External Fixators of the Foot and Ankle
The arthrodeses fused. There were no neurovascular complications, pin tract infections, or equipment breakage. Foot trauma frequently combines soft tissue injury and complex skeletal instability, which makes external fixation particularly attractive. Although ideal indications for the use of this technique have not yet been determined, the theoretical advantages and initial results are encouraging.
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In order to justify the increased cost, the benefits to the patient must outweigh the financial concerns of the institution. What The Literature Reveals The application of external fixation in arthrodesis of the foot and ankle was inevitable. It can be applied in any major joint of the foot as a primary or a salvage procedure. Other indications include infected nonunions, complex comminuted fractures, neuromuscular disorders, limb length discrepancies as well as acute and chronic Charcot neuroarthropathy.
In , Hulbert was the first to describe the compression clamp for arthrodesis of the first metatarsophalangeal joint. The tarsometatarsal articulation is a complex joint that is made up of the articulations between the metatarsals, the cuneiforms and the cuboid. The actual joint line is uneven due in large part to the recessed base of the second metatarsal.
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External fixation has also recently been used in the fixation of triple arthrodesis. It may take the form of a hybrid configuration or can be combined with a large lag screw in the subtalar joint with rails for the talonavicular and calcaneocuboid joints. In , Charnley described the compression arthrodesis of the ankle and shoulder after he successfully used the same technique in arthrodesis of the knee. Certainly, using thin wires avoids the problems of trying to fuse the ankle and subtalar joint with large lag screws, which often compete for space within the talus. If one is considering external fixation for a pantalar or tibiotalocalcaneal arthrodesis, keep in mind that a circular frame is preferred over the other systems.
Treatment of acute Charcot events has traditionally been conservative as physicians used casting and offloading with no attempt to reduce the deformity. Treatment of chronic deformities has involved the use of Crow walkers. Only recently have surgeons considered reconstruction via tarsal osteotomies as only a few papers have appeared in peer-reviewed journals describing the use of external fixation for such treatment.
External Fixation About the Foot and Ankle | SpringerLink
On the other hand, using internal fixation to treat Charcot patients can be problematic due in large part to the significant osteopenia associated with the disorder. Additionally, using external fixation reduces the need for extensive surgical exposure in reconstruction and may provide a means of reducing acute Charcot deformities and maintaining the reduction during consolidation. Using a single medial incision allows arthrodesis of the medial three joints as a unit, utilizing a ring fixator. In acute and chronic Charcot deformities with avascular necrosis, osteomyelitis or severe dislocation of the talus, a tibiocalcaneal fusion with an external skeletal frame is indicated.
One may also consider combining a tibiocalcaneal arthrodesis with tibionavicular and calcaneocuboid fusions for patients with untreated rigid talipes equinovarus. Certainly, the advantages are well recognized but there are also some limitations. We also emphasize that this method should only be utilized by experienced surgeons who have a complete knowledge of the anatomical, structural and physiological properties of bones and soft tissue.
References 1. Berenger-Feraud, LJB. Rev Ther Med Chir , Parkhill, C. A new apparatus for the fixation of bones after resection and in fractures with a tendency to displacement. Trans Soc Assoc , Further observations regarding the use of the bone clamp in ununited fractures with malunion and recent fractures with a tendency to displacement.
Ann Surg , Lambotte, A. The operative treatment of fractures: Report of fractures committee. Br Med J , Hoffmann, R. Closed osteosynthesis with special reference to war surgery. Acta Chir Scand. Fractures of the tibia and fibula treated with casts and transfixion pins.
- External Fixation of an Ankle Fracture.
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South Med J. Fractures of the tibia and fibula treated by cats and transfixion pins.
Clin Orthop. Charnley, J.
Positive pressure in arthrodesis of the knee joint. J Bone Joint Surg. Compression arthrodesis of the ankle and shoulder. The Calandruccio triangular compression device: a schematic introduction. Please rate topic. Please vote below and help us build the most advanced adaptive learning platform in medicine The complexity of this topic is appropriate for?
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