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Figure 2: Intraoperative marking of the proximal intertarsal joint | Figure 3: Insertion of the implants
Under general anesthesia, and following preparation for aseptic surgery, a 20-gauge
hypodermic needle is inserted in the proximal intertarsal joint. This needle will mark
the placement of the proximal edge of the T-plate to be used for the
arthrodesis. (See arrow Figure 2.)
The proximal edge of the plate is placed against the needle, and two screws are
placed in the central tarsal bone. One screw is placed in the distal intertarsal bone, the
next screw is placed eccentrically through the oblong hole into the metatarsus, and
the remaining screws are placed in a centered position. (See Figure 3). The apparent
space under the plate proximally is actually filled with less-ossified periosteal
new bone. Bending of the screw in the third tarsal bone is probably the result of
the eccentric placement of the fourth screw.
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