantalar arthrodesis.
It is important to have an adequate understanding of the deformity and perform comprehensive preoperative planning in order to maximize the potential for a successful surgery.
Evaluation should include weightbearing X-rays of the entire lower limb.It is possible to uncover pathology presenting to the pantalar arthrodesis site, which would necessitate correction of alignment abnormality.Nuclear and computed tomographic (CT) studies can provide a more thorough assessment of bone quality and help confirm an infective process.
A clinical exam for patients with a known history of peripheral vascular disease should be provided.If a patient has an ankle-brachial index less than 0.8 or a toe pressure greater than 30mm Hg, they should get a referral for a cardiovascular consultation as well as an internal medicine consultation.
It's not a simple surgery and we recommend that only experienced surgeons do it.Surgeons have used a lot of different methods for pantalar arthrodesis.There are many different fusion techniques, including one-and two-incision approaches with open reduction and internal fixation and the use of external fixation.
If there is any thought for fusion and total ankle joint replacement, one should try to remove as little bone as possible.
The talus is the most affected bone in the pantalar arthrodesis and surgeons need to assess its quality before and after the procedure.Severe accomodative changes in the structure and ultimate collapse of the talus can be caused by conditions such as flatfoot.Depending on the extent of structural change and reducibility, some surgeons advocate removal of the talus and reshaping for bone graft to assist with realignment and healing.
fusion between a devascularized talus and surrounding bone is difficult, which poses an added challenge to successful pantalar arthrodesis.They used a fibula transfer for patients with osseous defects larger than 4 cm.
Thorough fusion site healing can be accomplished with the use of resection and penetration of subchondral bone.There are options for resection, curettage, drilling, fish scaling and burring.There was no statistical difference between the two methods when they were loaded to failure.
It is important to have angles and measurements from the lower part of the body for comparison when aligning joints for pantalar arthrodesis.It is important to check positioning before and during each step of the pantalar arthrodesis.The calcaneal view with a simulation of weightbearing is a good place to check the ankle and foot views.
The talus should be aligned first with the tibia and then the foot, followed by the tibial mid-diaphyseal line.90 degrees to the tibia is what the sole of the foot should be.The calcaneal bisection line should be parallel to the mid-diaphyseal line of the tibia and translated to be in line with that line.10 to 15 degrees of external rotation of the foot is required.
There are many fixation options for pantalar arthrodesis.They range from combinations and configurations of plates and screws to external fixation.Patient comorbidities, infections, skin envelope and body habitus can guide fixation choices.There are many options for screw fixation.The technique to include screw augmentation across the tibiotalocalcaneal joints was described by the authors.
External fixators have been used for ankle and hindfoot surgeries.External ring fixators are equivalent to internal screw compression and can be used as the primary method of fusion.
There are indications for the Ilizarov technique that include impaired healing potential due to diabetes, cigarette smoking, previous nonunion of the fusion site, and/or soft tissue deficits in the ankle and hindfoot.
An extensive review of the published data shows that each of these methods continues to be studied with no evidence of superiority to another.
The success rates of pantalar arthrodesis have been satisfactory, reaching nearly 90 percent. Herscovici and colleagues demonstrated acceptable outcomes regardless of the implants used or whether the surgery was a single or staged procedure.
The AOFAS scores of patients who had pantalar arthrodesis were similar to those of the normal population.
In patients with rhythym, McKinley and coworkers showed that the pain scores had a significant improvement in the first six months after the procedure.The authors showed that the SF-12 scores had continuous improvement up to the 12-month follow-up.They reported that pantalar arthrodesis did not affect the ability of patients to walk long distances.
Complications with a high reported rate include malunion, osteoarthritis of adjacent joints, and wound healing problems.Local wound care, antibiotics and/or minor debridement can be used to treat these problems.Skin problems are not uncommon when performing pantalar arthrodesis.Fifty percent of patients who had pantalar arthrodesis developed infections or skin ulcerations.
Patients must be aware of the added stress on joints caused by arthrodesis.They found that most patients had more severe arthritis after having an isolated ankle arthrodesis.Some studies show that patient satisfaction does not correlate with the development of arthritic changes.95 percent of the patients remained satisfied with the results of their operation, despite the fact that at 25 and 44 years after triple arthrodesis, all patients had eventually developed progressive arthritic changes.
The development of pseudarthrosis with rates ranging up to 28 percent is the most serious consequence of pantalar arthrodesis.
There are problems and disabilities that occur with activities of daily living even with successful fusion and healing.Difficulties when driving a car, climbing a hill, inability to participate in many athletic activities, and need to wear shoes of different sizes are included.
Non-operative care may not be effective for patients with ankle and hindfoot instability or evidence of abnormal plantar pressures.
There is a long-term solution to these problems.A strong, stable and painless foot that probably will function adequately for the rest of the patient's life is what Pantalar arthrodesis can provide.Many consider pantalar arthrodesis to be a way of avoiding an amputation for the treatment of unstable and disabling conditions as a result of severe degenerative joint disease, rheumatoid arthritis, severe posttraumatic deformities of the anklefoot and hind joints, neuropathic joint destruction, and paralytic or flail
Appropriate patient selection and careful planning are required for Pantalar arthrodesis.Patients should be told that long periods of cast and non-weightbearing can still occur.The VAS, SF-36, and AOFAS scores show acceptable outcomes in patients with pantalar arthrodesis regardless of whether the patient had a staged or single approach.