Principles of Arthrodesis

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Questions and Answers

Which radiographic finding confirms a successful arthrodesis in the long term?

Increased joint space indicating bone remodeling.
Presence of bridging callus formation only on one side of the joint.
Visible joint space with minimal sclerosis.
Complete trabeculation across the joint. (correct)

When discussing arthrodesis with a patient, why might a surgeon prefer the term 'fusion'?

To use terminology that is more easily understood by the patient. (correct)
To avoid potential legal complications associated with the term 'arthrodesis'.
To emphasize the complexity of the surgical procedure.
To ensure the patient understands the permanent nature of the procedure.

A surgeon is reviewing pre-operative X-rays for a planned arthrodesis. What key radiographic feature require careful consideration?

Assessing for joint space narrowing or distraction. (correct)
The degree of periosteal reaction along the bone.
Evidence of soft tissue swelling around the joint.
The presence of any pre-existing hardware near the joint.

What does a successful arthrodesis aim to achieve in the affected joint?

Complete elimination of motion within the joint. (D) Signup and view all the answers

During a post-operative evaluation of an arthrodesis, the X-ray shows a persistent, clear gap between the bones intended to fuse. What does this radiographic finding most likely indicate?

Nonunion or failed fusion attempt. (B) Signup and view all the answers

What is the primary indication of the 'paprika sign' during a surgical procedure?

Indication of penetration through the subchondral bone. (A) Signup and view all the answers

Which of the following is the MOST significant disadvantage of planar resection in arthrodesis?

Loss of bone length. (C) Signup and view all the answers

In the curettage and fenestration technique for arthrodesis, what is the PRIMARY advantage of preserving the joint contour and bone length offset by?

Prolonged operative time. (C) Signup and view all the answers

What is a key distinction between fenestration and fish scaling techniques concerning the risk of thermal necrosis?

Fenestration carries a risk of thermal necrosis from drilling, while fish scaling does not involve thermal risk. (D) Signup and view all the answers

What is the intended purpose of fish scaling in the context of subchondral bone preparation?

To increase surface area for enhanced bone bleeding and growth. (A) Signup and view all the answers

A surgeon is preparing a PIPJ arthrodesis and aims to slightly plantarflex the joint to enhance toe purchase. What is the MOST likely degree of plantarflexion they would consider?

5-10 degrees, providing a subtle increase in toe purchase. (A) Signup and view all the answers

During arthrodesis, after adequate joint preparation but before graft insertion (if used), when should the surgeon MOST likely perform a thorough flushing of the surgical site?

After final joint preparation but before graft insertion. (D) Signup and view all the answers

In the context of arthrodesis procedures, what is the PRIMARY reason for emphasizing the importance of knowing topical anatomy for incision planning?

To minimize the risk of damaging crucial neurovascular structures. (B) Signup and view all the answers

Which action represents the MOST critical step in adhering to Glissan's Principles during an arthrodesis procedure?

Meticulously removing all residual calcified cartilage and preparing the joint surfaces. (D) Signup and view all the answers

When performing a planar resection during a PIPJ arthrodesis, what is the MOST crucial consideration for achieving proper alignment?

Aligning the toe straight in all three planes (rectus position). (B) Signup and view all the answers

During joint curettage on osteochondral specimens, what specific anatomical structure is noted to have a residual layer, potentially impacting subsequent procedures?

The subchondral plate interface, often requiring further preparation. (C) Signup and view all the answers

What is the MOST ACCURATE description of the purpose of using cup and cone reamers during joint preparation?

To precisely shape the opposing joint surfaces for optimal contact and stability. (B) Signup and view all the answers

A surgeon is planning a first metatarsophalangeal joint (1st MPJ) arthrodesis. Which of the following considerations is MOST crucial for a successful outcome?

Achieving proper alignment and stable fixation to ensure bone union. (B) Signup and view all the answers

What combination of arthrodeses constitutes a triple arthrodesis?

Subtalar joint, talonavicular joint, calcaneocuboid joint (C) Signup and view all the answers

During a talonavicular (TN) arthrodesis, what is a critical consideration regarding the talar head?

The talar head is structurally fragile. (B) Signup and view all the answers

In a subtalar joint (STJ) arthrodesis, what is the recommended valgus alignment range in the coronal plane?

0-5 degrees of valgus (C) Signup and view all the answers

During ankle arthrodesis, what is the primary sagittal plane alignment goal?

Neutral/plantigrade (C) Signup and view all the answers

What transverse plane alignment is generally targeted during ankle arthrodesis?

Approximately 10-15 degrees of external rotation (B) Signup and view all the answers

Postoperatively, what radiographic findings are indicative of successful joint union following an arthrodesis?

Trabeculation across the fusion site. (A) Signup and view all the answers

What radiographic sign(s) suggest a nonunion following an arthrodesis procedure?

Lucency surrounding the hardware without trabeculation. (A) Signup and view all the answers

Besides radiographic evaluation and hardware status, what clinical factor is crucial in assessing a potential nonunion after arthrodesis?

Symptomatic pain (D) Signup and view all the answers

What is the MOST appropriate sagittal plane positioning (dorsiflexion) of the first metatarsophalangeal joint (MPJ) relative to the weight-bearing surface during arthrodesis, considering typical clinical goals?

0-10 degrees dorsiflexed relative to the weight-bearing surface. (A) Signup and view all the answers

During first metatarsophalangeal joint (MPJ) arthrodesis, what is the PRIMARY rationale for ensuring the nail plate is parallel to the ground in the coronal plane?

To prevent rotational malalignment and subsequent skin irritation or ulceration. (D) Signup and view all the answers

In the context of a first tarsometatarsal joint (TMTJ) arthrodesis, achieving a neutral position in all planes is MOST critical when the procedure is performed for which condition?

Osteoarthritis, to optimize joint congruity and biomechanics. (A) Signup and view all the answers

When performing a first tarsometatarsal joint (TMTJ) arthrodesis, what is the MOST critical consideration regarding the depth of the joint?

The depth is approximately 3 cm, requiring longer saw blades to reach the plantar aspect. (A) Signup and view all the answers

What is the MOST accurate description of a 'double arthrodesis' in the context of rearfoot/ankle surgery?

Fusion of the talonavicular (TN) joint and the subtalar joint (STJ). (A) Signup and view all the answers

When performing a first metatarsophalangeal joint (MPJ) arthrodesis, what is the PRIMARY purpose of reaming the joint surfaces following the initial resection?

To increase the surface area for bone-to-bone contact, promoting fusion. (B) Signup and view all the answers

In the context of first tarsometatarsal joint (TMTJ) arthrodesis for pes planus correction, what is the MOST important objective regarding positioning?

Reducing the medial column fault to improve alignment. (A) Signup and view all the answers

When performing a first metatarsophalangeal joint (MPJ) arthrodesis, what is the PRIMARY goal of transverse plane positioning?

To achieve 10-15 degrees of abduction or parallel alignment with the second toe. (A) Signup and view all the answers

Which surgical scenario best exemplifies a distraction arthrodesis?

Fusing a joint and simultaneously lengthening the limb by incorporating a bone graft at the fusion site. (D) Signup and view all the answers

What is the primary objective of in situ arthrodesis?

To fuse a joint while maintaining its pre-operative position, without altering length or alignment. (A) Signup and view all the answers

In which of the following clinical presentations would deformity correction arthrodesis be MOST appropriate?

A patient with a malaligned joint, needing angular correction without any requirement for height adjustment. (A) Signup and view all the answers

A surgeon performs an osteotomy to realign a varus deformity of the knee, securing the correction with internal fixation but without fusing the joint. Which procedure aligns best with the actions taken?

ORIF (Open Reduction Internal Fixation). (C) Signup and view all the answers

A patient presents with severe arthritis of the ankle joint. The surgeon recommends a procedure to alleviate pain while preserving some range of motion in the joint. Which surgical intervention is MOST consistent with this treatment plan?

Arthroplasty of the ankle joint. (D) Signup and view all the answers

Flashcards

Arthrodesis

The surgical fusion of a joint, eliminating motion at that joint.

Arthrodesis Radiographic Sign

Complete bony bridging across a joint space seen on X-ray, indicating successful fusion.