Transcript الشريحة 1 - MoKazem.com

‫إيثاقات الطرف السفلي‬
‫إعداد الدكتور‬
‫علــي الـهــاللــــي‬
Arthrodesis
Arthrodesis : an operation to produce bony
ankylosis of a disease joint .
Indications : 1- infection
2- Tumors .
3- Trauma .
4- Paralytic conditions .
5- Osteoarthritis and
Rheumatoid arthritis.
Disadvantages :
1- stifness of adjacent joints .
2- ↑ energy reguirements .
Types:
1- internal Fixation .
2- external Fixation .
Ankle
most joint that undergo arthrodesis
comparision to other joints .
position of Ankel fusion :
Flexion
0
degree
Valgus
0-5
degree
external rotation
5 - 10 degree
General principles :
1- attempt should be made to create
abroad flat cancellous surfaces for
good apposition and fusion .
2- Rigid stabilization ( internal , external ).
3- good alignment between leg ,hindfoot ,
fore foot .
Types of fixation :
1- external fixation .
2- large cancellous screws .
3- intramedullary fixation .
Calandruccio triangular frame to
produce compression and control
motions in 3 planes .
another type is ring or circular fixators are
used to minimize pin track infection .
they can be used in patients with poor
bone quality , for non union or in failed
total ankle arthroplasty or active
infection .
Internal Fixation :
1- ease of insertion .
2- great resistance to shear force .
" Cancellous screw most commonly
Bone Grafting :
adding bone graft can be used alone or in
combination with other methods of fixation
wich is usually taken from the iliac crest .
Types :
1- sliding bone graft .
2- tricortical bone graft.
3- central bone graft .
Examples :
1- tibio talar arthrodesis with iliac crest
bone graft .
2- tibio talar arthrodesis with narrawing
osteotomiesm .
3- tibio talar arthrodesis with sliding bone
graft ( Blair Technique ) .
4- tibio talar arthrodesis with
intramedullary nailing .
5- posterior arthrodesis of ankle and
subtalar joints .
Knee :
most common indication of knee arthrodesis is
salvage of failed total knee arthroplasty .
Methods :
1- compression arthrodesis with external fixation :
indications : * minimal bone loss .
** broad cancellous surface .
*** adequet cortical bone .
disadvantages : * pin tract infection .
** poor patients compliance .
*** frequent need for early
removal and cast immobolization .
2- Arthrodesis with intramedullary rod fixation :
it can be used when extensive bone loss with
difficult to achieve compression.
1- tumor resection .
2- failed of total knee arthroplasty ( infection ) .
advantages : * immediate w.t bearing .
** early rehabilitation .
*** high fusion rate .
disadvantages ; * extensive blood loss .
** difficult in obtaining good aligement .
3- Arthrodesis with plate fixation .
Position :1- full extension or 15 degree flexion .
25 degree Valgus .
310 degree external rotation .
Hip :
Arthrodesis of hip decreased because of
the use of total cemetless arthroplasty .
Conditions :
* less than 40 years .
** severe post traumatic arthrities
*** normal lumbar spine function
contralateral hip , ipsilateral
knee .
absolute contraindication :
active sepsis of hip joint ( infection should
be inactive for 12 months befor arthrodesis )
relative contraindications :
1- severe degenerative changes in lumbo
sacral spine , contra lateral hip , ipsilateral
knee .
2- poor bone stock ( oteoporosis ) .
Positions :
* 30 degree flexion .
** 0 - 5 degree adduction .
*** 0 - 15 external rotation .
Types :
1- arthrodesis with cancellous screw
fixation .
2- arthrodesis with muscle pedicle bone
graft " portion of anterior illium with the
origin of tensor fascia lata , anterior
fibers of gluteus medius + minimus +inter trochantric osteotomy .
3- arthrodesis with cobra plate fixation .
advantages :
restoration of abductor function if the fusion
later converted to total hip arthroplasty .
4- arthrodesis with hip compression screw .
advantages :
1- delay the appearance of low back pain
because the fusion is in proper position .
2- minimize post operative immobolization .
3- late convert to total arthroplasty .
4- preseve the abductor musculature .
Arthrodesis in the absence of femoral head
used in patient with osteo necrosis of
femoral head , infection with complete
destruction of femoral head and neck the
operation carried out in 2 or 3 stages
Triple Arthrodesis
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‫• هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل األطباء المقيمين‬
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.‫• الموقع غير مسؤول عن األخطاء الواردة في هذه المحاضرة‬
• This lecture is one of a series of lectures were prepared and
presented by residents in the department of orthopedics in
Damascus hospital, under the supervision of Dr. Bashar Mirali.
• This site is not responsible of any mistake may exist in this
lecture.
Dr. Muayad Kadhim
‫ مؤيد كاظم‬.‫د‬