Lapidus Pearls: Gaining Joint Exposure to Decrease Non-Union скачать в хорошем качестве

Lapidus Pearls: Gaining Joint Exposure to Decrease Non-Union

Surgical Pearls to Decrease Non-Union in the Lapidus Procedure for the Correction of Large Unstable Bunion Deformity: Tarsal Joint Distractor The Lapidus Procedure has certainly undergone a resurgence in popularity in recent years for the correction of severe and unstable bunion deformities. Although fusion of the first met cuneiform joint can afford the surgeon the ability to easily correct a large bunion deformity or one with a component of first ray instability, it is critical that adequate joint preparation is performed in order to achieve a successful result. The most difficult part about this procedure is gaining access to the plantar aspect of the joint. Because of the depth and kidney bean-shaped curvature of the first metatarsocuneiform joint, it can be very challenging to reach the plantar-most section of the articular surface. The easiest way to open the fully joint the open and access the plantarlateral corner of the first met cuneiform joint is to use two k-wires applied on either side of the joint. Simply place one k-wire in the body of the medial cuneiform and one in the base of the first metatarsal. The Tarsal Joint Distractor can then be placed over these k-wires and used to retract the first metatarsocuneiform joint. Now by simply cranking the Tarsal Joint Distractor open, you have clear stable access the the articular surfaces. With the first met-cuneiform joint held open in this retracted position, you may then perform your joint preparation. If you prefer the curettage technique, you can of course curette all of the cartilage away. You may also use a burr, osteotome or powered sagital saw in order to remove the cartilage from the joint. Additional subchondral drilling, fenestration or fish-scaling of the joint may alsoe be performed while the joint is held in this retracted position. The key here is take make certain that the plantar-lateral corner of the first metcuneiform joint has been adequately prepared for fusion. By using the Tarsal Distractor it will be much easier for you to see all the way to the plantar aspect of the joint and assess your fusion site for complete preparation. Now that you have fully denuded the cartilage and prepared the joint for fusion, you can use the Tarsal Joint Distractor to close down the joint. As you close the joint, you can also rotate the distractor to fin-tune the alignment of your fusion site and ensure that you maintain the ideal positioning to reduce the first intermetatarsal angle and correct the bunion. Having achieved the desired alignment, you can further compress the fusion site with the Tarsal Joint Distractor. By doing so, you can use the distractor as a form of temporary fixation. This allows you to place your internal fixation without any loss of correction or compression of the joint. By making sure that all of the cartilage is removed (especially that plantarlateral corner of the first metatarsal-cuneiform joint) you will help increase your chances for successful fusion and a desirable surgical result for your bunion patient.