J Korean Orthop Assoc.
1976 Sep;11(3):435-446. 10.4055/jkoa.1976.11.3.435.
Triple Arthrodesis: Review of 167 Feet
- KMID: 2461288
- DOI: http://doi.org/10.4055/jkoa.1976.11.3.435
Abstract
- Triple arthrodesis was performed on 167 feet in 153 patients at the Department of Orthopaedic Surgery, Seoul National University Hospital, during the 19 years from July 1957 to March 1976. Review of statistics, technical problems, and complications has led to following conclusions. 1) Of the total of 167 feet, residual poliomyelitis was the most common etiology with 127 feet (76%). 2) The youngest age was 5 years and the oldest 54 years, the 12-17 year group with 84 feet occupying half of the cases. 3) 79 feet (46.7%) had equinovarus deformity and 27 feet had equinocavovarus. 13 feet had no deformities. 4) Hoke's lazy S incision was utilized in 110 feet and Olliers incision in 57 feet. Hokes technique was employed in 118 feet and Lambrinudi's technique or its modification in 44 feet, while in the 5 feet without deformity exeresis alone was performed. Steinmann pins were used in 121 feet for temporary internal fixation and staples were used in 39 feet. 7 feet had no internal fixation. The senior author (D.Y.L.) routinely employs Hoke's incision, Hoke triple arthrodesis and Steinmann pin fixation, while when there is no deformity simple exeresis may be performed. 5) In our opinion, Hoke triple arthrodesis can correct any deformity and is particularly suitable in severely deformed rigid feet, since excision and replacement of the head of the talus affords better exposure and mobilization as well as easier set-up of the foot. 6) Whenever necessary, triple arthrodesis was combined with tendo Achilles lengthening, percutaneous plantar fasciotomy, posterior capsulotomy, medial or posteromedial release, subtalar and midtarsal wedge osteotomy, tibiotalar arthrodesis, supramalleloar osteotomy, and transmetatarsal osteotomy, followed by cast wedging or tendon transfers if indicated. 7) There was no nonunion in our cases. Clinically significant skin necrosis and wound sloughing occurred in 8 feet, gross postoperative infection in 2 feet, secondary osteoarthritis of the ankle in 2 feet, significant residual equinus deformity in 8 fret(in seven tendo Achilles lengthening was not done and in the one with tendo Achilles lengthening the deformity had been extreme and rigid), residual varus deformity in 3 feet, and residual valgus in 1 foot. These major complications occurred mostly in older children and adults, in whom deformities were severe and rigid and extensive surgery was necessary in order to achieve adequate correction. In such feet, correction is extremely difficult and greater risks of a variety of complications demand meticulous attention to technical details and postoperative care.
