1
Patient Positioning
Place the patient in the supine or pseudo-lateral position with the foot at the terminal end of the table.
Clear visualization to the plantar aspect of the foot is critical. Be sure to prep and drape above the
knee to be able to assess limb rotation. If unaffected, assess contralateral limb for rotational alignment.
TECH TIP
• A trauma triangle with the apex padded or cushioned may be placed under the ankle
for ease of drilling and placing screws.
2
Joint Preparation
Instruments Used:
1. Steinmann Pin (18)*
2. 2.5 mm Fenestration Drill
A range of surgical approaches and incisions may be utilized to access the tibiotalar and subtalar joint. The surgical
approach chosen for joint prep and alignment is dependent upon factors such as the local anatomy, type of
deformity, and surgeon preference.
Adequate joint preparation and alignment is a critical step for achieving a successful fusion. Denude any remaining
cartilaginous surface, paying attention to any angular deformities in the coronal and talocalcaneal joints. If any
significant bone gaps are noted, they can be filled with either bone autograft or allograft per surgeon preference.
Continue joint preparation until good bone-to-bone apposition is achieved at the talocalcaneal and tibiotalar joints.
Meticulous attention should be paid for visual evidence of viable bone on each apposing surface. If in question, the
tourniquet should be deflated to evaluate for punctuate bleeding. The 2.5 mm Fenestration Drill may be used to aid
in creating viable bleeding bone or feathering the joint surfaces.
Provisional fixation with smooth Steinmann Pins to maintain desired alignment may be performed at this time,
paying close attention to all three planes (coronal, sagittal, and rotation). Typically, neutral to 7 degree valgus,
neutral dorsiflexion-plantarflexion and rotation comparable to the contralateral side is desired. Avoid varus
or excessive valgus positioning. To avoid excessive valgus with a neutral ankle, it is recommended to translate
the calcaneus medially under the talus. An excessive valgus or too medial insertion point may affect the
placement of the calcaneal PA Screw.
12
*(Number) represents corresponding position in Instrument Tray. Refer to page 6.