title: Single-incision lateral approach for triple arthrodesis.
abstract: BACKGROUND
  Triple arthrodesis is a powerful hindfoot corrective procedure involving fusion of the talonavicular (TN), calcaneocuboid (CC), and subtalar (ST) joints. A 2-incision approach, a single-incision medial triple arthrodesis, and a single-incision medial double arthrodesis are well described. We present a single-incision lateral approach to triple arthrodesis.
  
  
  METHODS
  We retrospectively reviewed 70 patients who underwent triple arthrodesis at our institution from 2007 to 2011. Patients had either double-incision (n = 33) or single-incision lateral (n = 37) triple arthrodesis. A single surgeon performed all procedures. The most common diagnosis was stage III planovalgus deformity. Deformity correction, union rate, time of surgery, complications, wound healing, reoperations, and pre- and postoperative visual analog scale (VAS) pain scores were analyzed for both groups.
  
  
  RESULTS
  There were no statistical differences in deformity correction, wound healing, complications, reoperations, or improvement in VAS pain scores. Operation time was significantly shorter in the single-incision lateral group (86 minutes vs 95 minutes, P = .0395). There was no difference in union rates with regard to the TN, ST, or CC joints. Five patients had radiographic nonunions of the CC joint between both groups.
  
  
  CONCLUSIONS
  This is the first study that presents outcomes of a single lateral approach for triple arthrodesis. The single-incision approach was faster. The low rate of symptomatic nonunions suggests that fusion of the CC joint may not be important in symptomatic relief or deformity correction.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Geisinger Medical Center, Danville, PA, USA bemooremd@gmail.com.
authors.forename: Blake E
authors.initials: BE
authors.lastname: Moore
authors.affiliation: Geisinger Medical Center, Danville, PA, USA.
authors.forename: Nathaniel C
authors.initials: NC
authors.lastname: Wingert
authors.affiliation: Geisinger Medical Center, Danville, PA, USA.
authors.forename: Kaan S
authors.initials: KS
authors.lastname: Irgit
authors.affiliation: University of Utah Health Care, Salt Lake City, UT, USA.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Gaffney
authors.affiliation: Geisinger Medical Center, Danville, PA, USA.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Cush
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016348:Osseointegration; D012086:Reoperation; D012189:Retrospective Studies; D013640:Tarsal Joints / Q000601:surgery*; D014945:Wound Healing
keywords: flatfoot deformity; pes planovalgus; tibialis posterior tendon dysfunction; triple arthrodesis