Triple Arthrodesis
Overview
This procedure will result in positional correction with a realignment arthrodesis of the tritarsal complex. Osteosynthesis is achieved with a combination of cannulated and standard ASIF compression screws. Gaps created within the sites of arthrodesis following positional realignment will be filled with bone graft to potentiate osteogenesis.
Patient Background
The patient is a middle-aged female with a diagnosis of posterior tibial tendon dysfunction, or adult acquired flat foot, with secondary degenerative joint disease of the tritarsal complex. She has had an extensive course of non-operative therapy, which has failed. This procedure will realign the hindfoot and eliminate the painful arthropathy.
Procedure
- The cartilaginous surfaces of the tritarsal complex are removed using the curettage debridement technique. The subchondral plate is left intact.
- The subchondral plates are fenestrated using a 2mm drill bit to create vascular channels and to encourage subchondral bleeding.
- The hindfoot is realigned to achieve positional correction, using the contralateral foot as a guide.
- Percutaneous fluoroscopically-guided provisional fixation is followed by permanent fixation using cannulated screws to stabilize and compress the sites of arthrodesis.
- A 2:1 mixture of Grafton DBM Putty and cancellous chips, along with a small amount of autogenous bone, is prepared using proper aseptic technique.
- Gaps that are present at the calcaneocuboid and subtalar joints following realignment anthrodesis are filled with the Grafton DBM mixture.
- A tamp is used to ensure tight compaction of the Grafton DBM mixture in and around the sites of arthrodesis, ensuring good coaptation.