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Tibio-Talo-Calcaneal (TTC/Double )fusion using Integra Advansys Plate Surgical Technique

Overview

Learn the Tibio-Talo-Calcaneal (TTC/Double )fusion using Integra Advansys Plate surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Tibio-Talo-Calcaneal (TTC/Double )fusion using Integra Advansys Plate surgical procedure.

 

The most common reason for performing a double-fusion is in concurrent ankle and subtalar arthritis in the symptomatic patient.

Consideration should also be given to the technique  in cases of revision of fusion surgery to the ankle or subtalar joint and  also avascular necrosis of the talus .

Arthritic change is however not a pre-requisite for this type of surgery. As a final option for an unstable ankle and hindfoot in the neurological patient it has significant merit also.

There are various techniques available surgically for performing a double fusion , these being to use large fragment screws in isolation , to fuse using an intra-medullary nail , an external frame or  a plate designed for the purpose.

The techniques of joint preparation and correction of deformity will be broadly the same irrespective of the technique chosen for fixation.

The INTEGRA Advansys TTC plate is designed for lateral application through a trans-fibular across the ankle & subtalar joints. As such both access and implantation are  straightforward .

These plates are sided and come in 4 lengths and 2 widths (of the Calcaneal limb). As such they are able to accommodate an appropriate variety of adult foot & Ankle sizes. THe INTEGRA TTC plate is of robust dimensions but also can be contoured if required (for example to accommodate heel valgus). The Integra screws have excellent thread purchase on bone and their innovative design (with a non-threaded head) allows them to pull the plate to the bone after which they can be locked into place with a threaded grub screw /washer. Compression is achieved  both using an external clamp anchored temporarily proximal to the top of the plate  as well as with a proximally placed compressive hole in the plate.

In my experience given the plate is applying compression laterally a medially placed large fragment screw across the ankle is usually required to counteract the medial tensile force that results .

Author: Mark Herron FRCS

Institution :The Wellington Foot & Ankle unit ,London ,UK.

 

 

 

 

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