Arthrodesis
A lis franc screw goes from the _______ to the ________
-1st cuneiform -2nd metatarsal base
The main motion of the lateral column comes from the ______ and ______, not the ______
-4th + 5th metatarsal and cuboid articulation -CCJ
What lab values are associated with non-union
-Albumin -Lymphocytes
Articular joint consists of:
-Articular cartilage -Subchondral bone plate
_______ of a joint can be resected with a curette, but ______ cannot
-Articular cartilage -Subchondral bone plate
Where can you do an incision for a TNJ arthrodesis?
-Between TA and TP -Medial to TA -Between TA and EHL -Between EHL and EDL
What are the parts of Perren's strain theory?
-Bone formation -Fibrocartilage formation -Granulation tissue formation
How to treat a non-union after an arthrodesis procedure?
-Bone stimulator -Revision surgery
Highest rates of non-union in TTC fusions are associated with:
-Charcot -Non-traumatic OA -Age -CKD -DM
Why are the components of a "functional triple" (TNJ) arthrodesis?
-Corrects forefoot abduction -Midfoot collapse -Rearfoot valgus
When you are concerned about a lis franc injury, always look at _____ and always order a ______
-Cuboid -CT
Thickening of the subchondral bone plate results in _____ and ______
-Decreased blood supply -Decreased shock absorption
What joints in the LE are good for contoured joint resection?
-Ellipsoid (condylar) -Saddle -Hinge -Some plantar joints
Benefits of layered anatomic closure
-Ensure nutrition to the arthrodesis site -Tamponade effect to control bleeding -Limit post-op edema
How to position the ankle for an ankle fusion:
-Foot 90 degrees to the leg (air on the side of equinus>calcaneus) -ER the same as the contralateral limb -Neutral position or some valgus (no varus) -Posterior translation of the talus on the tibia (5mm)
Classification systems for lis franc injuries
-Hardcastle -Quenu and Kuss
Types of non-union
-Hypervascular/hypertrophic -Atrophic/avascular -Pseudoarthrosis -Septic non-union
2 most efficient ways to gain exposure to a joint
-Joint disarticulation -Joint distraction
What instruments are used to obtain and maintain joint distraction?
-Lamina spreader -AO mini distractor -Femoral distractor -Tarsal distractor -Weinraub distractor
2 incision approach for a triple arthrodesis
-Lateral from the malleolus to the 4th metatarsal bade -Medial from the superior aspect of the malleolus to the inferior margin of the NC joint
Complications of TNJ arthrodesis
-Lateral midfoot pain (occurs because the long plantar ligaments gets stretched on the lateral side)
Incision for a STJ arthrodesis
-Lateral: above the peroneals and sural n. -Medial: too scary, don't do it
Why do want to avoid fusing in a varus position?
-Locks the transverse tarsal joint -Creates a stiff and painful foot -Puts them in a slight heel valgus with a plantigrade foot
Goal when doing contoured resection
-Maintain anatomic concave/convex relationship -Minimize shortening
Arthrodesis complications
-Malalignment/positioning (varus) -Affects distal joints -LLD -Non-union -Fixation problems -Failure to consider tendon transfers -Attempted on a patient with sepsis or OM
For an ankle fusion, a plate can be placed in which directions?
-Medial -Lateral -Anterior
Indications for fusion > fixation
-Medial and middle columns are already rigid -Restores functional anatomy -Fusion after ORIF is more difficult -Major ligament destruction -Multidirectional instability -Only requires 1 surgery -Pain
Non-surgical treatment for non-union
-NWB with prolonged immbolization -Bone stimulation
Disadvantages of the trephine arthrodesis
-Need for appropriate sized trephines -Relative inability to reduce significant joint malalignment
Use _______ sized trephine to resect the joint; this allows _____
-Next larger -The donor site to be slightly expanded by the graft material for a tight graft-host fit upon insertion
Indications for fixation > fusion
-ORIF has improved -Preserves the joint -Difficult to fuse multiple fractures -Using screws or plates could further damage the joint
Techniques for cartilage removal and joint preparation for arthrodesis
-Osteotomy and fishscaling -Contoured resection with currette/power shaver/power burr -Planar resection
Indictations for any fusion
-Pain -Deformity correction -Plantigrade foot -Replace bracing -Return the patient to normal activity -Trauma
When doing screw fixation for a STJ arthrodesis, use a _______ screw where ________
-Partially threaded -Threads go completely across the fusion site
What instruments can be used to break through the subchondral bone plate to expose cancellous bone?
-Power burr -Fenestration with a k-wire -Osteotome + mallet
If you are doing a procedure and realize the foot is in varus, how do you fix it?
-Pronate the forefoot before applying the dressing -Do a cotton procedure on the 1st cuneiform
In a trephine arthrodesis procedure, a cylindrical trephine instrument is used to create a circular partial bone resection that is sufficient size to ______
-Provide adequate surface area for graft healing -Stability at the joint once fusion is complete
Limitations of a trephine arthrodesis
-Relative inability to reduce significant joint deformity or malalignment -Makes assessing the status of the fusion following surgery difficult
What instruments can be used to remove cartilage for an arthrodesis procedure?
-Sagittal saw -Osteotome and mallet -Power shaver/power rasp -Rongeur -Hintermann (pin compressor/distractor) -Power burr Currette
What instruments are useful to help pry open a joint for an arthrodesis procedure?
-Sayer elevator -Key elevator -Freer elevator
Post-op treatment for a trephine arthrodesis
-Soft dressing -Below the knee cast -NWB for 6-8 weeks
Surgical technique for CCJ arthrodesis
-Start with an incision from the malleolus to the 4th metatarsal -Maintain saddle shape -Fix with screws, staples and a locking H-plate
1st layer of the subchondral bone plate characteristics
-Superficial -Calcified cartilage -Hard -Avascular
Bones get nutrients from ____ and ______
-Synovial fluid -Subchondral bone plate
Characteristics of subchondral bone
-Thin -Relatively avascular compared to cancellous bone -Made mainly of appositional layers of bone with trabeculae -No Haversian canals
Indications for trephine arthrodesis
-arthrosis, pain, or instability when the alignment of the foot is good (it is a simpler procedure with less soft tissue disruption) -midfoot procedures when you have to maintain the length/overall anatomy of the foot
Lis franc fracture/dislocation accounts fro _____% of TMT arthrodesis/lis franc arthrodesis
0.2
Name the type of incision for lis franc fusion: Use a bone clamp for the 1st metatarsal and 1st cuneiform to drive the screw
1 long
Advantages of contoured joint resection
1. Minimizes shortening 2. Allows for manual reduction of the deformity without having to remove more position to achieve the desired position
After a pantalar arthrodesis, the _______ joint has the highest rate of non-union
Ankle
_____ fusion is the gold standard
Ankle
Where should you have the incisions or an ankle fusion?
Anterior
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): Use lag screws (gives compression to assist with fusion)
Arthrodesis
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Absolute stability
Bone formation
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Rigid fixation
Bone formation
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Strain is <2%
Bone formation
"Healing of a fracture/fusion site is the race between _____ and _____"
Bone healing and fixation failure
Indications for ______ arthrodesis: -Isolated fusion or relapsed TEV - DJD -Correct midfoot adductus -Cuboid syndrome -Idiopathic lateral column pain -Aggressive plantar fasciotomy
CCJ arthrodesis
What tissue layer do you want to get to when doing an arthrodesis?
Cancellous bone
What is a complication of prolonged immobilization/NWB associated common with non-surgical treatment for non-union
Cast disease
Whatever method of fixation being used, the arthrodesis must be held in _______ until fill healing across the fusion site has occurred
Close, stable apposition
Name the type of atrophic non-union (torsion wedge, comminuted, defect, atrophic): Necrotic intermediate fragment
Comminuted
_______ increase NWB time post arthrodesis surgery
Comorbities
Name the technique for cartilage removal and joint preparation for arthrodesis: Use a scooping motion
Contoured resection with currette/power shaver/power burr
Contoured joint resection allows you to maintain the anatomic ________/______ relationship of the joint
Convex/concave
-Enlarged and irregular sesamoids -Autofusion -Joint mice -Dorsal spurring of the metatarsal heads
DJD
Complications of STJ arthrodesis:
Fuse the joint into varus position (this locks the forefoot into a cavus position ==> bad for shock absorption)
Fusion or fixation: Good for major ligament disruption
Fusion
Fusion or fixation: Good for multidirectional instability
Fusion
Fusion or fixation: Resotres functional anatomy
Fusion
Fusion or fixation: Which only requires 1 surgery
Fusion
______ may complicate a trephine arthrodesis if the opposite cortex is violated after trephine joint resection
Graft extrusion
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Non-union
Granulation tissue formation
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Strain is between 10 and 100%
Granulation tissue formation
Name the instrument used to remove cartilage for an arthrodesis: You put a k-wire though each hole at the end and they go on either side of the joint that is being fused
Hintermann
Where is the best location to get an autograph bone graft?
Hip (but this does damage the hip)
Name the type of hypertrohpic non-union (elephant foot, horse hoof, oligotrophic): -Mildly hypertrophic -Poor-moderate callus
Horse hoof
Hypertrophic or atrophic non-union: (+) Tech-99 scan
Hypertrophic
Hypertrophic or atrophic non-union: -Elephant foot -Horse hoof -Oligotrophic
Hypertrophic
Hypertrophic or atrophic non-union: Biology is sufficient for healing, it just needs stability
Hypertrophic
Hypertrophic or atrophic non-union: Treat by increasing stability
Hypertrophic
Hypertrophic or atrophic non-union: Well vascularized and callus present
Hypertrophic
Hypertrophic vs atrophic non-union: Judet-Weber A
Hypertrophic
________ may preclude the use of the most stable form of fixation for the procedure and may impede proper positioning
Improper incision placement
Proper ________ is of the utmost importance when performing any surgical procedure
Incision placement
Name the column: 2nd and 3rd TMT joints and NC joints
Intermediate column
Name the column: Rigid/no motion
Intermediate column
Why would you want to use a k-wire for an arthrodesis?
It makes smaller holes in the joint
Best way to get exposure of a MTPJ or IPJ
Joint Disarticulation
Best way to get exposure of the ankle joint and intertarsal joints
Joint Distraction
Hallux limitus/rigidus surgery goal
Joint preservation
-Thickening of the subchondral bone plate -Cysts -Microdamage -Thickening calcified cartilage
Late stage OA
Name the column: 4th and 5th TMT joints
Lateral column
Name the column: Essential for shock absorption
Lateral column
Name the column: Helps you accommodate to uneven surfaces
Lateral column
Name the column: Mobile (shouldn't fuse this)
Lateral column
If you fuse a heel into varus, you will get less/more motion?
Less
For a midfoot arthrodesis, more/less soft tissue dissection is performed
Less (full exposure isn't required)
-Commonly misdiagnosed -Delay in treatment leads to need for arthrodesis
Lis franc injury
Fleck sign (DP radiograph)
Lis franc injury
On a lateral radiograph, you see sagittal displacement of the metatarsals at the TMT joint
Lis franc injury
-Severe plantarflexion injury -Commonly associated with trauma -Ecchymosis on the plantar midfoot
Lis franc injury (until proven otherwise)
Indications for _____ arthrodesis: -Major ligament disruption -Multidirectional instability -Intra-articular with crushing -Previously failed ORIF -DJD -Deformed foot -Pain
Lis franc/TMT arthrodesis
Post-op pantalar arthrodesis
Long time of NWB
Preferred method to periosteal dissection
Making a linear incision in the periosteum to provide exposure
1st metatarsocuneiform and naviculocuneiform arthrodeses are done with a _____ incision
Medial
Name the column: Part of the rigid lever needed for propulsion
Medial and intermediate column
Name the column: 1st TMT and NC joints
Medial column
Name the column: Limited mobility at the TMT joint (better for fusion)
Medial column
Name the column: TN joint is the mobile segment
Medial column
Smaller trephine sizes (~6mm) are used for _____ joints
Midfoot
If you fuse a heel into valgus, you will get less/more motion?
More
Trephines of different diameters are constructed with a thin piece of metal to ______
Reduce the amount of bone displacement with use
Good for the 1st, 2nd, and 3rd TMT joints
Rigid fixation
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): For rigid joints
Rigid fixation
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): Use any size solid screw
Rigid fixation
_______ or ________ can be used for controlled depth resection of the subchondral bone plate
Rongeur or osteotome with mallet
Indications for ____ arthrodesis: -DJD from an old talus/calcaneal fracture or failed calcaneal fracture repair -Recurrent TEV -Coalition -RF varus/valgus -PTTD
STJ arthrodesis
Only use ______ to remove cartilage in a TNJ arthrodesis if you have to do deformity correction
Sagittal saw
Wedge resection is best achieved with a _______, so a uniform planar surface can be created
Sagittal saw
Most people use ______ for fixation for lis franc arthrodesis
Screws
It may be difficult to delineate/gain access to a joint secondary to _____
Severe degenerative changes
In the periarticular area, the periosteum is continuous with the joint capsule and is firmly attached to bone by _____
Sharpey Fibers
_______ must be sectioned. Sharply in the same plane as the subperiosteal dissection
Sharpey Fibers
You have to be careful controlling the depth with a reaming system to minimize _____
Shortening
According to glissan's principles, you should/should not remove the subchondral bone plate
Should
When doing an arthrodesis, always position the foot ______
Slightly valgus (to ensure you are not in varus)
Diffusion of nutrients through the cartilage matrix is significantly faster/slower than going though the synovial fluid
Slower
Don't do fusions on patients who ________
Smoke
When doing a wedge resection arthrodesis, you adjust position by removing a wedge piece of bone ==> Every adjustment causes _____
Some degree of shortening
Plantar ligaments are weaker/stronger than dorsal ligaments
Stronger ==> This is why there is dorsal dislocation of the metatarsals
2nd layer of the subchondral bone plate characteristics
Subchondral bone
Articular Joint - Articular cartilage or subchondral bone plate: Composed of 2 layers
Subchondral bone plate
For a midfoot arthrodesis, the patient is laying ______
Supine
Indications for _____ arthrodesis: -PTTD -Arthritis -Equinovarus -Post-polio -Vertical talus -Rearfoot stabilization
TNJ arthrodesis
Name the arthrodesis: Functional triple
TNJ arthrodesis
Name the arthrodesis: Most powerful
TNJ arthrodesis
Name the arthrodesis: Reduces STJ motion and CCJ motion by 2/3rds
TNJ arthrodesis
_______ fusion has high risk for complications
TTC
Indications for ________ arthrodesis: -Charcot -Talar AVN -Failed ankle arthroplasty -OA
TTC fusion
When doing TNJ Arthrodesis, be careful with dissection around the ______
Talus
Ensuring nutrition to the arthrodesis site is done by reapproximating each tissue layer in close apposition and holding it in place until the body has reestablished the ______ strength of the tissue to maintain the anatomical alignment
Tensile
What is deep to the subchondral bone plate?
Vascular cancellous bone
______ joint resection is used for reduction of rigid deformities or the resection of some plantar joints
Wedge
________ joint resection is done to resect a joint in a planar or linear surface fashion
Wedge
Do you lose a lot of motion with a TNJ fusion?
Yes
Yes or No During disarticulation of a PIPJ, the collateral ligaments will still be attached to the head of the proximal phalanx
Yes
For a STJ arthrodesis, why might you want the screw to go from the talus to the calcaneus?
You have a bigger bone to aim for
When you are fusing 2 bones, you should debride them until ______
You see raw bleeding bone
Scoring system for hip non-unions:
RUSH
Scoring system for tibia non-unions:
RUST
_______ systems are designed for joint resection to maintain anatomic convexity/concavity
Reaming
Glissan principles to increase fusion rate
1. Must completely remove all cartilage, fibrous tissue, and any other material that would prevent close approximation of the raw bone surfaces (remove all interposing soft tissue/removal of the articular cartilage and subchondral bone plate) 2. Must provide an accurate and close-fitting construct for fusion (no gaps) 3. Must have optimal position of the joint to be fused (no varus) 4. Must maintain the bone apposition in an undisturbed fashion until the fusion is complete
AO Principles
1. Preserving blood supply to the fracture/fusion 2. Obtaining anatomic reduction 3. Provide stable fixation 4. Early and active ROM of the involved body part
Procedure for screw placement for a lis franc Arthrodesis
1. Throw lis franc screw 2. Throw 1st ray screw 3. Through screw though the 3rd cuneiform
Lis franc's ligament is an interosseous ligament between ______
1st cuneiform and 2nd metatarsal
There is no intermetatarsal ligament between the ________ metatarsals
1st-2nd
Name the type of incision for lis franc fusion: Creates a skin bridge (he likes this one)
2 incisions
Transverse intermetatarsal ligaments secure ________ metatarsals
2nd-5th
TNJ arthrodesis has a non-union rate of _____%
35
Articular Joint - Articular cartilage or subchondral bone plate: Avascular
Articular cartilage
Articular Joint - Articular cartilage or subchondral bone plate: Relatively malleable
Articular cartilage
Articular Joint - Articular cartilage or subchondral bone plate: Uncalcified
Articular cartilage
When doing a STJ arthrodesis, how many facets do you need to fuse?
At least 2 of 3
Be careful about doing a lis franc arthrodesis in _______ patient
Athlete
Hypertrophic or atrophic non-union: (-) Tech-99 scan
Atrophic
Hypertrophic or atrophic non-union: -Comminuted -Torsion wedge -Defect/void -Atrophic
Atrophic
Hypertrophic or atrophic non-union: Occurs because of an issue with revascularization of the bone fragments adjacent to the fracture site due to injury/surgery
Atrophic
Hypertrophic or atrophic non-union: There is a biological defect that is preventing healing
Atrophic
Hypertrophic or atrophic non-union: Treatment: -Take them back to surgery and debride until you get bleeding bone, then fixate -May need a bone graft (autotomous)
Atrophic
Hypertrophic vs atrophic non-union: Judet-Weber B
Atrophic
Name the type of atrophic non-union (torsion wedge, comminuted, defect, atrophic): Scar tissue with no osteogenic potential replaces the missing fragment
Atrophic
Arthrodesis procedure is for _____
Correction of deformity
How does subchondral bone differ from cortical bone?
Cortical bone has Haversian canals, subchondral bone does not
Goal of wedge resection
Create a planar or linear surface when resecting the subchondral bone plate
Cell count increases/decreases with aging
Decreases
Mitotic activity increases/decreases with aging
Decreases
Name the type of atrophic non-union (torsion wedge, comminuted, defect, atrophic): Loss of fragment from the diaphysis
Defect
Inject the patient with 2cc of lidocaine and have the walk around and see if the pain is gon
Diagnostic injection — Do this to make sure you know which joint is the issue
According to glissan's principles, removing the articular cartilage and subchondral bone plate adds/does not add strength
Does not add
Tarsometatarsal arthrodeses are done with a _____ incision
Dorsal
-Removal of the 2 proximal static locking screws and use a tantalum spacer to increase stability and promote fusion -Done for non-unions
Dynamization procedure
Name the type of hypertrohpic non-union (elephant foot, horse hoof, oligotrophic): -Hypertrophic -Rich callus
Elephant foot
Ideally the foot is 90 degrees to the leg for an ankle fusion. But if you had to pick, would you rather have the foot in equinus/calcaneus position
Equinus
-Always take cartilage off first -Do this on both sides of the joint -Avoid confluence (2 holes touching each other)
Fenestration/microfracture
Using a k-wire to make holes in the bone past the subchondral bone plate to help get the capillary buds into the fusion site
Fenestration/microfracture
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Callus formation
Fibrocartilage formation
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Eventual union
Fibrocartilage formation
Name the stage of perren's strain theory (bone formation, fibrocartilage formation, granulation tissue formation): Strain is between 2% and 10%
Fibrocartilage formation
Use a cylindrical trephine instrument to partially resect adjacent surfaces of a joint and then ________ for a subtotal, but effective fusion
Fill the defect with cancellous bone graft
Fusion or fixation: Preferable if there is multiple fractures
Fixation
Fusion or fixation: Preserves the joint
Fixation
Sliver of bone that is pulled off the medial side of the base of the 2nd metatarsal
Fleck sign
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): For mobile joints
Flexible fixation
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): Good for the 4th and 5th TMT joints
Flexible fixation
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): Use k-wires
Flexible fixation
For flatfoot surgery, always check the ______ before putting a dressing on
Forefoot (it is commonly in varus and needs to be fixed)
Following incision, _______ is used to begin subperiosteal blunt dissection over the diaphyseal bone region ==> this provides a known target layer on the proximal and distal aspect fo the joint to be fused
Freer elevator
What type of graft is preferred for a trephine arthrodesis?
Freeze-dried allograft
Do you lose a lot of motion with a STJ fusion?
No
-No radiograph progression for 3 months -Surgery occurred at least 9 months ago and has not healed
Non-union
-Pain and swelling at the fusion site for longer than you'd expect -Can WB without pain
Non-union
Judet-Weber classification is for ______
Non-union
You order a CT if you have Lis franc injury because you could have _______ (not seen on x-ray)
Nutcracker compression of the cuboid
Fusion after ______ is more difficult
ORIF
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): Function = maintain alignment
ORIF
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): No compression
ORIF
Name the type of fixation (ORIF, rigid fixation, flexible fixation, arthrodesis): Use positional screws (no counter drilling)
ORIF
Name the type of hypertrohpic non-union (elephant foot, horse hoof, oligotrophic): -Not hypertrophic -No-minimal callus
Oligotrophic
-Implant device -Drill a whole in the metatarsals and put in the implant for articulation -Can be used for painful arthritis
Orthospheres
Name the technique for cartilage removal and joint preparation for arthrodesis: Destroys the subchondral bone plate without removing it
Osteotomy and fishscaling
When doing any procedure, ______ > function
Pain relief
Fusion of everything that touches the talus (CCJ, TNJ, STJ< TTJ/ankle)
Pantalar arthrodesis
Goals of ______ arthrodesis: -Reduce pain -Fix malalignment -Preserve some function
Pantalar arthrodesis
Indications for _____ arthrodesis: -Polio -Destructive arthritis (Charcot or RA) -Trauma -Neuromuscular -Last resort before a below the knee amputation (salvage procedure)
Pantalar arthrodesis
-Present once cancellous bone is exposed -Recognized by capillary bleeding within the resected bony surface
Paparika Sign
Pinpoint bleeding after cartilage resection
Paprika sign
_______ provides ~80% of the blood supply to bone
Periosteum
When doing a trephine arthrodesis, the trephine instrument should be angled _______ to the joint
Perpendicular
Name the technique for cartilage removal and joint preparation for arthrodesis: Not recommended
Planar resection
Name the technique for cartilage removal and joint preparation for arthrodesis: Shortens the bone and leaves a big gap (requires a bone graft)
Planar resection
Name the technique for cartilage removal and joint preparation for arthrodesis: Use a sagittal saw to remove 2 equal amounts of bone from both sides of a joint and fixation
Planar resection
When doing a STJ arthrodesis, you should take an x-ray with the beam towards the lateral malleolus so you can see the _____
Posterior facet
Name the instrument used to remove cartilage for an arthrodesis: Doesn't make the bone shorter
Power burr
Name the instrument used to remove cartilage for an arthrodesis: Leaves normal anatomy and contour of the joint
Power burr
Once the incision is planned, strict adherence to ______ is vital
Proper surgical technique
Why do you want to retain the opposite cortex when doing a trephine arthrodesis?
Provides a closed space to receive the bone graft
For a STJ arthrodesis, why might you want the screw to go from the calcaneus to the talus?
The screw will go from less dense to more dense and might bite better
As arthritis progresses, the subchondral bone plate gets thicker/thinner and loses its blood supply (becomes sclerotic)
Thicker
Why do you need to take care to maintain the periosteum as a single layer during arthrodesis procedures?
To minimize disruption of the periosteal blood supply
Function of fixators in an arthrodesis procedire
To stabilize the arthrodesis site while the bone heals
Name the type of atrophic non-union (torsion wedge, comminuted, defect, atrophic): Intermediate fragment
Torsion wedge
Dowel Fusion
Trephine arthrodesis
_______ is an in-situ technique where fusion can be accomplished without complete joint resection
Trephine arthrodesis
Fusion of the STJ, TNJ, and CCJ
Triple arthrodesis
Paprika sign
Triple arthrodesis
