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 5 mm of posterior talar translation 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 lateral transfibular approach allows for dual joint preparation as well as local autograft 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 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 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 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 (OBQ16.211) A 59-year-old male present with left ankle pain and drainage 3 years after surgery for a traumatic injury to the left ankle. He notes worsening pain over the past year. On examination ankle range of motion is limited to a 10-degree arc of motion with erythema and serous drainage from an anterior ankle incision. Figures A and B are his current radiographs. The patient requests a discussion of limb salvage surgery. Of the following, which is the best surgical plan for his condition? Tested Concept QID: 8973 FIGURES: A B Type & Select Correct Answer 1 Maintenance of prior hardware and simultaneous arthrodesis 0% (5/2061) 2 Maintenance of prior hardware and staged arthrodesis 0% (5/2061) 3 Removal of hardware, I&D, and simultaneous arthrodesis 5% (111/2061) 4 Removal of hardware, I&D, and staged arthrodesis 92% (1899/2061) 5 Removal of hardware, I&D, and simultaneous ankle arthroplasty 1% (15/2061) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept 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 (OBQ13.16) A 45-year-old laborer sustained the injury shown in Figure A. Closed reduction is performed and post-reduction films are shown in Figure B. He elects to proceed with nonoperative treatment. Two years later he now presents with persistent ankle pain and difficulty walking long distances. On physical exam, he is found to have an antalgic gait with limited ankle motion secondary to pain. Crepitus is felt with passive range of motion of the ankle. The most recent radiographs are shown in Figure C. An MRI report indicates the presence of degenerative changes in the ankle. What would be the most appropriate option for definitive management? Tested Concept QID: 4651 FIGURES: A B C Type & Select Correct Answer 1 Steroid injection into the ankle 1% (24/3057) 2 Total ankle arthroplasty. 2% (68/3057) 3 Tibiotalocalcaneal (TTC) arthrodesis with femoral head allograft 75% (2290/3057) 4 Subtalar Fusion 5% (146/3057) 5 Triple arthrodesis 17% (506/3057) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (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? Tested Concept QID: 4708 FIGURES: A B Type & Select Correct Answer 1 Arthroscopic debridement of the tibiotalar joint and corticosteroid injection 7% (393/5297) 2 Tibiotalar arthrodesis with screws 80% (4231/5297) 3 Total ankle arthroplasty 5% (287/5297) 4 Tibiotalocalcaneal arthrodesis with an intramedullary device 6% (317/5297) 5 Tibiotalocalcaneal arthrodesis with an extramedullary device 1% (44/5297) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept (SBQ12FA.13) A 42-year-old female sustains the injury exhibited in Figure A. Fluoroscopic images are exhibited in Figure B following open reduction and internal fixation. Should she go on to develop tibiotalar arthritis and fail conservative management for this, which of the following treatment modalities has the highest success rate? Tested Concept QID: 3820 FIGURES: A B Type & Select Correct Answer 1 Isolated osteochondral allograft transplantation 1% (22/2779) 2 Interpositional soft tissue replacement 1% (20/2779) 3 Tibiotalar fusion 83% (2299/2779) 4 Arthroscopic debridement and microfracture 2% (62/2779) 5 Tibiotalocalcaneal fusion 13% (365/2779) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Tested Concept QID: 4540 FIGURES: A B Type & Select Correct Answer 1 Brostrom anatomic reconstruction with Gould modification 9% (353/3925) 2 Hindfoot arthroscopy with synovial debridement and Os trigonum resection 7% (280/3925) 3 Subtalar arthrodesis 63% (2459/3925) 4 Chrisman-Snook nonanatomic reconstruction using tendon transfer 3% (136/3925) 5 Triple arthrodesis 16% (643/3925) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept 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? Tested Concept QID: 2904 FIGURES: A Type & Select Correct Answer 1 Lateral plantar 81% (1722/2128) 2 Medial plantar 1% (16/2128) 3 Sural 13% (284/2128) 4 Superficial Peroneal 4% (85/2128) 5 Deep Peroneal 0% (9/2128) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.60) When performing an ankle fusion, the foot should be in: Tested Concept QID: 446 Type & Select Correct Answer 1 0 degrees dorsiflexion/plantarflexion, 0-5 degree hindfoot valgus, 5-10 degree external rotation 80% (1712/2148) 2 0 degrees dorsiflexion/plantarflexion, 0-5 degrees hindfoot valgus, 0 degrees external rotation 8% (175/2148) 3 10 degrees dorsiflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation 8% (168/2148) 4 0 degrees dorsiflexion/plantarflexion, 20 degrees hindfoot valgus, 5-10 degrees external rotation 1% (30/2148) 5 10 degrees plantarflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation 2% (50/2148) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review tested concept
All Videos (10) Podcasts (1) 2019 Orthopaedic Summit Evolving Techniques Evolving Technique Update: Ankle Arthrodesis & Total Ankle Arthroplasty After Failed Osteochondral Allograft Transplantation: Which Procedure Is The Right One To Use - Kenneth J. Hunt, MD Kenneth Hunt Foot & Ankle - Ankle Arthrodesis 11/9/2020 222 views 3.0 (1) 2019 Orthopaedic Summit Evolving Techniques Honored Professor Lecture: Arthrodesis Versus TAR- Gait Analysis & Long-Term Outcomes - Bruce Sangeorzan, MD Foot & Ankle - Ankle Arthrodesis 11/9/2020 214 views 3.0 (1) 2018 Orthopaedic Summit Evolving Techniques 5 Tips in 5 Minutes for a Successful Ankle Fusion - Troy S. Watson, MD (OSET 2018) Troy Watson Foot & Ankle - Ankle Arthrodesis A 9/11/2019 1008 views 4.8 (4) Foot & Ankle⎪Ankle Arthrodesis Team Orthobullets (AF) Foot & Ankle - Ankle Arthrodesis Listen Now 9:4 min 10/15/2019 182 plays 4.7 (3) See More See Less
failed bimalliolar fracture (C1635) krishnaprasad nimmagadda Foot & Ankle - Ankle Arthrodesis E 9/24/2013 98 0 0 Pilon (C1502) Foot & Ankle - Ankle Arthrodesis E 5/4/2013 657 5 14 ?avn of cuneiforms,navicular,base of metatarsals of left foot (C1286) avisek majumder Foot & Ankle - Ankle Arthrodesis E 10/11/2012 58 1 8 See More See Less