8
Chapter 3
Surgical Technique
Tensioner
RR3028
Once all wires are placed, the posts can be disconnected from their original
positions and realigned on the foot ring. This bends the 2mm wires in
anticipation of tensioning them to compress the arthrodesis sites. For a triple
arthrodesis the three essential wires, which have been described, are moved as
follows:
1. Move the two posts holding the transosseous calcaneal wire 1 or 2 holes
on the foot ring forward (towards the toes) and then reattach the posts
to the foot ring.
2. Move the two posts holding the transosseous talar wire 1 or 2 holes on
the foot ring back (towards the heel) and then reattach the posts to the
foot ring.
3. Move the two posts holding the transosseous midfoot wire 1 or 2 holes
on the foot ring back (towards the heel) and then reattach the posts to
the foot ring.
The fourth, additional wire should be moved in the same manner as the wires
described above. If the wire was placed in the calcaneus, the posts should be
moved forward and reattached. If the wire is placed in the midfoot, then the
posts should be moved back and reattached.
TENSIONING THE WIRES:
Tensioning of transosseous thin wires increases frame rigidity. By utilizing arched
wire concepts, bone segments can be manipulated to apply compression across
arthrodesis sites. When utilizing olive (stopper) wires, tension should be pulled
from the
opposite
side of the olive.
The calcaneal wire is the first to be tensioned. Before tensioning this wire,
the posts should be firmly tightened to the footplate using the 10mm wrench.
The wire bolts and wire nuts on one side of the 2mm wire need to be firmly
tightened next. With the olive (stopper) wires, it should specifically be noted that
the wire nut or post on the same side as the olive needs to be tightened first.
Once the wire nut on one side of the foot has been firmly tightened, the
tensioner (RR3028 TENSIONER) is applied over the wire on the
opposite
side of
the foot, and moved down to contact the wire bolt.