Clayton-Fowler metatarsophalangeal arthroplasty

Clayton-Fowler's metatarsal arthroplasty is used for the surgical treatment of rheumatoid arthritis of the foot. Rheumatoid arthritis in the foot mainly invades the forefoot. Often manifested as valgus, metatarsophalangeal joint dislocation or subluxation, claw toe, humeral head painful sacral sacral and hammer toe and other deformities. The joints of the midfoot can also be affected, resulting in the disappearance of the longitudinal arch and flat feet. Due to the erosion of the synovitis and the distance from the scaphoid joint, the talus ligament, the branch ligament and the ligament and joint capsule are lost. The weight bearing of the foot can lead to valgus valgus, forefoot pronation and longitudinal arch. disappear. For forefoot rheumatoid arthritis, surgical treatment is often required because of the persistence of pain, the development of old deformities, or the appearance of new deformities. The surgical method is mainly forefoot arthroplasty. The patient should be made clear before surgery, the pathological process of the disease is gradual, so the surgical correction of deformity is only palliative, not radical treatment. Its purpose is to relieve pain, correct deformities, improve appearance and walking function, and try on a variety of shoes. There are many methods for forefoot arthroplasty. Combining the reports, you can get the following conclusions: 1.80% to 90% of patients can get satisfactory results. 2. If the bone resection is not enough, the soft tissue around the metatarsophalangeal joint may not be loose, which may affect the surgical effect. 3. The length of the second to fifth metatarsal bones should be consistent, so that the stump of the humerus forms a smooth arc, otherwise the surgical effect is not good. 4. After removing the metatarsophalangeal joint, the bone fragments remaining in the weight of the forefoot should be removed, otherwise the effect will be affected. 5. The surgical effect will gradually decrease over time. 6. If the first metatarsophalangeal joint fusion and the second to fifth metatarsophalangeal joint resection are combined, complications such as malformation recurrence and painful paralysis can be reduced. The vast majority of forefoot arthroplasty has evolved from surgery such as Clayton-Fowler or Kates. Treating diseases: rheumatoid arthritis Indication Clayton-Fowler's metatarsal arthroplasty is suitable for: 1. Persistent pain in the metatarsophalangeal joint is not effective after non-surgical treatment. 2. The deformity is aggravated. 3. Due to the development of old deformities or the appearance of new deformities, the shoes are deformed and need to be replaced frequently. Contraindications 1. The patient's general condition is not able to tolerate the operator. 2. The dorsal artery of the foot is weak and the blood circulation is poor. 3. Patients with local skin damage due to rheumatoid vasculitis. Preoperative preparation 1. Carefully brush the local skin (10 ~ 15min) before surgery, especially between the toes and the nails. Then wrap it in a sterile towel. Brush again in the operating room. 2. Broad-spectrum antibiotics should be used prophylactically 30 minutes before surgery, 48-72 hours after surgery and 48-72 hours after surgery. 3. If the lesion is in the active phase, it should cooperate with the physician to strengthen the drug treatment before and after surgery. Surgical procedure Incision Take an arcuate incision at the back of the dorsal bone. 2. Reveal Cut the skin and subcutaneous tissue and separate them longitudinally with scissors or a hemostat to reveal the superficial veins of the foot. Separated deep, dissected the deep branch of the iliac crest and the dorsal artery of the dorsal sac To cut off the blood vessels that interfere with the operation of the operation, care should be taken to protect the deep veins of the foot. If accompanied by a "claw-toe" deformity, the proximal phalanx is located at the humeral neck, obstructing the exposure of the humeral head, and can cut the length of the toe and long tendon, and remove part of the proximal phalanx, which is beneficial to reveal the humeral head. Sharply peels off the soft tissue attached to the humeral head. 3. Osteotomy The humeral head was cut at 5 to 7 mm proximal to the humeral head and neck junction. The stump of the blunt humerus, especially the stump of the fourth metatarsal, should be used to bite off the remaining sharp bones with a rongeur. Check the stump head stumps so that they differ by about 5 mm from the inside to the outside. In order to reduce the formation of the bursa at the fifth metatarsal stump, the length of the cut can be appropriately increased. 4. Close the incision Carefully remove the broken bone fragments left in the incision and suture the skin with no absorbent thread. The dressing wraps the toes in the functional position. A 1.5mm Kirschner wire can also be used to retrograde the toe from the proximal end of the proximal phalanx. After the metatarsophalangeal joint is restored, the Kirschner wire is inserted into the tibia for fixation. Bend the stump of the K-wire to prevent the steel needle from slipping.