Making triple arthrodesis easier and more reliable

Abstract

Triple arthrodesis is a successful procedure for endstage midfoot and hindfoot pathology. Although consistent results can be expected from triple arthrodesis, it can be technically demanding and there is a learning curve. One complication is poor positioning of the forefoot on the rearfoot. We offer a technique of midtarsal joint resection and arthrodesis that helps simplify the procedure and still obtain good correction and consistent results. Preparation of joint surfaces for fusion can be performed in situ or with joint resection. There are intrinsic advantages and disadvantages to these techniques, which have been outlined by Kissel et al. (1). Critics of joint resection state that it is technically more demanding and results in shortening of the foot. Our technique for midtarsal joint resection provides a simple method with minimal shortening. Standard lateral and medial dissection is carried out to obtain adequate visualization and mobilization of the subtalar, calcaneocuboid, and talonavicular joints. The posterior facet of the subtalar joint is prepared for fusion by the surgeon's preference. The ankle and subtalar joints are placed in the desired position and temporarily fixated. With the midtarsus held in proper alignment, the articular surfaces of the calcaneocuboid joint is resected using a sugittal saw. An osteotome is placed on the resected surface of the calcaneocuboid joint. This will serve as a parallel guide to resect the talonavicular joint. A sagittal saw is lined up parallel to the osteotome in all three cardinal planes and subchondral resection of the talonavicular joint is performed (Fig. l). At this point, the midtarsal joint should have good apposition without gapping. If both the talonavicular and