Arthrodesis

Question 1

Fusion Position:

Trapezio-Metacarpal

Answer 1

• 35° radial abduction
• 30° palmar abduction
• 15° pronation

Question 2

Fusion Position:

Ankle (Tibio Talar)

Answer 2

• neutral dorsiflexion
• 5-10° of external rotation
• 5° of hindfoot valgus

Question 3

Fusion Position:

MTP

Answer 3

• 10 to 15 degrees of valgus in relation to the metatarsal shaft
• 15 degrees of dorsiflexion in relation to the floor

Question 4

Fusion Position:

Knee

Answer 4

• 5-8° valgus
• 0-10° of external rotation (match other leg)
• 0-15° of flexion
• some limb shortening advantageous for patient self-care

Question 5

Fusion Position:

Shoulder

Answer 5

think “30°-30°-30°”

• 20°-30° of abduction
• 20°-30° of forward flexion
• 20°-30° of internal rotation

Question 6

Fusion Position: Elbow

Answer 6

Debatable - some advocate putting patient in splints at different flexion degrees to see what they prefer

in a unilateral arthrodesis

• 90° of flexion
• 0-7° of valgus

in a bilateral arthrodesis

• one elbow in 110 ° of flexion for feeding
• one elbow in 65 ° of flexion for perineal hygiene

Forearm:

Unilateral:

• Supination of 10-20 degrees

Bilateral

• Dominant arm: 30-45 degrees pronation
• Non-dominant arm: 20-35 degrees supination

Question 7

What position is most detrimental for shoulder fusion?

Answer 7

Too much abduction & too little flexion

Dogma has been that too much abduction is bad

Question 8

Fusion Position:

Hip

Answer 8

• 20-35° of flexion
• 0°-5° adduction
• 5-10° external rotation

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• avoid abduction as it creates pelvic obliquity and increased back pain

Question 9

Fusion Position:

DIP

Answer 9

• 2nd and 3rd digit fused in extension
• 4th and 5th fused in 10-20° of flexion

Question 10

Fusion Position:

PIP

Answer 10

Recreate normal cascade of fingers

• index- 30°
• long- 35°
• ring- 40°
• small- 45°