LAMBRINUDI

BY

OPERATION
L. HART, M.D.,

FOR
MINNEAPOLIS,

DROPFOOT*
MINNESOTA

VERNON

In Lolldoul, been The

tions,

1927

and

again
a new performed

in

1933
operation and

Mr.
accepted

C.
on

Lambninudi
drop-foot. by many

of Guys
The orthopaedic

Hospital,
has surgeons.

proposed successfully

operation

object
and on

of this
the which a joint The

paper

is to present
of the operation

the

indications,
and to

the
emphasize

contna-indicathe surgical

technique

prmciple

it is based.

The
to stabilize in
posterior

principle

as expressed
without principle then

by
ankylosing

Lambninudi
it is to

is that
allow or

The
it to natural lock

best
bone

method
check.

in a normal

manner. When
tile

is a physiological

complete
portion

equinus,
of

the
the joint as the the

foot

cannot
abuts in bony controls

drop
against plantan

any
flexion drop-foot

further
the tibia. and in the by arthrodesing

because
The may locking the correcting he

astragalus is taut natural

anterior an the tarsus equinus important equinus mechanism.

capsule The

of the factor, deformity

ankle

as well Lambrinudi at position mortise

AND

obstruction, joint which and

operation subastragalar to the of the astragalus, ankle

in a functional within
INDICATIONS

is locked

in complete

the

joint.
FOR THE OPERATION

CONTRA-INDICATIONS

Lambninudi on equinus deformity and inactive or peronea! muscles dicated arthrodesis

implantation

devised paralyzed are active

this

operation with dorsiflexor and strong,

for

the

correction

of soleus

drop-foot muscle the inIf is not

in a foot

an active

gastrocnemius

and peroneal muscles. then this operation

because a combined
of their

more constructive with anterior

tendons to foot with the the

and logical transposition

dorsum treated in slight of the by

procedure is of the peronei

tarsus. a panastragalar The The

triple with
Lam-

bninudi
writer

operation
believes that

would
arthrodesis

definitely

improve
is best foot

a flail

or dangle
equinus.

foot

but
operation

the
and

a dangle

calcaneocuboid

is not

indicated of the

if the

patient If may

has

an

unstable

knee

joint

which

requires of the deformity the height Achilles is foot

should

the support extremity, serves of the tendon paralyzed. never be

*

a brace. operation

there is considerable not be indicated if the with due when

the

shortening equinus to

to compensate for the shortening, heel of the shoe. A mild equinus position of the foot provides
If this

an

addition

to contracture the
equinus

of the
deformity

stability
situation

to

the
is

knee
present,

quadriceps procedure. Academy

femoris The

completely at the
Boston,
NO.

eliminated Annual Meeting

by
on January

any of the
24,

surgical American
1940.

Presented

of Orthopaedic
937

Surgeons,
VOL. XXII,

Massachusetts,
io

4, OCTOBER

938

V.

L.

HAHT

\\ili(ll for
Present.

Laifli)uiulll(li this operation uiay (lefOlnlity tlhl(l l11posteiioi overact would and he a small iou i)e a tiiereelinliand segi

a yams
to an a(ti\e

(tile

/1.

Ol)1)05((l

til)ittliS Flie
IilIls(le

nlluscle.
of this

(lefornling

factor

fore it llate(l
ex(ision uiieuit
a

should
i)y exposure

of of tlse

teul(lOul incision

Oule-ilich to

preniani

liniinary sectiun.
of tile

till

dis-

Lat(ral
astragalus within

the
joillt

nlortise
is not

of for

the t he opera.t

ankle failure
10115 joint,

infrequently

t lie reason
of st ahilizing
tile

\
I

at

subastragalar

111111 the
(latiOul

Launhninucli \\Olll(l If factor h( this is

110

opnudepresent, foot. l)y a

(eption. sirahle
a better (all

functioning he secured the as the arthrodesis

panastuagalar which joint tnagalar

FIG. i age of

stabilizes as well articulation. the

ankle suhasThe is an

patient

Lateral roentgenogram taken with the foot in completc equinus. A wedge of bone is removed from the head, neck, and body of the astragalus so that the inferior surface of the astragalus forms a plane at an angle of about 95 or 100 degrees with the vertical axis of the leg. The tarsus is then arthrodesed to the remaining portion of the astragalus.

iIl11)OFttlult

the tiot.
tile

operation, be

(ollsiderltiOil like other anshould before

throdesing

methods, I)erfOrmed

age

of
An

about
extreme
of for

years.

eight forethe correcspecial than the (Ic(heSURGERY

foot. entire
tiOll.

equinius foot,
As

should
since

not
it will by of

he
demand

confused

with

an

equinus

deformity
technique

a different and Seddon, to

surgical the of The

suggested in deformities paralyses

Fitzgerald the foot.

operation origin foot. and

BONE ANI)

is of other

value residual

due

paralysis

of anterior

poliomyelitis.

(Irop

of liemiplegia, equinus
JOINT

permanent.
fonmity

common
which has

perouieal resisted

nerve manipulative
THE

injury,

(ongenit al equinovarus

corrections,
JOURNAL OF

LAMBIflNVDI

OPERATION

FOR

DRIJP-FOOT

939 (tile
to

folIllit

ics

ssit Ii loss
ll1

of

dorsiflexou by

an(I the

peioneal lan1)uinh1(li

nlus(les,
Oj)eIatiOil.

t Isiul inn

5111(11)111115,

find solution

FE(.HNIQVE
.. 1;lt(Ial

Ioeiltgenogl:lIll

of st

tile

affected t he flexion t he
,

foot 1)lalies

and
of

;uikle 1)one

in section

eo11lplete

((

111111115

15

(Ss(il

t ittI 1

for oI)e1at

tidy
ion

in planniulg
.

hefoie t he assit ii ssli icli

,

I lie

a(t

ual

sulgi(al
in

F1ie an(l
Ileck

roentgeiioguain size hod

forni

( Fig. 5111(1 one of t he a plane 2). edge

1)

511055s

t iagalus
t1((l1i1(
iS

locke
t

t he ext renl( of t lie t lie of tile vertical of

95

of l)lstIltal

(5111 deteiullille

lie

(leguee I fioiui

angle head,

of hone

to lie

1)e renove
inferior surface

:uid leg leg

of t lue ast iagalus of ahout The is (onlplete foot

95

so t lInt degrees 1e
of

ast ragalus
axis of

will the the

iii

relation at au

to

t lie angle

( Fig. if t here

5110111(1 paralysis

pia(e(l

degrees

to

FIG.

2
indicates

FIG.

tioll and body of the astragalus removed to (orre(t th( equi11115 (lefOIIll ity at. t he sui)ast ragalar joint.. flie inferior surface of the remaining I)OIt loll of tue astragalus forms a plane of ai)Out 100 degrees ill relation to the eit i(al axis of the leg. lhe equinus (l(foimitV iS (orlectcd sshen the tarsus is art hlro(iesed to the astraga.lus, Whi(iI

lig. 2: The shading of the head, neck,

the

pou-

is lo(ked

within
3: After

the ankle
FIG.

joint
of

mortise.

3 wedge os bone is
tile supe(alcis is denuded to form a plane

Fig.

the the the

remoVed from nor surface of of cartilage and

astragalus, 1)one

I)arallel wit ii tile horizontal axis of the foot. (artilage is removed from the calcaneocuhoid jOiilt. Finally a not(h is made horizontally from side to side iii the posterior and inferior portion of the scaphoi(l i)One. 1his notch ssill receive ast.ragalus.
VOL.

at anthrodesing timi to

t...

....

(1
ill functional Wilicil is the mortise posi-

the

sharp

anterior

border

of

the

tile tarsus the astragalus, complete equinus within ankle joint.

lo(ked
of

in

the

XXII.

NO.

4,

O(TOIIER

1940

940

V.

L.

HART

FIG.

Roentgenographic tarsus svitii correction the dorsiflexor and

evidence of the peroneal

of bony drop-foot muscles;

union between the astragalus deformity at the subastragalar however, an angle in to the of an from manner of
tile donsum

and
joint.

the

100

degrees
of

should
muscles

be planned if there or the peronei wilich The

such also as because a push

is

some
may be

available
transplanted

power at a right,

dorsiflexon the

tarsus.
because

foot
it

should
does prevents off

never
not the

be
active

placed
the

angle

to
ordinary
coming

the

leg
heel
into

a position

permit when

wearing

and
action

gastnocnemius walking. usual

mechanism

long

The subastragalar lateral curved

joint is exposed in the Kochen incision. Complete

through

media!

dislocation

of the

tarsus at the subastragalar joint is essential after sectioning the penoneal tendons, opening the astragaloscaphoid and calcaneocuboid joints and dividing the interosseous and external lateral ligaments of the ankle. The wedge of bone, which was determined when the lateral roentgenogram was studied, is removed from the head, neck, and body of the as-

tragalus of cartilage superior horizontal cuboid in the anterior wedged

after surface axis joint, posterior

the (Fig.

inferior 2).

surface Cartilage

of the and

astragalus bone are

is completely then removed is parallel from the (Fig. from 3).

denuded from the with the ca!caneoside to side The sharp

of the os calcis to form a plane which of t.he foot. The cartilage is removed and, finally, a notch and inferior portion of the prepared remaining notch is made of the horizontally scaphoid

margin into the

portion of the astragalus of the scaphoid while the

THE JOURNAL OF BONE

is then firmly superior bleeding

AND JOINT SURGERY

LAMBRINUDI

OPERATION

FOR

DROP-FOOT

941
bleeding
angle

surface

of

tile

05

calcis
4).

is approximated
The foot is now

to the
at the

inferior
desired

surface
of 95 or

of
100

tile

astragalus

(Fig.

degrees to the axis of the leg and cannot be plantar-flexed further, since the astragalus is locked at the ankle joint in complete equinus. The incision is closed and a long plaster-of-Paris leg cast is applied to maintain the
position About
with

of the the a

foot or

and
of

permit the third

postoperative week, while a short

elevation walking

of

the cast with (Fig.

extremity. is applied

beginning

rubber are

felt are

heel

incorporated increased.
evidence joints,

within
periods of bony

the
of

plaster.
walking

Periods
weight5) at

of

elevation

gradually

decreased

bearing
until suhastragalar and

on the
there

cast
and

gradually

Plaster
which

fixation
union requires

is continued
the three between

is roentgenographic calcaneocuboid

five months.
REFERENCES

LAMBRINUDI, LAMBRINUDI,

C.: New Operation on Drop-Foot. British J. Surg., XV, 193, 1927. C.: A Method of Correcting Equinus and Calcaneous Deformities at the Sub-Astragaloid Joint. Proc. Roy. Soc. Med., XXVI, 788 (Sect. Orthop., 56), 1933. FITZGERALD, F. P., .xD SEDDON, H. J.: Lambrinudis Operation for Drop-Foot. British

J. Surg.,

XXV,

283, 1937.

VOL.

XXII,

NO.

4,

OCTOBER

1940