Procedures

Triple Arthrodesis Using
Grafton® DBM Putty and Cancellous Chips

Alan R. Catanzariti, D.P.M.
Director of Residency Training
The Western Pennsylvania Hospital, Pittsburgh, PA
The patient is a middle-aged female with a diagnosis of posterior tibial tendon dysfunction, or adult acquired flat foot, with secondary degenerative joint disease of the tritarsal complex. She has had an extensive course of nonoperative therapy, which has failed. This procedure will realign the hindfoot and eliminate the painful arthropathy.
The subtalar and calcaneocuboid joints following joint debridement, realignment and osteosynthesis. Note gaps within arthrodesis sites.
A 2:1 mixture of Grafton® DBM Putty and cancellous chips is prepared. A small amount of autogenous bone harvested during the procedure is added to enhance osteoinductivity.
The Grafton® DBM Putty, cancellous chips, and autogenous bone mixture is placed initially with tweezers into the gap near the calcaneocuboid and subtalar joints.
A tamper is used to pack the bone graft mixture tightly into osseous voids created by realignment and arthrodesis of the tritarsal complex.
 The arthrodesis sites after placement of bone graft.
"I prefer Grafton® because it's very easy to work with in its putty form; and unlike other materials, it provides an active tvpe of biologic substrate that will result in active healing by recruiting osteoprogenitor cells to become osteoblasts."

Dr. Alan R. Catanzariti
General Remarks
This procedure will result in positional correction with a realignment arthrodesis of the tritarsal complex. Osteosynthesis is achieved with a combination of cannulated and standard ASIF compression screws. Gaps created within the sites of arthrodesis following positional realignment will be filled with bone graft to potentiate osteogenesis.

Detailed Description
  • The cartilaginous surfaces of the tritarsal complex are removed using the curettage debridement technique. The subchondral plate is left intact.

  • The subchondral plates are fenestrated using a 2mm drill bit to create vascular channels and to encourage subchondral bleeding.

  • The hindfoot is realigned to achieve positional correction, using the contralateral foot as a guide.

  • Percutaneous fluoroscopically-guided provisional fixation is followed by permanent fixation using cannulated screws to stabilize and compress the sites of arthrodesis.
  • A 2:1 mixture of Grafton® DBM Putty and cancellous chips, along with a small amount of autogenous bone, is prepared using proper aseptic technique.

  • Gaps that are present at the calcaneocuboid and subtalar joints following realignment anthrodesis are filled with the Grafton® mixture.

  • A tamper is used to ensure tight compaction of the Grafton® mixture in and around the sites of arthrodesis, ensuring good coaptation of all surfaces.

BACK TO TOP

© Copyright Osteotech, Inc. 2007. All rights reserved.