• the fused joint is stable again
What Is Arthrodesis?
Arthrodesis is a surgical procedure which fuses the
bones that form a joint, essentially eliminating the
joint. The procedure is commonly referred to as joint
fusion. Surgeons implant pins, plates, screws, wires, or
rods to position the bones together until they
fuse. Bone grafts are sometimes needed if there is
significant bone loss. If bone grafting is necessary,
bone can be taken from another part of the body or
obtained from a bone bank.Arthrodesis is usually
performed on ankles andwrists, but it can be
performed on other joints,
including thumbs, toes, fingers, and the spine.
Who Is a Candidate for Arthrodesis?
Arthritis patients who have joints so severely
damaged that usual pain management techniques fail
are candidates for arthrodesis. Depending on which
joint is affected, the patient may have the option of
joint replacement surgery or arthrodesis. The goals for
recovery may be factored into the decision.
The Benefits of Arthrodesis
The primary benefit of arthrodesis is pain relief in the
affected joint. By surgically eliminating the joint, pain
relief is an attainable goal, barring any complications
of surgery. Consider your goals when deciding if
arthrodesis is the best option for you.
Pros:
• pain relief
• patients will be able to bear weight on the fused
joint without pain
• improved alignment in patients with severe
arthritis
Cons:
• joint replacement may still be better option for
certain patients
• there is loss of flexibility and motion with a
fused joint
• slight possibility of wound healing complications
Recovering from Arthrodesis
After surgery, a cast will be placed over the joint that
underwent arthrodesis. Until there is x-ray evidence of
fusion, use of the operated joint will be limited. The
process is a long one. For example, ankle arthrodesis
patients are not allowed to bear weight for between 8
to 12 weeks. Patients should keep their leg elevated
to decrease swelling and promote healing, until there
is evidence of fusion. While the patient needs to be
non-weightbearing, crutches or wheelchairs may be
very useful.
Arthrodesis is not without potential complications.
Pain at the site of bone fusion, nerve injury, infection,
or broken hardware (e.g., pins, screws) are known
risks associated with arthrodesis. The most
troublesome potential complication is a failed fusion,
meaning the joint physically does not fuse.
Arthrodesis, though, is normally a very successful
procedure and serious complications are rare

Pathophysiology
The AC joint is composed of the articular surfaces of the clavicle and the
acromion, a surrounding capsule, and 2 sets of ligaments (AC and
coracoclavicular [CC] ligaments). The AC ligament is composed of
stronger superior and inferior ligaments as well as weaker anterior and
posterior ligaments. The AC ligament is the principle restraint to
anteroposterior translation between the clavicle and the acromion. The CC
ligament is composed of the conoid and trapezoid ligaments, which
together form a strong, heavy band that provides vertical stability. The AC
joint has minimal mobility
Classification of injury
The degree of clavicular displacement depends on the severity of injury to
the AC and CC ligaments, the AC joint capsule, and the supporting
muscles of the shoulder (trapezius and deltoid) that attach to the clavicle.
Allman and Tossy initially proposed a 3-grade classification that Rockwood
expanded to 6 types of injury. Grades I and II are the same in both
classification schemes with grade III injuries in the Tossy classification
subdivided into grades III, IV, V, and VI in the Rockwood classification.
The Rockwood classification is as follows:
• Type I - Minor sprain of AC ligament, intact joint capsule, intact CC
ligament, intact deltoid and trapezius
• Type II - Rupture of AC ligament and joint capsule, sprain of CC
ligament but CC interspace intact, minimal detachment of deltoid
and trapezius
• Type III - Rupture of AC ligament, joint capsule, and CC ligament;
clavicle elevated (as much as 100% displacement); detachment of
deltoid and trapezius
• Type IV - Rupture of AC ligament, joint capsule, and CC ligament;
clavicle displaced posteriorly into the trapezius; detachment of
deltoid and trapezius
• Type V - Rupture of AC ligament, joint capsule, and CC ligament;
clavicle elevated (more than 100% displacement); detachment of
deltoid and trapezius
• Type VI (rare) - Rupture of AC ligament, joint capsule, and CC
ligament; clavicle displaced behind the tendons of the biceps and
coracobrachialis
Pediatric AC injury
AC joint injuries in children are uncommon, and they differ anatomically
from such injuries in adults. The immature clavicle is encased in a
periosteal tube. The CC ligament is within this tissue, while the AC
ligament is exterior to it. This anatomic relationship explains why the AC
ligament is frequently injured with direct trauma, while the CC ligament
remains intact. When evaluating a pediatric radiography, remember that
incomplete closure of or failure of an ossification center may appear to be
a fracture.
The pediatric Rockwood classification is as follows:
• Type I - Clavicle stable; joint radiographically normal
• Type II - Partial tear of the periosteal tube, allowing for some
mobility of the distal clavicle; AC ligament disrupted
• Types III-VI - Larger tear through the periosteal tube, allowing for
greater clavicle mobility and gross instability with clavicle
positioning; CC ligament remains attached to the clavicle
periosteal tube