Jay Lieberman DPM, FACFAS

This is a 57-year-old male who underwent a medial column fusion more than 14 years ago.  Initially patient did not appear to have any postoperative complications or sequelae.  His ability to ambulate for extended periods of time increased significantly.  Over the last year his symptoms returned. He also reported pain associated with extruding hardware. The X-ray below demonstrates a failed fusion of both the talonavicular and navicular cuneiform joints. The fixation devices used in the initial surgery were fractured.

Failed Medical Column Fusion - AP

Failed Medial Column Fusion - Oblique

CT scanning indicated that the subtalar joint was preserved.

PAST MEDICAL HISTORY: Hypertension and hypercholesterolemia

MEDICATIONS: Norvasc, Benicar, and Diclofenac

SURGICAL HISTORY: Negative other than the aforementioned procedure.

REVIEW OF SYSTEMS: Unremarkable other than hypertension

LOWER EXTREMITY EXAMINATION: The dorsalis pedis pulse is graded +2/+4 bilateral. Posterior tibial pulse is graded +2/+4 bilateral. Capillary refill is <5 seconds bilateral. Digital hair growth is noted. Proprioceptive sensoriums are intact. The patient can discern a 10gm Semmes-Weinstein filament. The skin is supple and well hydrated. There is some dystrophy to the nails.

The patient was brought to surgery for take down of the failed fusion sites.

Extruding Hardware

The joint surfaces were freshened utilizing a combination of subchondral drilling, curettage, and reciprocating planing.  A four-hole Uni-CP™ compression plate was used to fixate the talonavicular joint and a two-hole plate was used for the navicular cuneiform joint.

Drill Guides in Place

Uni CP™ - 1

Once the plate is positioned, compression plate forceps (spreader) will spread the central component and add a dimension of axial compression.

Post Op with Uni-CP™ in place

Post Op Fluoro

It is easy to see how this device combines all the unique characteristics of a staple, screw, and locking bone plate.  It is ideally suited for a medial column fusion.

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