Talo-navicular fusion using Zimmer-Biomet locking plate surgical technique
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Talonavicular osteoarthritis is a moderately common condition to be seen and treated by foot and ankle surgeons. It has many aetiologies including being the sequelae of trauma as in this case.
Painful degenerative or post-inflammatory changes at the talonavicular joint are the principle indications for talo-navicular arthrodesis. The procedure may also be used to reduce deformity in severe tibialis posterior tendonosis where a medialising calcaneal osteotomy and tendon transfer are not considered robust enough, for example in an older person with poor collagen or in those with severe deformity but without subtalar arthrosis. Union rates and clinical outcomes reported are good for isolated talonavicular fusions (see ref Diezi et al below)
I not infrequently will take iliac crest bone graft to augment my fusion. This is because this joint tolerates bone defects poorly because of the poor blood supply to both the talus and the navicular bones. In this case I prepared the crest for harvest but did not need to use it. I prefer iliac crest bone graft to that from the calcaneus or the proximal tibia in light of its greater osteoblast and precursor cell count though I am aware that it has a higher reported complication rate (see reference Chiodo et al. below)
Non operative treatments involve the use of accommodative semi-rigid orthoses, activity modification and analgesia. When this conservative approach fails operative intervention should be considered.
Chiodo CP, Hahne J and Wilson MG. Histological Differences in Iliac and Tibial Bone Graft, Foot and Ankle International May1, 2010.
Author: Mr Chris Blundell FRCS (Tr & Orth).
Institution: The Northern General Hospital, Sheffield, UK.
Author: Author: Mr Chris Blundell FRCS (Tr & Orth).
Institution: Institution: The Northern General Hospital, Sheffield, UK.
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Question 1 of 14
The principle indication for a talo-navicular fusion is which one of the following?CorrectIncorrect
Question 2 of 14
Which one of the following best describes how often Bone grafting of the talo-navicular joint is used in fusion cases?CorrectIncorrect
Question 3 of 14
Iliac crest bone graft is preferred by the author for which one of the following reasons?CorrectIncorrect
Question 4 of 14
Which one of the following is not useful for managing talo-navicular disease conservatively?CorrectIncorrect
Question 5 of 14
With respect to the imaging of patients with talo-navicular disease which one of the following statements is true?CorrectIncorrect
Question 6 of 14
The deep peroneal nerve is protected using which one of the following tendons?CorrectIncorrect
Question 7 of 14
Capsule release is important in order to achieve for which one of the following?CorrectIncorrect
Question 8 of 14
For stabilising the arthrodesis site which one of the following constructs is the strongest?CorrectIncorrect
Question 9 of 14
Regarding positioning the compression screw which one statement is correct?CorrectIncorrect
Question 10 of 14
Regarding the plate which one statement is correct?CorrectIncorrect
Question 11 of 14
Which one statement about the screws in the locking plate is correct ?CorrectIncorrect
Question 12 of 14
Repairing the inferior extensor retinaculum is important for which one of the following reasons ?CorrectIncorrect
Question 13 of 14
Which one of the following is not part of the rationale for post operative casting?CorrectIncorrect
Question 14 of 14
Which one statement is correct according to the paper by C Diezi et al?CorrectIncorrect