Arthrodesis Positions

Arthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and stability. The bones are fused in a position permitting most useful function but lose their natural motion.

Shoulder

  • Flexion: 30ยฐ
  • Abduction: 20ยฐ
  • Internal rotation: 40ยฐ

Elbow

  • One side: 90ยฐ
  • Both side: One in 110ยฐ (feeding) and another is 65ยฐ (perineal hygiene)

Wrist

  • Non-rheumatoid: 10-20ยฐ dorsiflexion (power gripping) and neutral radio-ulnar deviation
  • Rheumatoid: Neutral or flexed with 5-10ยฐ ulnar deviation (hygiene and perineal care are easier)

Hand

FingersMCPPIPDIP
Index254010
Middle304510
Ring355010
Little405510
MCP is preferably not fused because the arc of motion is initiated here

Thumb

  1. CMC joint: 45ยฐ palmar abduction and 20ยฐ radial abduction (manual workers)/30-40ยฐ radial abduction (women)
  2. MCP joint: 10-20ยฐ flexion, 20ยฐ pronation, 20ยฐ abduction
  3. IP joint: 0-15ยฐ flexion
Source: Miller’s Orthopedics

Hip

  • Flexion: 25-30ยฐ
  • Abduction: 0ยฐ
  • Rotation: 0ยฐ

Knee

  • Flexion: 10-15ยฐ
  • Valgus: 0-7ยฐ
  • External rotation: 10ยฐ

Ankle

  • Hindfoot valgus: 5ยฐ
  • External rotation: 5-10ยฐ
  • Dorsiflexion: Neutral
  • Talus: Posterior

If the ankle is fused in varus, the supinated foot becomes rigid and does not adapt to the ground during the second rocker phase. The lever arm of the foot becomes too long and impairs the third rocker phase if the talus is fused in an anterior position.

Subtalar

  • Dorsiflexion: Neutral
  • Heel valgus: 10ยฐ

Talonavicular

  • Neutral dorsi/plantarflexion

Calcaneocuboid

  • Heel valgus: 10ยฐ
  • Forefoot ad/abduction and prono-supination: Neutral

Talonavicular joint should be fixed before calcaneocuboid joint during a triple arthrodesis.

1st great toe MTP

  • Valgus: 15-20ยฐ
  • Dorsiflexion: 10-15ยฐ
  • Rotation: Neutral

Acronyms:

  1. CMC: Carpometacarpal
  2. MCP: Metacarpophalangeal
  3. PIP: Proximal interphalangeal
  4. DIP: Distal interphalangeal
  5. IP: Interphalangeal

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