midfoot fusion: indications and techniques

• Introduction

• Indications/Goals of Midfoot Arthrodesis

• Types of Midfoot fusions

• Technique for fusions

• Fixation • Conclusion

• Arteries

• Nerves

• Tendons

• Ligaments

Initial injury is often missed acutely:

• Conservative/Non surgical • Surgical

Sangeorzan et al, Foot & Ankle, Vol 10, 4:193, 1990

Preoperative Considerations:

Determining Extent of Arthrodesis:

Surgical Goals:

Pain relief

Preservation of function

“Although tarsometatarsal arthrodesis may be necessary to manage persistent pain, complete relief of symptoms, even after fusion, may not occur.”

Myerson, et al, Orthop Clin North Am, 20(4):655, 1989

• Nemec et al, FAI, 2011

• Gougoulias, Foot and Ankle Surgery, 2016

Complications:

Special situations:

Diabetic Neuroarthropathy-Indications

• Extent of Arthritis

• Medical conditions

• Deformity

Lamm, Stasko, JFAS, 2016

Lamm, Stasko, JFAS, 2016

Thermal necrosis

• Avoid thermal necrosis

• USE ON COMPROMISED PATIENTS, REVISIONS, DEFECTS

• Johnson et al, JFAS, 2009

• Withey et al, JFAS, 2014

• Ray et al, JFAS, 1998

• Yu, 1993/ Coetzee, 2004/ Patel, 2004

• Eriksson, Acta Orthop Scan, 1984

• Cottom et al. JFAS 2013 • Fixation of Lapidus Arthrodesis with a Plantar

Interfragmentary Screw and Medial Locking Plate: A Report of 88 Cases

• Adavistic joint

• Drummond et al, Foot Ankle Surg, 2018 • Stability of Locking plate and compression

screws for Lapidus arthrodesis: A Biomechanical comparison of plate position

• Eccentric compression • Locking

• Sangeorzan et al, Foot & Ankle, 1990

• Bevilacqua, Clin Pod Med Surg, 2017

• Gait analysis and functional outcome in patients after lisfanc injury treatment

• Van Hoeve et al, Foot Ankle Surg, 2017

• Ajis et al. FAI 2014

Caused by Hypermobility of the medial column, applying increased pressure to the 2nd TMT

• DO NOT WANT TO MAKE THE MIDFOOT TOO RIGID