Arthrodesis

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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


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