What are indications for arthrodesis? (7)
- joint instability that cannot be addressed by reconstruction (if you can maintain joint function, you should)
- intractably painful joint d/t OA
- inability to maintain joint posture (mechanical, neurological)
- irreparable intra-articular fracture
- shearing injury
- infective OA
- primary bone tumor (limb spare)
What joints tolerate arthrodesis well? What joints do not tolerate arthrodesis well? What joints should never be arthrodesed?
- Well tolerated: anebrachiocarpal joint, middle carpal joint, carpo-metacarpal joint, proximal intertarsal joint, traso-metatarsal joint
- Not as well tolerated: shoulder, talcrural joint, stifle, elbow
- Never arthrodese: hip, temporomandibular joint
What are the principals of arthrodesis? (9)
- correct procedure at appropriate time
- atraumatic surgical approach
- fix limb in a weight-bearing positiondebride articular cartilage
- implant cancellous bone graft
- rigid internal fixation
- post-op coaptation (splint to immobilize)
- exercise restriction
- follow-up radiograph
What is the best place to harvest a cancellous bone graft?
If an arthrodesis is going to be successful, there should be...
stable joints above and below the joint to be arthrodesed- more loading will be put on these other joints
If a stifle arthrodesis is performed, you must...
remove the plate to prevent long term load concentration at the margins of the plate and fracture above or below the plate
What diagnostic is crucial in evaluating joints, especially before arthrodesis?
stressed radiographs (you can see at what level of the joint there is instability or hyperextension) in addition to your standard orthogonal views
You CANNOT treat carpal hyperextension injuries with ____________.
What is the general recommendation for carpal hyperextension injuries?
- pancarpal arthrodesis (as opposed to partial carpal arthrodesis) stabilized with a dorsal plate
- debride all joints
- transfix radiocarpal bone
How is proximal intertarsal luxation managed?
- calcaneoquartal arthrodesis
- pin and figure 8 wire
- more complex cases- lateral plate fixation
How is tarsometatarsal luxation managed?
- lateral plate fixation
- engaged multiple metatarsal cortices (screws go through multiple metatarsal bones)
What are complications of arthrodesis? (7)
- failure of fusion
- implant failure
- incorrect angle
- gait alteration
- DJD of other joint (increased loading)