Name: Mini-Open Approach to Tibiotalar Arthrodesis With the Minimally Invasive Anterior Ankle Fusion
Uploaded: 2020-01-31T00:00:00Z
Channel: Arthrex
Description: J. Chris Coetzee, MD, MBChB (Minneapolis, MN), demonstrates an ankle arthrodesis using the Mini-Open Anterior Ankle Fusion Plate. The design of this plate provides increased construct rigidity while decreasing micromotion at the ankle fusion interface when compared to the standard 3-screw fusion construct.

<p>J. Chris Coetzee, MD, MBChB (Minneapolis, MN), demonstrates an ankle arthrodesis using the Mini-Open Anterior Ankle Fusion Plate. The design of this plate provides increased construct rigidity while decreasing micromotion at the ankle fusion interface when compared to the standard 3-screw fusion construct.</p>

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VID1-000818-en-US | A | Mini-Open Approach to Tibiotalar Arthrodesis With the Minimally Invasive Anterior Ankle Fusion

J. Chris Coetzee

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Mini-Open Approach to Tibiotalar Arthrodesis With the Minimally Invasive Anterior Ankle Fusion

Okay, so what I want to show today is for those situations where you either do an arthroscopic ankle fusion or you do a mini open fusion. And for me, it was often the case that if you just do two medial screws or even if you do a home run, screw that. The stability was just not good enough with planter and dorsiflexion, and we wanted to add a small plate in the front that you can still do your medial or your home run screw, and then add a small plate to give you excellent stability in planter and dorsiflexion. So this is especially applicable to people that do arthroscopic fusions and want to add a little bit of stability, because you can use your medial portal and just extend it a little bit. Or what I often do is I use a small medial approach for my fusions can just as well be lateral depending upon where the majority of your deformity is. So with just medial to the tibialis anterior tendon, which would be in any case where you should be for your medial portal for a scope, or if you do, a smaller ankle fusion. My approach to fusions in young people changed a lot over the past ten years, because at this point I try never to fuze the medial or lateral gutter because if you ever want to take this down and convert it back to a replacement, if they're older, it makes it much easier if your gutters are open. Okay. So I will turn it a little bit so you can see we have a pretty good exposure of the joint. And at this point, if they are osteophytes, you remove them. Before you start preparing the joint, you can use whatever method you prefer to prepare the joint. In this case, we'll use a curved osteotomy. You can use a bur. You can use motorized osteotomies Terms. Important technical tip if you do it through a small incision like this, then it's important to make sure that you clean out the lateral side as well and not only the medial side. Otherwise you will force the ankle in a few degrees. Varus. This is where an arthroscopic cleaning is actually very helpful because you can look through your scope, make sure that everything is the way that you want it, and then you can just make the incision to insert your plate. Important at this point. Also, to make sure that you can get the ankle to a few degrees valgus and at least neutral. I like to put them in 1 or 2 degrees dorsiflexion, and at this point will put my two medial screws. I personally don't use the posterior homerun screw often anymore. For one, it's a fairly difficult screw to get in, but it's a very difficult screw to take out if you want to convert this to a replacement later on. For the screws, I make a small incision. You can do it completely percutaneous as well, but I usually like to make sure I have the saphenous vein out of harm's way. And the first guide pin I want just above the joint spacer in the medial one third of the talus. The second one goes proximal to that. And I want that in the latter half of the talus. I think it's at this point good to look at your guide pins before you put screws in, just to make sure that you're happy with your position. So that's the positioning of the guide wires, which I think is about ideal. The one goes into the medial quarter of the talus and the other one goes into the lateral half on the AP view. They are parallel which I think is fine. On the lateral view you can see they are not parallel. I think it's actually good to divert them a little bit because that gives you a better purchase and better stability in fixation. Personal preference. But I prefer to put the lateral screw in first so you close the lateral side down first to prevent the slight tendency to go into various when you close it down and give me a 65. So at this point I always overdraw, especially in post-traumatic. This can be very hard bone. You can hand tighten the screws to. So at this point traditionally that's about where you were done. You can either put a home run screw in or you can put a screw in from the lateral side. But my concern always is that does not give you planter and dorsiflexion stability in the long run, especially if it's a heavy patient or somebody that finds it difficult to be non-weight bearing. So to compensate for that, we decided to use this small plate that's specifically made for small incision, whether it's arthroscopic and then open or if you do it many open. To start with, you might have to use a carb or an osteotomy just to create place for the plate to slide. If you look at the plate, there is also an hole for a wire. If you want to tack it down with a tack prior to inserting any screws, and you obviously don't have to use a tack, and it can go in any hole just to secure the plate to the tibia. I usually like to put my tailor screw in first. And the concern initially was that this screw might run into the two medial screws, but in reality those are always too far lateral for this hole. So this measure to 26. It's interesting. In almost all females the screw will be 26 and males it will be 28 or 30. Again that very nicely pulled the plate onto the talus. Now we can remove the tack. So the second screw is the compression screw. If you look at the plate there's a oval screw hole. And that will aid in getting your ankle into dorsiflexion and keep it in the correct position. So off center drilling. This is a non-locking screw 45. And you can do the proximal screw with the guide or without the guide, depending upon how small you want your incision. And because you have compression over the joint already, this will be a locking screw. Make sure everything is nice and tight and locked. We can take the two guide pins out. Wipe it off so we can talk to that now. So if you look at the length of the incision, this is a four centimeter or 1.5in incision. And with that you can see the entire plate. So as you get more comfortable and do this through a smaller incision, you can get away with about a 2 or 2.5cm incision, which is not much bigger than your medial scope portal. Very nice construct, very stable with the two screws from medial tibia into talus. So we will have a look at this under X-ray as well. See how it looks. So that's a typical appearance. You can see the two screws from medial that gives the initial compression in position. And then the plate which does not interfere with the two medial screws. And you can obviously position that plate anywhere that you want. And we'll move to a lateral view. So just a comment about the x ray. This is obviously a cadaver. So the full joint prep was not done. That's why you can still see a little bit of joint space there. Good position. You can see the positioning of the plate on the ankle. The screw goes into the neck of the talus and The contour of the plate sits very nicely on the distal tibia. This will give you excellent fixation and good stability right off the bat. And as far as post-operative protocol, I put them in a cast for two weeks. They can be toe touch weight bearing. In two weeks they go into a cam boot. And at that point they can be 50% weight bearing, flat footed. They can start with active range of motion without the boot, but not passive range of motion. At six weeks we do x rays and if that looks good they can start physical therapy. And usually by eight weeks we do a CT scan to see if the joint is actually healed enough that we can be more aggressive with therapy. On average, the healing time will be somewhere between 6 and 12 weeks, depending upon patient factors as well.

Mini-Open Approach to Tibiotalar Arthrodesis With the Minimally Invasive Anterior Ankle Fusion

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