triarthrodesis

Three-joint fixation is used for the treatment of flexible flat feet. The deformable flat foot, or loose flat foot, is characterized by the disappearance of the medial longitudinal arch at the time of weight bearing, and the longitudinal arch can return to a normal state when the weight is not loaded. In addition, there may be a talus protruding to the medial and temporal sides of the foot, the forefoot in the plane and achilles tendon plane abduction, heel valgus and Achilles tendon shortening. Treatment should be based on non-surgical treatments, such as using an arch pad or wearing orthopedic shoes to strengthen the muscles of the foot. Surgical treatment is considered only after symptoms such as pain are severe and non-surgical treatment is ineffective. Surgical methods should be based on the patient's condition, strict surgical indications. Treatment of diseases: flat feet Indication Three-joint fixation is available for: 1. The deformable flat foot of the age of 12 years and older loses its bendability due to secondary changes of bone joints and soft tissues, forms a fixed deformity, and has obvious symptoms. 2. The main joints of the foot are generally loose, or the tibia has obvious deformity, and the symptomatic deformable flat feet are older than 12 years old. 3. The stiff flat feet caused by the connection with the boat, women over 14 years old, males over 16 years old and adults, or those with obvious degenerative arthritis changes in the distance from the scaphoid. Preoperative preparation According to the deformity and degree of the foot before surgery, the surgical plan should be carefully designed according to the principle of wedge osteotomy. Good skin preparation, orthopedic instruments such as bone knives, hand drills, Kirschner wires or Sterling nails, or nails. Surgical procedure Incision The lateral oblique oblique incision is made from the second wedge bone and extends backward to the lower part of the outer iliac crest. Cut the deep fascia and cruciate ligaments, taking care not to damage the iliac tendon at the back of the incision. Retract the skin and subcutaneous tissue to the dorsal and temporal sides. Do not loose or excessively pull to avoid skin necrosis. 2. Reveal the heel joint The fat in the sinus sinus was dissected and excised, the talus ligament was cut off, and the periosteum of the talus and calcaneus was excised to the dorsal and temporal sides to reveal the heel joint. The Achilles tendon and the scaphoid joint are exposed: the toe long extensor tendon is retracted to the medial side, and the anterior and posterior calcaneus is cut off at the anterior and posterior aspect of the calcaneus, and the periosteum is peeled off to the distal side. Incision of the ankle joint capsule reveals the ankle joint. The periosteum of the upper part of the talar neck was peeled off, and the scapular capsule was cut open to expose the scaphoid joint. If it is difficult to reveal the joint of the boat, a longitudinal auxiliary cut can be made on the inside of the foot to expose the joint of the boat. 3. Excision of articular cartilage surface and wedge osteotomy correction deformity According to the preoperative design, the wedge osteotomy is performed, and the articular cartilage and a small part of the bone are first removed in the achilles tendon. A wedge-shaped osteotomy was made at the scapular joint to the medial side and to the temporal side to correct the forefoot abduction deformity and the medial longitudinal arch collapse. A wedge-shaped osteotomy of the base inward of the joint plane is then performed to correct the heel valgus deformity. After the bone was cut, the deformity was observed. The osteotomy was properly trimmed so that the three bone surfaces were in good contact, and the deformity was completely corrected. The excised bone is removed, and the cartilage portion is removed, and the cancellous bone is implanted into the space of the osteotomy surface to promote bone healing. In order to maintain a good position after osteotomy, a nail can be used to make an internal fixation across each osteotomy surface if necessary. It can also be used for internal fixation from the distal side to the proximal side of the boat and the Achilles tendon joint with two Sterling needles or a thick Kirschner wire. The tail of the steel needle is buried under the skin. complication 1. Necrosis of the skin incision edge. 2. Injury of the iliac tendon, long extensor tendon and dorsal artery. 3. The foot deformity is not corrected or the joint has no bone fusion.