-
Hand Clinics Nov 2017Partial wrist arthrodesis (PWA) is a well-known procedure for treating degenerative or posttraumatic wrist conditions. Four-corner fusion (4CF) is mostly used for... (Review)
Review
Partial wrist arthrodesis (PWA) is a well-known procedure for treating degenerative or posttraumatic wrist conditions. Four-corner fusion (4CF) is mostly used for scapholunate advanced collapse and scaphoid nonunion advanced collapse. The author performed 39 procedures, including 4CFs, 2-corner fusions, 3-corner fusions, scaphoid-capitate/scaphoid-capitate-lunate fusions, scaphoid-trapezium-trapezoid arthrodeses, and radioscapholunate arthroscopic PWAs (A-PWAs). There were 8 revision cases including 4 partial nonunions. All A-PWAs healed satisfactorily after revision surgery. This article discusses the surgical techniques and tips to avoid mistakes. The pros and cons for open versus arthroscopic techniques and for screws versus Kirschner wires are also discussed.
Topics: Arthrodesis; Arthroscopy; Humans; Osseointegration; Postoperative Care; Postoperative Complications; Preoperative Care; Wrist Joint
PubMed: 28991585
DOI: 10.1016/j.hcl.2017.07.013 -
Hand Surgery & Rehabilitation Apr 2023Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's... (Review)
Review
Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.
Topics: Humans; Carpal Bones; Wrist Joint; Wrist; Osteoarthritis; Arthrodesis
PubMed: 36642245
DOI: 10.1016/j.hansur.2022.12.006 -
Operative Orthopadie Und Traumatologie Jun 2016Realignment and stabilization of the hindfoot by subtalar joint arthrodesis. (Clinical Trial)
Clinical Trial
OBJECTIVE
Realignment and stabilization of the hindfoot by subtalar joint arthrodesis.
INDICATIONS
Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction.
CONTRAINDICATIONS
Inflammation, vascular disturbances, nicotine abuse.
SURGICAL TECHNIQUE
Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws.
POSTOPERATIVE MANAGEMENT
Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6‑week X‑ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10-12 weeks. Stable walking shoes. Active mobilization of the ankle.
RESULTS
Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.
Topics: Adolescent; Adult; Aged; Arthrodesis; Bone Screws; Bone Wires; Exercise Therapy; Female; Flatfoot; Humans; Male; Middle Aged; Subtalar Joint; Treatment Outcome; Young Adult
PubMed: 26895251
DOI: 10.1007/s00064-016-0438-8 -
Acta Orthopaedica Belgica Mar 2015The aim of this study is to review the results of isolated subtalar arthrodesis in adults and to make a comparative analysis of the clinical outcomes between the...
The aim of this study is to review the results of isolated subtalar arthrodesis in adults and to make a comparative analysis of the clinical outcomes between the patients with posttraumatic subtalar arthritis and the ones with other etiologic factors, and to evaluate the effects of grafting. This study included 19 men and 12 women. The mean postoperative follow-up was 36.8 months. The mean AOFAS hindfoot score improved from a mean of 46 preoperatively to a mean of 77.3 postoperatively. Thirty-one of 33 arthrodeses achieved bony union at a mean time of 15.7 weeks. The mean increase in the talocalcaneal height was 3.8 mm in the feet operated without grafting, whereas it was 8.1 mm in the feet for which grafting was performed. Improvement in talocalcaneal angle was significantly better in the feet operated with bone grafting. The feet with posttraumatic subtalar arthritis were more prone to Reflex Sympathetic Dystrophy.
Topics: Adult; Aged; Arthritis; Arthrodesis; Calcaneus; Female; Fractures, Bone; Humans; Male; Middle Aged; Radiography; Reflex Sympathetic Dystrophy; Retrospective Studies; Young Adult
PubMed: 26280869
DOI: No ID Found -
Hand Clinics May 2018This article is an in-depth analysis of proximal interphalangeal joint arthrodesis indications and surgical techniques. There are a wide variety of indications for... (Review)
Review
This article is an in-depth analysis of proximal interphalangeal joint arthrodesis indications and surgical techniques. There are a wide variety of indications for proximal interphalangeal joint arthrodesis with relatively few contraindications. Moreover, although there is a limited surgical approach, there is a wide breadth of modalities in which to obtain the arthrodesis, of which several are listed here. Proximal interphalangeal joint arthrodesis has been shown to have excellent outcomes and a high success rate.
Topics: Arthrodesis; Finger Joint; Humans; Postoperative Care; Postoperative Complications
PubMed: 29625637
DOI: 10.1016/j.hcl.2017.12.007 -
Clinics in Podiatric Medicine and... Jul 2020A malaligned ankle arthrodesis is a painful and complicated pathology. Deformities may be present in the frontal, sagittal, or transverse plane or a combination of... (Review)
Review
A malaligned ankle arthrodesis is a painful and complicated pathology. Deformities may be present in the frontal, sagittal, or transverse plane or a combination of planes. Thorough preoperative evaluation of the deformity and the patient as a whole is crucial to successful revision. Surgical site for revision should be based on center of rotation of angulation, when possible. Revision commonly is performed through opening wedge osteotomy. Closing wedge and focal dome osteotomies, however, are excellent options. Revision also may be performed through external fixation or total ankle replacement. Although the literature is not rich with data, the options discussed provide favorable results.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Bone Malalignment; Fracture Fixation; Humans; Osteotomy; Postoperative Complications; Reoperation
PubMed: 32471613
DOI: 10.1016/j.cpm.2020.03.003 -
The Journal of Foot and Ankle Surgery :... 2022Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the... (Review)
Review
Hindfoot arthrodesis is often required for end-staged deformities, such as posterior tibial tendon dysfunction, osteoarthritis, or rheumatoid arthritis. Although the need for hindfoot arthrodesis is generally accepted in severe deformities, there is a debate whether a double or triple arthrodesis should be performed. The aim of our systematic review is to review the fusion rates and mean time to fusion in double and triple arthrodesis. A total of 184 articles were identified using the keyword search through the database of articles published from 2005 to 2017. After review by 3 physicians, a total of 13 articles met the eligibility criteria. The reason for double or triple arthrodesis within the studies were posterior tibial tendon dysfunction, tarsal coalition, degenerative joint disease, osteoarthritis, rheumatoid arthritis, Charcot Marie Tooth, Multiple Sclerosis, Polio, neuromuscular disorder, cerebral palsy, acrodystrophic neuropathy, clubfoot, post-traumatic, and seronegative arthropathy (spondyloarthritis). Within these 13 studies, there were a total of 343 (6-95) subjects extremities operated on. The overall fusion rate for double arthrodesis was 91.75% (289/315) compared to 92.86% (26/28) triple arthrodesis fusion rate, p value .8370. The mean time to fusion for double arthrodesis was 17.96 ± 7.96 weeks compared to 16.70 ± 8.18 weeks for triple arthrodesis, p value = .8133. There are risks associated with triple arthrodesis including increased surgical times, lateral wound complications, residual deformity, surgical costs and peri-articular arthritis. Given the benefits of double arthrodesis over triple arthrodesis and the nearly equivalent fusion rates and time to fusion, double arthrodesis is an effective alternative to triple arthrodesis. The authors of this systematic review recommend double arthrodesis as the hindfoot fusion procedure of choice.
Topics: Arthritis, Rheumatoid; Arthrodesis; Humans; Osteoarthritis; Posterior Tibial Tendon Dysfunction; Tarsal Joints
PubMed: 35221217
DOI: 10.1053/j.jfas.2022.01.012 -
The Journal of the American Academy of... Jan 2017Total wrist arthrodesis remains an important technique in the surgical armamentarium of upper extremity surgeons. The procedure has evolved over time but continues to... (Review)
Review
Total wrist arthrodesis remains an important technique in the surgical armamentarium of upper extremity surgeons. The procedure has evolved over time but continues to provide reliable pain relief at the expense of wrist motion. It is indicated for management of a wide variety of upper extremity conditions, including rheumatoid arthritis, posttraumatic osteoarthritis, cerebral palsy, and brachial plexus injuries, and as a salvage technique after failed implant arthroplasty. Recent studies demonstrate high levels of patient satisfaction and good functional outcomes after bilateral wrist fusion. Compared with total wrist arthroplasty, total wrist arthrodesis provides more reliable pain relief with lower rates of complications, but further studies are needed to compare functional outcomes and cost-effectiveness.
Topics: Arthrodesis; Humans; Patient Satisfaction; Treatment Outcome; Wrist Joint
PubMed: 27893490
DOI: 10.5435/JAAOS-D-15-00424 -
Hand (New York, N.Y.) May 2022Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity...
BACKGROUND
Proximal interphalangeal joint (PIPJ) arthrodesis can provide reliable pain relief and restore hand function in patients with PIPJ arthritis. However, there is a paucity of literature on patient-specific preoperative risk factors that are associated with adverse outcomes after PIPJ arthrodeses. Therefore, the primary purpose of this study was to assess preoperative predictors of nonunion and reoperation after PIPJ arthrodesis.
METHODS
This study identified all patients who underwent PIPJ arthrodesis at a single community practice between 1987 and 2013. The final analysis included 415 PIPJs treated with arthrodesis. The mean follow-up was 1.3 years. Data on preoperative diagnosis, demographics, comorbidities, and operative techniques were recorded, as well as the occurrence of nonunions and reoperations. Logistic regression models were used to identify independent risk factors of nonunion and reoperation.
RESULTS
There were 40 nonunions (10%) and 62 reoperations (15%). Of the reoperations, there were 39 incidences of isolated hardware removal, 9 irrigation and debridement, 8 amputations, 5 revision arthrodeses, and 1 corrective osteotomy. The highest number of nonunions occurred in the traumatic diagnosis group (37%), followed by the rheumatoid group (23%) and the scleroderma group (15%). The highest number of reoperations occurred within the traumatic joint disorder group (40%), followed by the rheumatoid group (24%) and the scleroderma group (11%). Multivariate analysis revealed that male sex ( < .01) and hepatic disease ( = .03) were significant risk factors of nonunion. Male sex was also significantly associated with increased reoperation risk ( < .01).
CONCLUSION
Risks of nonunions and reoperations after PIPJ arthrodeses are low; however, these findings may guide clinicians and patients in the preoperative decision-making process and help with targeted postoperative surveillance to mitigate these risks.
Topics: Arthritis; Arthrodesis; Finger Joint; Humans; Male; Postoperative Complications; Reoperation
PubMed: 32772578
DOI: 10.1177/1558944720939196 -
The Journal of the American Academy of... May 2016Metacarpophalangeal arthrodesis and interphalangeal arthrodesis are excellent tools in the surgeon's armamentarium to restore function of the disabled hand. Typical... (Review)
Review
Metacarpophalangeal arthrodesis and interphalangeal arthrodesis are excellent tools in the surgeon's armamentarium to restore function of the disabled hand. Typical indications for these procedures are pain, deformity, and/or stiffness. Arthrodesis is generally considered a salvage procedure to be used when other reconstructive procedures, such as arthroplasty, are not possible or would be associated with a high rate of complication or failure. To determine the most functional position for arthrodesis in each patient, the surgeon should preoperatively evaluate the compromised joint in the context of the disease process, determine the initial cause of the joint pathology, and assess the condition of the surrounding joints. Current methods of achieving fusion of metacarpophalangeal and interphalangeal joints include options for incisions, bone preparation techniques, and surgical implants; each has advantages and associated risks.
Topics: Age Factors; Arthritis; Arthrodesis; Finger Joint; Humans; Lupus Erythematosus, Systemic; Postoperative Care; Postoperative Complications; Scleroderma, Localized
PubMed: 27097126
DOI: 10.5435/JAAOS-D-15-00033