arthrodesis

Non-Operative

Education regarding shoe wear

- extra wide / large toe box

Insoles

- longitudinal arch support

- pre MT dome for metatarsalgia

- podiatry to attend to callosities

Toe spacers

Analgesia

Operative

Indications

1.  Continued pain and discomfort

2.  Difficulties with shoe wear

Issues

1.  Painful Bunion / Hallux valgus

2.  Metatarsalgia / MTPJ dislocation

3.  Claw toes

Nalebuff Classification

Type I - Boutonniere 

- commonest

- MP flexion /  IP hyperextension

- usually EPB rupture with EPL subluxation

Type II

- Boutonniere & Swan Neck

- doesn't exist according to Nalebuff

Conditions

1.  PIPJ Synovitis

- synovectomy via dorsomedial approach

2.  Flexor tenosynovitis

- may cause trigger finger

- trial HCLA

- remove synovits but don't release A1 pulley

- will worsen ulna drift

3.  DIPJ

- rarely affects

Indications

Indications have narrowed

- due to success of shoulder arthroplasty

1. Chronic infections of GHJ

2. Stabilization in paralytic disorders

3. Post-traumatic brachial plexus palsy

4. Salvage of failed GHJ Arthroplasty

- may need bone graft procedures

5. Arthritic diseases unsuitable for arthroplasty / young patient

Indications

Very few

- young labourer with severe disabling elbow pain

- trial in POP at 90^o for 6 weeks

Poor function

- adjacent joints cannot compensate for loss of function

Contraindications

RA

- high failure rate especially flail elbow with poor bone stock

Indications

Severe LBP 

- most common indication

Ipsilateral knee pain

- less beneficial

Malposition

- especially abduction

Contraindications

Absent abductor mechanism

Flail

Active infection

Insufficient bone stock

Examination

LLD

Indications

Young adult 

- 16 - 30 years old

- monoarticular disease

- heavy demand 

Exhausted options of osteotomy

- risk of THA failure  / multiple revision surgeries considered too high

Aims of arthrodesis

Maximise bony contact

Minimise shortening

Definition

No good definition

- flexible flat foot

- medial longitudinal arch of foot in weight-bearing is in contact with ground or closer to ground than 'normal'

Epidemiology

Common

- almost always bilateral

- strong familial tendency

Aetiology

Physiological

All infants have flat feet

Types

1.  Grice

2.  Lambrinudi

3.  Dunn

Grice

Definition

Extra-articular STJ fusion

- lateral bony block in sinus tarsi

- prevents valgus deformity

- allows undisturbed foot growth

Indication

Flexible valgus hindfoot in children 4 - 12

Polio