Skip to main content
SpringerLink
Log in

Prinzipien der reorientierenden Tripelarthrodese

Principles of reorientation in triple arthrodesis

  • Leitthema
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Die Tripelarthrodese ermöglicht die dreidimensionale (3D-)Korrektur schwerer Rückfußdeformitäten. Entscheidend sind die exakte Reposition und die stabile Osteosynthese. Wegen der Blockierung der Rückfußbewegung ist eine plantigrade Einstellung in allen 3 Ebenen anzustreben. Zusätzliche Deformitäten im Vorfuß sind gleichzeitig anzugehen. Die Operationstaktik unterscheidet sich beim Klumpfuß und beim Knickplattfuß. Das Risiko der langfristigen Entwicklung von Anschlussarthrosen ist abhängig von Vorschädigungen und dem Grad der Korrektur. Bei der Beurteilung der Ergebnisse ist der Ausgangsbefund wesentlich. Statische Kriterien sollten durch dynamisch-funktionelle ergänzt werden. Die Vergleichbarkeit von Literaturstudien ist wegen der unterschiedlichen Indikationsbereiche, Operationstechniken und Evaluationskriterien erschwert.

Die Ergebnisse der Tripelarthrodese sind bei primären Knickplattfüßen oder posttraumatischen Deformitäten weitaus besser als bei neurogenen Fehlstellungen oder angeborenen Klumpfüßen. Um den Wert der Methode besser abschätzen zu können, sollten künftige Studien auf die Durchmischung ihrer Kollektive verzichten.

Abstract

Triple arthrodesis can be used for a three-dimensional correction of all types of hindfoot deformities. Prerequisites are a functional integrity of the ankle joint and an adequate bone stock. The procedure blocks the cardanic mechanism of the hindfoot and therefore reduces the shock-absorbing and mobile-adaptive functions of the foot. This results in increased stresses with the risk of long-term degenerative changes.

In addition to triple arthrodesis, procedures to the forefoot are often necessary. Especially in neurogenic deformities, muscle lengthening and balancing procedures may be needed.

In the evaluation of the results, different etiologies (e.g. posttraumatic, degenerative, neurogenic, congenital) and different deformities (varus, valgus, cavovarus, equinus) should not be mixed up. The results in congenital and neurogenic deformities in the literature are inferior to those of degenerative and posttraumatic origin. A standardization of indications, techniques, and evaluation criteria is still needed in order to exactly estimate the value of this procedure for different pathologies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a, b
Abb. 2a, b
Abb. 3a, b
Abb. 4a, b
Abb. 5
Abb. 6
Abb. 7a–c
Abb. 8a–d
Abb. 9a–d
Abb. 10
Abb. 11a–c
Abb. 12
Abb. 13

Literatur

  1. Adelaar RS, Dannelly EA, Meunier PA (1976) A long-term study of triple arthrodesis in children. Orth Clin North Am 7: 895–908

    Google Scholar 

  2. Angus PD, Cowell HR (1986) Triple arthrodesis: A critical long term review. J Bone Joint Surg Br 68: 260–265

    PubMed  Google Scholar 

  3. Bednarz PA, Monroe MT, Manoli A (1999) Triple arthrodesis in adults using internal fixation: An assessment of outcome. Foot Ankle Int 20: 356–363

    PubMed  Google Scholar 

  4. Bennett GL, Graham CE, Mauldin DM (1991) Triple arhrodesis in adults. Foot Ankle 12: 138–143

    PubMed  Google Scholar 

  5. Carr JB, Hansen ST, Benirschke SK (1988) Subtalar distraction bone block fusion for late complications of os calcis fractures. Foot Ankle 9: 81–86

    PubMed  Google Scholar 

  6. Crego CH, Mc Carroll HR (1938) Recurrent deformitis in stabilized paralytic feet: Report of 1100 consecutive stabilizations in poiliomyelitis. J Bone Joint Surg 20: 609–620

    Google Scholar 

  7. Döderlein L, Wenz W, Schneider U (1999) Der Klumpfuß. Springer, Berlin Heidelberg New York

  8. Döderlein L, Wenz W, Schneider U (2002) Der Knickplattfuß. Springer, Berlin Heidelberg New York

  9. Döderlein L, Wenz W, Schneider U (2004) Der Spitzfuß, der Hackenfuß. Springer, Berlin Heidelberg New York

  10. Dunn HL (1922) On stabilising operations in paralytic deformities of the feet. Proc Roy Soc Med 15: 15–20

    Google Scholar 

  11. Figgie MP, O‘Malley MJ, Ranawat C (1993) Triple arthrodesis in rheumatoid arthritis. Clin Orthop Relat Res 292: 250–254

    PubMed  Google Scholar 

  12. Graves SC, Mann RA, Graves KO (1993) Triple arthrodesis in older adults: Results after long term follow up. J Bone Joint Surg Am 75: 355–362

    PubMed  Google Scholar 

  13. Hansen ST (2000) Functional reconstruction of the foot and ankle. Lippincott, Philadelphia, pp 300–306

  14. Heus De JAC, Marti RK, Besselaar PP, Albers GHR (1997) The influence of subtalar and triple arthrodesis on the tibiotalar joint. J Bone Joint Surg Br 79: 644–647

    Article  PubMed  Google Scholar 

  15. Hoke M (1921) An operation for stabilizing paralytic feet. Am J Surg 3: 494–507

    Google Scholar 

  16. Johnson KA (1990) Hindfoot arthrodeses. Instr Course Lect Am Acad Orthop Surg 39: 65–69

    Google Scholar 

  17. Lambrinudi C (1927) A new operation on drop foot. J Bone Joint Surg Br 15: 193–196

    Google Scholar 

  18. Lange M (1962) Orthopädisch-Chirurgische Operationslehre. Bergmann, München, S 808–811

  19. Marek FM, Schein AJ (1945) Aseptic necrosis of the astragalus following arthrodesin procedures of the tarsus. J Bone Joint Surg 27: 587–590

    Google Scholar 

  20. Medhat MA, Krantz H (1988) Neuropathic ankle joint in Charcot-Marie-Tooth disease after triple arthrodesis of the foot. Ortrhop Rev 17(9): 873–880

    Google Scholar 

  21. Patterson RL, Parrish FF, Hathaway EN (1950) Stabilizing operations on the foot:the study of the indications,techniques used and end results. J Bone Joint Surg Am 32: 1–26

    Google Scholar 

  22. Pell RF, Myerson MS, Schon LC (2000) Clinical outcome after primary triple arthrodesis. J Bone Joint Surg Am 82: 47–57

    PubMed  Google Scholar 

  23. Ryerson EW (1923) Arthrodesing operations on the feet. J Bone Joint Surg 5: 453–471

    Google Scholar 

  24. Scranton PE (1991) Results of arthrodesis of the tarsus: Talocalcaneal, midtarsal and subtalar joints. Foot Ankle 12: 156–164

    PubMed  Google Scholar 

  25. Sangeorzan BJ, Smith D, Veith R et al. (1993) Triple arthrodesis using internal fixation in tretament of adult foot disorders. Clin Orthop Relat Res 294: 299–307

    PubMed  Google Scholar 

  26. Southwell RB, Sherman FC (1981) Triple arthrodesis:a lomg term study with force plate analysis. Foot Ankle 2: 15–24

    PubMed  Google Scholar 

  27. Steindler A (1940) Orthopedic operations. Thomas, Springfield, pp 328–335

  28. Tang SC, Leong JCY, Hsu LCS (1984) Lambrinudi triple arthrodesis for correction of severe rigid drop foot. J Bone Joint Surg Br 6: 66–70

    Google Scholar 

  29. Van Dijk CN, Lim LS, Poortman A (1995) Degenerative joint disease in female ballet dancers. AmJ Sports Med 23: 295–300

    Google Scholar 

  30. Vogler HW (1989) Triple arthrodesis as a salvage for end stage flatfoot. Clin Podiatr Med Surg 6: 591–604

    PubMed  Google Scholar 

  31. Wapner KL (1998) Triple arthrodesis in adults. J Am Acad Orthop Surg 6(3): 188–196

    PubMed  Google Scholar 

  32. Wernick J, Volpe RG (1996) Lower extremity function and normal mechanics. In: Valmassy RL (ed) Clinical biomechanics of the lower extremities. Mosby, St. Louis, pp 1–58

  33. Wetmore RS, Drennan JC (1989) Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease. J Bone Joint Surg Am 71: 417–422

    PubMed  Google Scholar 

  34. Wukich DK, Bowen JR (1989) A long term study of triplke arthrodesis for correction of pes cavovarus in Charcot-Marie-Tooth disease. J Pediatr Orthop 9: 433–437

    PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Stiftung orthopädische Universitätsklinik, Heidelberg

    L. Döderlein

  2. Stiftung orthopädische Universitätsklini, Schlierbacher Landstraße 200a, 69118, Heidelberg

    L. Döderlein

Authors
  1. L. Döderlein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Döderlein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Döderlein, L. Prinzipien der reorientierenden Tripelarthrodese. Orthopäde 35, 405–421 (2006). https://doi.org/10.1007/s00132-005-0869-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-005-0869-7

Schlüsselwörter

Keywords

Search

Navigation