إيثاقات الطرف السفلي إعداد الدكتور علــي الـهــلالــــي

1. إيثاقات الطرف السفلي إعداد الدكتور علــي الـهــلالــــي

2. 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.

3. Disadvantages : 1- stifness of adjacent joints . 2- ↑ energy reguirements . Types: 1- internal Fixation . 2- external Fixation .

4. 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

5. 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 .

6. External 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 used "

15. 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 .

17. 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 .

25. 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 .

26. 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 . 2- 5 degree Valgus . 3- 10 degree external rotation .

30. 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 .

31. 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 .

32. 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 .

33. 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 .

37. Triple Arthrodesis

40. MoKazem.com • هذه المحاضرة هي من سلسلة محاضرات تم إعدادها و تقديمها من قبل الأطباء المقيمين في شعبة الجراحة العظمية في مشفى دمشق, تحت إشراف د. بشار ميرعلي. • الموقع غير مسؤول عن الأخطاء 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 د. مؤيد كاظم