Arthrodesis

Mid-foot and hindfoot arthrodesis of neuropathic joints should be considered salvage procedures, as they are technically demanding and frequendy associated with complications. Recent reports have been encouraging with respect to satisfactory outcomes of these procedures as an alternative to amputation of the limb. However, there is still a need for caution, as surgical complication rates remain high. Stabilization of the medial column of the foot is crucial to the success of mid-foot arthrodesis.

Factors leading to successful arthrodesis include the preoperative condition of the foot, control of infection, operative technique and postoperative management. In general, no patient should be considered for surgery until the acute arthropathy has subsided. The precise timing for this has not been quantified. Regardless of which joints are fused, basic surgical techniques remain the same.

Technique for successful arthrodesis

• Thorough removal of all cartilage and detritus

• Careful removal of sclerotic bone down to healthy bleeding bone

• Meticulous fashioning of congruent bone surfaces for apposition

• Rigid fixation of bone.

Modern surgical techniques for internal and external fixation have greatly increased the chances for successful outcomes. Of equal importance is the necessity for prolonged postoperative immobilization, often two to three times longer than that required for a patient without neuropathic bone disease. Patients must remain non-weightbearing, and require physiotherapy and rehabilitation, with a gradual return to protected weightbearing.

The following case is a striking example of acute Charcot's arthropathy, with fracture dislocation of the mid-foot, that required realignment arthrodesis with fusion of the medial column of the foot.

Fig. 8.38 Acute Charcot's arthropathy of the left foot, (a) Anteroposterior radiograph reveals fracture-dislocations of the tarsometatarsal joints (Lisfranc's joint), with medial dislocation of the 1st metatarsocuneiform joint, and dorsally displaced fractures of the 2nd, 3rd and 4th metatarsal heads, (b) Illustration of the radiographic findings.

Fig. 8.38 Acute Charcot's arthropathy of the left foot, (a) Anteroposterior radiograph reveals fracture-dislocations of the tarsometatarsal joints (Lisfranc's joint), with medial dislocation of the 1st metatarsocuneiform joint, and dorsally displaced fractures of the 2nd, 3rd and 4th metatarsal heads, (b) Illustration of the radiographic findings.

Metatarsocuneiform Joint What This
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