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Tarsometatarsal Arthrodesis 28730

 

 

 

 

synonyms:tarsometatarsal fusion, tarsometatarsal arthrodesis, midfoot fusion, midfoot arthrodesis

Tarsometatarsal Arthrodesis CPT

Tarsometatarsal Arthrodesis Indications

  • tarsometatarsal arthritis that has failed conservative management

Tarsometatarsal Arthrodesis Contraindications

  • Soft tissue compromise
  • Inadequate arterial inflow

Tarsometatarsal Arthrodesis Alternatives

  • Non-op treatment

Tarsometatarsal Arthrodesis Pre-OP Planning

  • Avoid arthrodesis of the more mobile 4th and 5th tarsometatarsal joints even in the presence of radiographic arthrosis. (Sangeorzan, Foot Ankle 1990;10;193-200).
  • Smoking is prohibited

Tarsometatarsal Arthrodesis Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • Supine position on radiolucent operating table. All bony prominences well padded. tourniquet high on thigh.
  • General endotracheal anesthesia
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Dorsal incision between 1st and 2nd web space
  • EHL, deep peroneal nerve, DP artery identified and retracted as a unit
  • expose 1st, 2nd, TMT joints
  • Debride affected joints and remove all cartilage
  • Reduce beginning medially progressing laterally
  • Align medial aspect of 1st MT with medial cuneiform to reduce 1st TMT.  Expose entire medial aspect of 1st TMT joint to ensure no plantar gapping exists
  • Provisional fixation with k-wire, final fixation=3.5/2.7mm coutersunk fully threaded screw from gase of 1stMT into medial cuneiform.
  • 2nd MT reduced to medial border of middle cuneiform, k-wire>3.5/2.7mm fully threaded countersunk screw from base of 2ndMT into middle cuneiform.
  • 3.5mm screw from medial cuneiform into base of 2ndMT
  • Consider fixation with pre-coutoured midfoot specific plates instead of screw fixation. 
  • Irrigate
  • Close in layers.
  • SLC, non-weight bearing

Tarsometatarsal Arthrodesis Complications

  • Compartment syndrome
  • Cellulitis / wound infection
  • CRPS
  • Vascular injury: dorsalis pedis artery often disrupted (mutiple branches of ant/post tibial A. therfore usually not a problem)
  • Superficial peroneal nerve palsy
  • Hardware failure / Broken screws
  • DVT/PE
  • Chronic pain
  • Malunion
  • Nonunion

Tarsometatarsal Arthrodesis Follow-up care

  • Post-op: Bulky-Jones Posterior splint, NWB, elevation
  • 7-10 Days: Wound check, confirm reduction on xrays. Short-leg cast, NWB
  • 6 Weeks:Place in cam-walker / fracture boot. Begin partial weight bearing at 10 weeks.
  • 3 Months: Review xrays. Wean out of cam-walker.
  • 6 Months: Fit custom-molded semirigid orthotic with arch support. Progress with activities.
  • 1Yr: Assess outcomes. Follow-up xrays. Symptomatic screws may be removed after 16wks 

Tarsometatarsal Arthrodesis Outcomes

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Tarsometatarsal Arthrodesis Review References

  • Sangeorzan BJ, in Masters Techniques in Orthopaedic Surgery: The Foot and Ankle, 2nd Ed, Lippincott, 2002
  • Jung HG, Myerson MS, Schon LC. Spectrum of operative treatments and clinical outcomes for atraumatic osteoarthritis of the tarsometatarsal joints. Foot Ankle Int. 2007 Apr;28(4):482-9°