anatomic approach to preparation and fusion of the interphalangeal ...

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$closure of deep fascia in ankle fracture surgery - The Podiatry Institute$

54CHAPTER 12Figure 7A. Deviation of resection angle in thetransverse plane can occur on one side as depicted, orto varying degrees on both resection surfaces.Figure 7B. Apposition of the joint after this type ofresection will need revision to achieve uniform jointapposition.Figure 8A. Deviation of resection angle in the sagittal plane can occur onone side as depicted, or to varying degrees on both resection surfaces.Figure 8B.Apposition of the joint after this type of resection will needrevision to achieve uniform joint apposition.to high and low areas of bone ends that may not beadequately apposed when the joint is fixated (Figures 9-15).In addition to the technical problems with their use,there are certain deficiencies with these set-ups. Care mustbe taken with high speed powered saws to minimizeprolonged contact with the bone ends and avoid excessiveheat generation. This is a function of the relatively largesurface area of the side of the blade rapidly moving againstthe bone surface and generating friction. It is widely knownthat excessive heat generation can result in bone cell death,and consequently can compromise the intended outcome ofthe operation. Saw blade depth can also be problematic inthe sense that the oscillations carry the square cutting surfacethrough an arc, and consequently the blade edges escapeinto the soft tissues when cutting the small cylindrical bone.Hand instrumentation is not without its owndeficiencies; the method can be extremely slow due tomultiple passes back and forth between the surgical site anda sponge to remove the material from the instrument. InFigure 9. Complete removal of joint surfaces usingmicrosaws leaves uniformly flat surfaces. These candrift, in either the transverse or sagittal planes, orrotate in the frontal plane.
CHAPTER 12 55Figure 10A. Anatomic, contoured joint resection ofthe head of the proximal phalanx.Figure 10B. This technique minimizes boneshortening and increases the surface area available tocontact the middle phalanx.Figure 11A. Anatomic, contoured joint resection ofthe base of the middle phalanx.Figure 11B. This technique minimizes boneshortening and increases the surface area available tocontact the proximal phalanx.Figure 13. The contoured cup and dome fit allows fine tuning final toeplacement on the three cardinal planes, including the sagittal plane foranatomic, flexed fusions.Figure 12. The resultant approximation of thecorresponding head and base when the contours areexactly fitted.
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Page 7: CHAPTER 12 57JOINT FIXATIONThe stan

anatomic approach to preparation and fusion of the interphalangeal ...

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