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Triple Arthrodesis

Principles

  • Wedge resection of talus to correct fixed equinus deformity
  • 60% had residual deformity
  • 23% Pseudarthrosis
  • 25% Significant pain
  • 38% Degenerative changes in ankle
  • May need elongation of tendo Achilles & soft tissue release before able to obtain correction
  • This may ↓ resection required & incidence of AVN of talus

Surgical Technique

  • Make straight incision over sinus tarsi from peroneus brevis tendon to lateral border of extensor tendons (shoe top)
  • Elevate periosteum of calcaneus & reflect EDB distally as flap of tissue
  • Incise capsule of
    • calcaneo-cuboid
    • Talo-navicular
    • subtalar joints
  • Establish correct position of bones prior to resection & establish if wedges are required to correct deformity
  • Remove articular surfaces of calcaneo-cuboid & talo-navicular joints first (may need second dorso-medial incison to get adequate exposure of talo-navicular joint)
  • Finally excise articular surface of subtalar joint
  • Reduce bone surfaces & stabilise with percutaneous 'K' wires
  • Place chips of cortio-cancellous graft in region of junction of bone cuts & in any spaces
  • Replace EDB & close wound
  • Apply BK walking POP
  • mobilise when swelling settled commencing with PWB for 2/52 then WB as tolerated
  • Remove pins at 6 weeks & reapply walking cast for another 2 - 4 weeks
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