Indications Indications painful arthritis following infection trauma (most common cause) chronic instability AVN of the talus inflammatory arthropathy primary OA neuropathic arthropathy tumor resection salvage for failed ORIF salvage for failed TAA Technique Optimal Position neutral dorsiflexion 5-10° of external rotation 5° of hindfoot valgus Arthroscopic arthrodesis only indicated if minimal deformity present Open arthrodesis transfibular approach often used when deformity present screw fixation plate and screw construct external fixation staged approach infection should be cleared prior to placement of definitive internal hardware for arthrodesis Tibiotalocalcaneal (TTC) fusion with retrograde intramedullary nail Load-sharing device with improved bending stiffness and rotational stability compared to plate-and-screw constructs Indications: End-stage ankle and subtalar arthritis Charcot neuroarthropathy Significant hindfoot bone loss (failed total ankle arthroplasty, failed arthrodesis) Osteonecrosis of the talus Severe acute trauma Contraindications: Active infection Profound vascular disease Severe tibia malalignment Complications Nonunion incidence 10% non union rate tobacco users have 2.7x risk neuropathy is greatest risk factor for persistent nonunion with revision of nonunion Lateral plantar nerve injury Superficial peroneal nerve injury to superficial peroneal nerve during transfibular approach Hindfoot arthritis adjacent hindfoot arthritis commonly occurs following fusion isolated hindfoot arthritis due to chronic pes planus is treated with subtalar joint arthrodesis
Technique Guide 10/4/2016 Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Tibiotalar Arthrodesis Andrew Hsu Foot & Ankle - Ankle Arthritis
QUESTIONS 1 of 15 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ09.91) A patient with subtalar and tibiotalar arthritis underwent the surgery shown in Figure A. The patient now complains of numbness on the plantar/lateral aspect of his foot including the 4th and 5th toes. Which nerve was most likely injured? Review Topic QID: 2904 FIGURES: A 1 Lateral plantar 82% (1402/1715) 2 Medial plantar 1% (14/1715) 3 Sural 13% (218/1715) 4 Superficial Peroneal 4% (66/1715) 5 Deep Peroneal 0% (7/1715) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.73) A 36-year-old construction worker sustained an ankle fracture 4 years ago after falling off a roof. Postoperative radiographs are seen in Figure A. The hardware is removed 2 years later. He now returns with ankle pain and intermittent swelling but has no difficulty with uneven surfaces. Examination reveals 5 degrees of gastrocnemius equinus contracture, pain with passive plantar and dorsiflexion, but no pain with hindfoot inversion and eversion. Recent radiographs are seen in Figure B. CT scan shows no degenerative changes in the hindfoot. What is the best treatment option? Review Topic QID: 4708 FIGURES: A B 1 Arthroscopic debridement of the tibiotalar joint and corticosteroid injection 7% (332/4557) 2 Tibiotalar arthrodesis with screws 81% (3674/4557) 3 Total ankle arthroplasty 5% (231/4557) 4 Tibiotalocalcaneal arthrodesis with an intramedullary device 6% (260/4557) 5 Tibiotalocalcaneal arthrodesis with an extramedullary device 1% (39/4557) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 2 (OBQ08.60) When performing an ankle fusion, the foot should be in: Review Topic QID: 446 1 0 degrees dorsiflexion/plantarflexion, 0-5 degree hindfoot valgus, 5-10 degree external rotation 80% (1254/1558) 2 0 degrees dorsiflexion/plantarflexion, 0-5 degrees hindfoot valgus, 0 degrees external rotation 8% (130/1558) 3 10 degrees dorsiflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation 7% (114/1558) 4 0 degrees dorsiflexion/plantarflexion, 20 degrees hindfoot valgus, 5-10 degrees external rotation 1% (15/1558) 5 10 degrees plantarflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation 2% (34/1558) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ12.180) A 40-year-old male presents with long-standing right heel pain. He reports pain and swelling and points to the region of the sinus tarsi as the maximal area of pain, particularly when walking on uneven surfaces. He also reports a history of recurrent ankle sprains when he was younger. A clinical image of his foot posture is shown in Figure A. Inversion and eversion of the hindfoot reproduce pain. He has no discomfort with passive ankle dorsiflexion and plantarflexion. Coleman block testing reveals a rigid hindfoot. Sensation is fully intact throughout the extremity and he has full strength with ankle dorsiflexion, ankle plantarflexion and he can perform a single-leg heel rise without difficulty. A radiograph is shown in Figure B. What is the most appropriate step in management if conservative measures fail? Review Topic QID: 4540 FIGURES: A B 1 Brostrom anatomic reconstruction with Gould modification 9% (306/3424) 2 Hindfoot arthroscopy with synovial debridement and Os trigonum resection 7% (243/3424) 3 Subtalar arthrodesis 63% (2148/3424) 4 Chrisman-Snook nonanatomic reconstruction using tendon transfer 3% (112/3424) 5 Triple arthrodesis 17% (566/3424) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
The Great Ankle Arthritis Debate: Arthrodesis - Glenn Pfeffer, MD (COA 2018, 3.1) Foot & Ankle - Ankle Arthrodesis - All COA 2018 Annual Meeting The Great Ankle Arthritis Debate: Arthrodesis - Glenn Pf... 8/30/2018 446 views Reconstructing the Arthrodesis Malunion: John Ketz, MD (CSFA #11, 2017) Foot & Ankle - Ankle Arthrodesis - Treatment Consult Reconstructing the Arthrodesis Malunion: John Ketz, MD(CSFA #11, 2017) 5/12/2017 136 views Reconstructing the Arthrodesis Malunion: John Ketz, MD (CSFA #10, 2017) Foot & Ankle - Ankle Arthrodesis - Treatment Consult Reconstructing the Arthrodesis Malunion: John Ketz, MD(CSFA #10, 2017) 5/12/2017 160 views See More See Less
failed bimalliolar fracture (C1635) Foot & Ankle - Ankle Arthrodesis HPI - pain& deformity of right ankle since 3 months,varus deformity increses on weight bearing,h/o underwent conservative treatment for 5 weeks by below knee cast,after removal of cast,instability&deformity persists,pt under went orif with reconplate & screw fixation to right ankle, after 6 weeks post operative,pt c/o rt ankle deformity, what is the choice of treatment? 9/24/2013 81 0 0 Pilon (C1502) Foot & Ankle - Ankle Arthrodesis HPI - Jumped out of second story house. Was found by police screaming and intoxicated. What would you do for initial treatment 5/4/2013 618 5 14 ?avn of cuneiforms,navicular,base of metatarsals of left foot (C1286) Foot & Ankle - Ankle Arthrodesis HPI - patient is having pain in his left foot for 7 month aggravated by last 3 month.cant mobilise because on stepping he feels pain.on biopsy we found avn of bones.but ct angio and dopler studies found arterial system intact. what can be the differential diagnosis and line of treatment 10/11/2012 54 1 8 See More See Less