Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Save to My Library
Look up keyword
Like this
1Activity
0 of .
Results for:
No results containing your search query
P. 1
Mr Simon Moyes -Ankle Arthrodesis

Mr Simon Moyes -Ankle Arthrodesis

Ratings: (0)|Views: 33 |Likes:
Published by Skylark Creative
The surgical procedure of fusing damaged bones in the ankle is known as arthrodesis. Simon Moyes explains why arthroscopic surgery will help the patient return to activity more quickly.

Simon Moyes specialises in arthroscopic and minimally invasive treatment for problems of the knee, shoulder, foot and ankle. He uses arthroscopy to carry out effective and accurate diagnoses of joint problems.

Simon Moyes combines the latest in sophisticated technology with his considerable experience as an orthopaedic surgeon.

Based in London, Simon Moyes consults in three different London based locations.

For further information on Simon Moyes please see:
http://www.ankle-arthroscopy.co.uk/about-simon-moyes/
http://www.simonmoyes.com/about.php
The surgical procedure of fusing damaged bones in the ankle is known as arthrodesis. Simon Moyes explains why arthroscopic surgery will help the patient return to activity more quickly.

Simon Moyes specialises in arthroscopic and minimally invasive treatment for problems of the knee, shoulder, foot and ankle. He uses arthroscopy to carry out effective and accurate diagnoses of joint problems.

Simon Moyes combines the latest in sophisticated technology with his considerable experience as an orthopaedic surgeon.

Based in London, Simon Moyes consults in three different London based locations.

For further information on Simon Moyes please see:
http://www.ankle-arthroscopy.co.uk/about-simon-moyes/
http://www.simonmoyes.com/about.php

More info:

Published by: Skylark Creative on Jun 02, 2009
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

04/06/2010

pdf

text

original

 
http://www.ankle-arthroscopy.co.uk/surgeon/ankle_arthrodesis 
Ankle arthrodesis
An ankle arthrodesis, if successful, allows patients to return to work and somesports with a virtually normal gait. Fusion rates have been reported from manyseries as in the order of 80% and infection occurring in 5-25% (103-107).Morgan in 1985 reported a 96% fusion rate with 90% good / excellent results;he maintained the contour of the talar dome, kept the ankle in neutral andused cross-screw internal fixation (108). Two years earlier, Schneider firstdescribed arthroscopic ankle arthrodesis (109). But it was Morgan (110) whopublished the first report in 1987. Myerson (111, 112) compared open andclosed techniques of ankle arthrodesis with a reported quicker fusion timearthroscopically of 8.7 versus 14.5 weeks theoretically because of the lack of diruption pf the soft tissues and therefore a better blood supply to the fusingsurfaces. The faster fusion rate was backed up by Ogilvie-Harris (113) whoreported an 89% fusion rate arthroscopically with 88% fused by the third postoperative month. Winson I G et al (114) reported a very large series of 118arthroscopic fusions. The mean time to union was 12 weeks; non-unionoccurring in 7.6%.The advantages of an arthroscopic arthrodesis are reduced morbidity, shorter hospital stay, faster fusion rate, better cosmesis and lower complication rates.Against these are a long learning curve for the surgeon and theatre staff, itcan be a longer procedure and requires expensive arthroscopic equipment.Also it cannot correct large varus or rotational deformities.The contra-indications for an arthroscopic arthrodesis are >15 degreesdeformity, a previously failed arthrodesis, the presence of infection, RSD anda charcot joint.
 
Mann showed that the best fusion position is with the ankle in neutral,avoiding >10 degrees plantar-flexion and with the os-calcis in 5 degreesvalgus (115). Also the ‘Mann’ position results in the best gait (116). You do,however, lose 70% of the total motion arc with an ankle fusion, and tarsalhypermobility is increased 85% (117).The arthroscopic technique is to have the standard arthroscopic set up witheither invasive or non-invasive distraction. Remove all articular cartilageinitially from the talar dome and plafond, then the gutters to expose bleedingunderlying bone and finally the anterior osteophyte needs removal as thiswould otherwise resist talar reduction. Then the fusion is secured with parallelcannulated screws. Screw positioning is arthroscopically assisted and thelength of the screws can be image intensifier assisted.Patients then spend 3 weeks non weight bearing followed by 4-6 weekspartial weight bearing. The screws can be removed later if they are causingpain. A range of 3-12 months has been reported for standard open fusion tooccur (118-120), this compares unfavourably with the arthroscopic technique.Mann (121) from a multi-centre trial recently demonstrated a 91% fusionfusion and 84% good / excellent results. This fusion rate leaps to 96% if known poor techniques are avoided, eg laser, external charnley typecompression.
References
(103) Ahlberg A, Henricson A S, ‘Late results of ankle fusion’ Acta OrthopScand 198; 52:103(104) Boobyer G N, ‘The long term results of ankle arthrodesis’ Acta OrthopScand 1981; 52:107(105) Johnson F W, Boseker E H, ‘Arthrodesis of the ankle’ Arch Surg 1968;97:766(106) Morrey B F, Wiedeman G P, ‘Complications and long term results of ankle arthrodesis following trauma’ JBJS 1980; 62A777(107) Said E, Hunka L, Siller T M, ‘Where ankle fusion stands today’ JBJS1978; 60B:211(108) Morgan C D, Henke J A, Bailey R W, Kaufer H, ‘Long term results of tibio-talar arthrodesis’ JBJS 1985; 67A:546(109) Schneider D, ‘Arthroscopic ankle fusion’ Arth Video 1983; 3(110) Morgan D C, ‘Arthroscopic tibiotalar arthrodesis . Jefferson Orthop J198; 16:50(111) Myerson M S, Allon S M, ‘Arthroscopic ankle arthrodesis . ContempOrthop 1989; 19:21(112) Myerson M S, Quill G, ‘Ankle arthrodesis - a comparison of anarthroscopic and an open method of treatment’ Clin Orth 1991; l 268:84(113) Ogilvie-Harris D J, Lieberman I, Fitsialis D, ‘Athroscopically assistedarthrodesis for osteoarthritic ankles’ JBJS 1993; 75A 1167(114) Winson I G et al, ‘Arthroscopic arthrodesis’ JBJS 2005; 87:3; 343-7(115) Mann R A, Coughlin M, ‘Surgery of the foot and ankle’ St.Louis: C VMosby, 1991; 676(116) Mazur J M, Schwartz E, Simon S R, ‘Ankle arthrodesis: long termfollow-up with gait analysis’ JBJS 1979; 61A:964

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->