Case Presentation: Medial Column Fusion
by Jay Lieberman, DPM, FACFAS
|
|
|
Jay Lieberman, DPM
|
A few years back, I wrote a
Residency Insight with one of my former, super, residents Dr. Cherison Cuffy. The article discussed a case using a 120mm 7.5 mm headless, canulated, screw to achieve a medial column fusion. The screw ran through the medullary canal of the first ray into the medial cuneiform, then into the navicular and ultimately into the head and neck of the talus, to fuse the medial column.
In my opinion, this is a very effective method of fixation for this procedure. The method is not new. It has been used to salvage the Charcot foot for many years.
Many eyebrows were raised when I showed this large screw running through the articular cartilage of the first metatarsal head.
 |
The circumstances were unique in that the patient had advanced rheumatoid arthritis. In any other circumstance, I would have been reluctant to use this technique. In subsequent cases, I returned to the use of compression staples to fuse the talonavicular joint and navicular cuneiform joint because I wanted to preserve the integrity of the 1st MPJ. In this recent article, entitled Medial Column Rodding Facilitated by Transitional Osteochondral Graft by Jeremy Cook, Emily Cook, and Philip Basile: Foot Ankle Spec April 2011 4: 106-111; the authors describe an effective way of avoiding 1st MP joint destruction while using the medial column rodding procedure in these situations. The authors also discuss the use of a transitional osteochondral graft to allow passage of a large diameter screw in the foot. This is an excellent way of preserving functionality of the first metatarsal phalangeal joint.
In the case I present here, the patient was five years status post treatment for a Grade IV functional hallux limitus. We used a Bio-Action total joint implant. The patient had a very satisfactory postoperative result.
When the same person returned to my office two years ago, I assumed it was for total joint implantation of the contra lateral foot. Actually, he was primarily focused on ankle and subtalar joint pain associated with posterior tibial tendon dysfunction.
Conservative care consisting of neutral posted orthotics and Ritchie braces in conjunction with intra-articular injections of Depo Medrol, but these did not satisfactorily address the problem.
We jointly agreed to proceed with a medial column fusion.
As you will note, the patient also had advanced functional hallux limitus.
This again presented us with the opportunity to run a large compression screw through the first ray. In this instance, a Reflexion total joint implant was inserted into the first metatarsal phalangeal joint. Certainly a Bio-Action® total joint implant would have been an equally good choice. Reflexion was used here because the stem does not rely on press fitting. The stem is also round and large. Once the screw passed through the joint, it would not negate the use of Reflexion. To ensure a tight fit, we used OsteoVationEX extremity bone void filler.
The medial column fusion not only addresses the rearfoot instability, but also the hyper mobility of the first ray.
The head of the ReFlexion implant offers the added advantage of having a titanium head which is oriented dorsal proximal/plantar distal. This allows for greater joint excursion.
|
OsteoMed is a leading global innovator, developer, manufacturer and marketer of specialty medical devices, surgical implants and powered surgical instruments. The company's success is driven by its ability to develop and deliver innovative, quality products that improve patient outcomes and offer technically advanced, simple and cost effective solutions for its surgeon and hospital customers. Our state of the art manufacturing facility and world headquarters is located in Dallas, Texas.
|
|
To learn more about OsteoMed and its products and services,
visit www.osteomed.com or call toll free at 1.800.456.7779. |
