LAMBRINUDI

BY

OPERATION
L. HART, M.D.,

FOR
MINNEAPOLIS,

DROPFOOT*
MINNESOTA

VERNON

In Lolldoul, been The
tions,

1927

and

again
a “new performed

in

1933
operation and

Mr.
accepted

C.
on

Lambninudi
drop-foot”. by many

of Guy’s
The orthopaedic

Hospital,
has surgeons.

proposed successfully

operation

object
and on

of this
the which a joint The

paper

is to present
of the operation

the

indications,
and to

the
emphasize

contna-indicathe surgical

technique

prmciple

it is based.

The
to stabilize in
posterior

principle

as expressed
without principle then

by
ankylosing

Lambninudi
it is to

is that
allow or

“The
it to natural lock

best
bone

method
check.

in a normal

manner”. When
tile

is a physiological

complete
portion

equinus,
of

the
the joint as the the

foot

cannot
abuts in bony controls

drop
against plantan

any
flexion drop-foot

further
the tibia. and in the by arthrodesing

because
The may locking the correcting he

astragalus is taut natural

anterior an the tarsus equinus important equinus mechanism.

capsule The

of the factor, deformity

ankle

as well Lambrinudi at position mortise
AND

obstruction, joint which and

operation subastragalar to the of the astragalus, ankle

in a functional within
INDICATIONS

is locked

in complete

the

joint.
FOR THE OPERATION

CONTRA-INDICATIONS

Lambninudi on equinus deformity and inactive or peronea! muscles dicated arthrodesis
implantation

devised paralyzed are active

this

operation with dorsiflexor and strong,

for

the

correction

of soleus

drop-foot muscle the inIf is not

in a foot

an active

gastrocnemius

and peroneal muscles. then this operation

because a combined
of their

more constructive with anterior
tendons to foot with the the

and logical transposition
dorsum treated in slight of the by

procedure is of the peronei
tarsus. a panastragalar The The

triple with
Lam-

bninudi
writer

operation
believes that

would
arthrodesis

definitely

improve
is best foot

a flail

or dangle
equinus.

foot

but
operation

the
and

a dangle

calcaneocuboid

is not

indicated of the

if the

patient If may

has

an

unstable

knee

joint

which

requires of the deformity the height Achilles is foot
should

the support extremity, serves of the tendon paralyzed. never be
*

a brace. operation

there is considerable not be indicated if the with due when
the

shortening equinus to

to compensate for the shortening, heel of the shoe. A mild equinus position of the foot provides
If this

an

addition

to contracture the
equinus

of the
deformity

stability
situation

to

the
is

knee
present,

quadriceps procedure. Academy

femoris The

completely at the
Boston,
NO.

eliminated Annual Meeting

by
on January

any of the
24,

surgical American
1940.

Presented

of Orthopaedic
937

Surgeons,
VOL. XXII,

Massachusetts,
io

4, OCTOBER

The tarsus is then arthrodesed to the remaining portion of the astragalus. A wedge of bone is removed from the head. L. As should since not it will by of he demand confused with an equinus deformity technique a different and Seddon. equinus JOINT permanent. neck. be (‘ollsiderltiOil like other anshould before throdesing methods.t ankle failure 10115 joint. and body of the astragalus so that the inferior surface of the astragalus forms a plane at an angle of about 95 or 100 degrees with the vertical axis of the leg. JOURNAL OF . (‘ongenit al equinovarus corrections. i age of stabilizes as well articulation. of tile till’ dis- Lat(’ral astragalus within the joillt nlortise is not of for the t he opera. fonmity common which has perouieal resisted nerve manipulative THE injury. entire tiOll. iIl11)OFttlult the tiot. Laifli)u’iulll(li this operation uiay (lefOl’nlity tlhl(l l11postei’ioi’ overact would and he a small iou i)e a tiiereelinliand segi a yams to an a(’ti\’e (tile /1. eight forethe correcspecial than the (Ic(heSURGERY foot.938 V. Ol)1)05(’(l til)ittliS ‘Flie IilIls(’le nlluscle. operation origin foot. the ankle suhasThe is an patient Lateral roentgenogram taken with the foot in completc equinus. equinius foot. HAHT \\‘ili(’ll for Present. to surgical the of The suggested in deformities paralyses Fitzgerald the foot. foot. tile operation. l)y a (‘eption. sirahle a better (‘all functioning he secured the as the arthrodesis panastu’agalar which joint tnagalar FIG. I)erfOrmed age of An about extreme of for years. and BONE ANI) is of other value residual due paralysis of anterior poliomyelitis. infrequently t lie reason of st ahilizing tile \ I at subastragalar 111111 the (‘l’atiOul Launhninucli \\‘Olll(l If factor h(’ this is 110 opnudepresent. (Irop of liemiplegia. of this (lefornling factor fore it llate(l ex(’ision uiieuit a should i)y exposure of of tlse teul(lOul incision Oule-ilich to preniani liniinary sectiun.

foot 1)lalies and of . O(’TOIIER 1940 . 2 indicates FIG. 3 wedge os bone is tile supe(‘alcis is denuded to form a plane Fig. 3 tioll and body of the astragalus removed to (‘orre(’t th( equi11115 (lefOI’Ill ity at. 4. at anthrodesing timi to t.ragalus. NO..lt(’I’al I’oeiltgenogl’:lIll of st tile affected t he flexion t he . t I’siul inn 5111(11)111115. hefoi’e t he ass’it ii ss’li icli . Finally a not(’h is made horizontally from side to side iii the posterior and inferior portion of the scaphoi(l i)One.. t he sui)ast ragalar joint. ‘edge 1) 511055’s t i’agalus t1(’(’l1i’1(’ iS locke t t he ext renl(’ of t lie t lie of tile vertical of 95 of l)lstIltal’ (5111 detei’ullille lie (legu’ee I fi’oiui angle head. joint of mortise. 5111(1 one of t he a plane 2). 1his notch ss’ill receive ast.. 2: The shading of the head. flie inferior surface of the remaining I)OI’t loll of tue astragalus forms a plane of ai)Out 100 degrees ill relation to the ‘ei’t i(’al axis of the leg. lhe equinus (l(’foi’mitV iS (‘orl’ectcd ss’hen the tarsus is art hlro(iesed to the astraga.lus. find solution ‘FE(.. (‘artilage is removed from the calcaneocuhoid jOiilt.HNIQVE . I lie a(t ual sul’gi(’al in F1ie an(l Ileck roentgeiiogu’ain size hod’ forni ( Fig. 1)one I)arallel wit ii tile horizontal axis of the foot.. (1 ill functional Wilicil is the mortise posi- the sharp anterior border of the tile tarsus the astragalus.LAMBIflNVDI OPERATION FOR DRIJP-FOOT 939 (tile to fol’Illit ics ss’it Ii loss ll1 of dorsiflexou’ by an(I the pei’oneal lan1)u’inh1(li nlus(’les.uikle 1)one in section eo11lplete (‘( 111111115 15 (‘Ss(’il t ittI 1 for oI)e1’at tidy ion in planniulg . VOL. Whi(’iI l”ig. the pou’- is lo(’ked within 3: After the ankle FIG. lo(’ked of in the XXII. of hone to lie 1)e renove inferior surface :uid leg leg of t lue ast i’agalus of ahout The is (‘onlplete foot 95 so t lInt degrees 1e of ast ragalus axis of will the the iii relation at au to t lie angle ( Fig. neck. . complete equinus within ankle joint. the the the remoVed from nor surface of of cartilage and astragalus. if t here 5110111(1 paralysis pia(’e(l degrees to FIG..‘ 1.. Oj)eI’atiOil.

HART FIG. is removed from the head. The wedge of bone. usual mechanism long The subastragalar lateral curved joint is exposed in the Kochen incision. because foot it should does prevents off” never not the be active placed the angle to ordinary coming the leg heel into a position permit when wearing and action gastnocnemius walking. posterior the (Fig. surface Cartilage of the and astragalus bone are is completely then removed is parallel from the (Fig.he foot. L. Complete through a media! dislocation of the tarsus at the subastragalar joint is essential after sectioning the penoneal tendons. a notch and inferior portion of the prepared remaining notch is made of the horizontally scaphoid margin into the portion of the astragalus of the scaphoid while the THE JOURNAL OF BONE is then firmly superior bleeding AND JOINT SURGERY . union between the astragalus deformity at the subastragalar however. denuded from the with the ca!caneoside to side The sharp of the os calcis to form a plane which of t. 5 Roentgenographic tarsus svitii correction the dorsiflexor and evidence of the peroneal of bony drop-foot muscles. which was determined when the lateral roentgenogram was studied. The cartilage is removed and. inferior 2). and body of the as- tragalus of cartilage superior horizontal cuboid in the anterior wedged after surface axis joint. from 3). finally. an angle in to the of an from manner of tile donsum and joint. neck.940 V. dorsiflexon the tarsus. opening the astragaloscaphoid and calcaneocuboid joints and dividing the interosseous and external lateral ligaments of the ankle. the 100 degrees of should muscles be planned if there or the peronei wilich The such also as because a “push is some may be available transplanted power at a right.

. Soc.. 1937. since the astragalus is locked at the ankle joint in complete equinus. evidence joints. XXII.: A Method of Correcting Equinus and Calcaneous Deformities at the Sub-Astragaloid Joint. 193. walking Periods weight5) at of elevation gradually decreased bearing until suhastragalar and on the there cast and gradually Plaster which fixation union requires is continued the three between is roentgenographic calcaneocuboid five months.xD SEDDON. 56). within periods of bony the of plaster. C. REFERENCES LAMBRINUDI. 788 (Sect. Surg. OCTOBER 1940 . LAMBRINUDI. . British J. F.: Lambrinudi’s Operation for Drop-Foot. Roy. British J. Surg. 283. while a short elevation walking of the cast with (Fig. is approximated The foot is now to the at the inferior desired surface of 95 or of 100 tile astragalus (Fig. P. Orthop. is applied beginning rubber are felt are heel incorporated increased.: New Operation on Drop-Foot. NO. The incision is closed and a long plaster-of-Paris leg cast is applied to maintain the position About with of the the a foot or and of permit the third postoperative week. XV. VOL. XXV. 4. Proc. XXVI. extremity. Med. H. J. 1927. degrees to the axis of the leg and cannot be plantar-flexed further.... 1933. C.LAMBRINUDI OPERATION FOR DROP-FOOT 941 bleeding angle surface of tile 05 calcis 4). FITZGERALD.

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