Midfoot Arthritis: Fusion With a Plate and Screws

Midfoot Arthritis: Fusion With a Plate and Screws

This surgical video demonstrates the fusion of the second tarsometatarsal joint in the midfoot, using a plate and screws. Here we see a left foot. The surgeon has used a skin marker to plan the skin incision on the top of the foot. They begin the surgery by cutting the skin along the line and opening the skin with a retractor. This exposes the second tarsometatarsal joint, formed from the joining of one of the tarsal bones with the second metatarsal bone.

The surgeon uses a bone chisel, called an osteotome, to remove bone spurs, called osteophytes, that have grown due to arthritis at the joint. Next, the surgeon attaches a drill guide to each bone of the joint. The surgeon twists a bolt on the guide to slowly separate the 2 bones. Now, the surgeon has access to the joint. A bone saw is used to cut off the remaining cartilage between the 2 bones. If there is any cartilage left, the fusion may not heal together.

Then, the surgeon measures the length of the plate that should be used. The plate has a box attached to it that holds its position, and when it is removed, the plate compresses the bones together. The plate is aligned, and a small ball-headed pin is placed to temporarily hold its position.

The surgeon places a guidewire through the joint and confirms its position with x-ray. The length of the guidewire is measured to select the correct screw length, and the surgeon places the screw over the guidewire through the joint. Then, the surgeon places a screw into the screw hole on the top of the plate and then at the bottom of the plate. The placements of the screws are confirmed with an x-ray view again.

Now, the surgeon unscrews the box attached to the plate. Here, you can see how much the plate has compressed from its starting shape. The surgeon will close the skin incision with sutures, and the procedure is complete.